Cirrhosis : a practical guide to management by Samuel S. Lee, Richard Moreau
By Samuel S. Lee, Richard Moreau
Cirrhosis: a pragmatic advisor to management presents gastroenterologists and hepatologists with an up to date scientific advisor featuring the superior evidence-based perform within the prognosis, therapy and administration of liver cirrhosis and its many complications. Designed to supply functional suggestions always, it presents medical professionals with a very great tool within the medical environment, with each one bankruptcy that includes diagnostic/management algorithms, key issues and different pedagogic features.
Divided into 2 components, a analysis and pathophysiology part and a administration of issues part, key issues include:
- Diagnostic laboratory tests
- Diagnostic imaging modalities
- Acute-on power liver failure
- brokers and medicine to avoid
- finish level liver failure: liver transplant evaluation
- Hepatocellular carcinoma
aimed toward the expert, in addition to the practising trainee on the top-end of distinctiveness education, the emphasis throughout is on delivering optimal medical administration information such a lot suitable to working towards hepatologists and gastroenterologists, and is a useful advisor to this more and more universal condition.
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Additional resources for Cirrhosis : a practical guide to management
Hepatology 2009;50: 291–308. Triger DR, Wright R. Hyperglobulinaemia in liver disease. Lancet 1973;301:1494–6. Papadakis MA, Fraser CL, Arieff AL. Hyponatremia in patients with cirrhosis. Q J Med 1990;76:675–88. Ginees P, Guevara M. Hyponatremia in cirrhosis: pathogenesis, clinical signiﬁcance, and management. Hepatology 2008;48:1002–10. Ruf AE, Kremers WK, Chavez LL, Descalzi VI, Podesta LG, Villami FG. Addition of serum sodium into the MELD score predicts waiting list mortality better than MELD alone.
In patients with alcoholic hepatitis, the AST : ALT ratio is often greater than 2 , whereas patients with most forms of nonalcoholic hepatitis have a ratio of less than 1. However, as the chronic hepatitis progresses to cirrhosis, the ratio of AST : ALT may reverse, with a ratio greater than 1 having a speciﬁcity of more than 80% for liver cirrhosis and a sensitivity that varies from 32% to 83% [5–8]. This suggests that we need to check for the presence of cirrhosis in patients with nonalcoholic liver disease when the AST : ALT ratio rises above 1.
The arterioportal shunt is a communication between the hepatic arterial and portal venous systems that allows arterial blood to ﬂow into a region of the portal venous territory . In patients with cirrhosis, the arterioportal shunt is usually found on the arterial phase of a CT scan. The mechanism underlying such an arterioportal shunt is not clear, but it is thought that distortion and capillarization of the hepatic sinusoid disturbs hepatic venular ﬂow and increases intrahepatic vascular resistance, resulting in the arterial blood ﬂow regurgitating to the PV via the arterioportal shunt .