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Ascites, Hyponatremia and Hepatorenal Syndrome: Progress in Treatment
von: A.L. Gerbes
Karger, 2010
ISBN: 9783805595926 , 220 Seiten
Format: PDF, ePUB, OL
Kopierschutz: DRM
Preis: 242,76 EUR
cover
1
Contents
6
Preface
8
Differential Diagnosis of Ascites
10
Abstract
10
Clinical Work- Up and Problems
10
History and Physical Examination
12
Diagnostic Imaging Techniques
12
Diagnostic Paracentesis and Ascitic Fluid Analysis
12
Macroscopic Appearance of Ascites
13
Diagnostic Tests for Ascites
13
Some Common Causes of Ascites
16
Novel Aspects and Future Developments
17
References
18
Current Treatment Strategies: Diuretics
20
Abstract
20
Aldosterone Antagonists
21
Other ‘Potassium- Sparing’ Diuretics
24
Loop Diuretics
25
Diuretic Treatment Strategies in Decompensated Cirrhosis
26
References
30
Paracentesis
32
Abstract
32
Nomenclature Used in Assessment of Ascites
32
Confirmation and Ascitic Fluid Analysis
33
Indications of Abdominal Paracentesis
33
Contraindications
33
Paracentesis Techniques
34
Large- Volume Paracentesis
35
Ascitic Fluid Analysis
36
Coagulopathy in Liver Disease
37
Complications
38
References
39
Large- Volume Paracentesis: Which PlasmaExpander?
41
Abstract
41
Large- Volume Paracentesis in Clinical Practice
41
Rationale for Using Plasma Volume Expansion
42
Evidence Supporting the Use of Albumin for Plasma Expansion
43
References
47
Albumin: Not Just a Plasma Expander
49
Abstract
49
Albumin in Liver Disease
50
Albumin in Non- Liver Disease
55
Functional Characteristics in Liver Disease and Failure – Albumin Is Dysfunctional,Why?
57
References
58
Transjugular Intrahepatic PortosystemicShunt for Ascites: Which Patients WillBenefit?
61
Abstract
61
Treatment of Ascites
62
Prediction of Post- TIPS Survival
64
Predictors of Efficacy
69
Post- TIPS Quality of Life
69
Post- TIPS Hepatic Encephalopathy
70
References
71
Spontaneous Bacterial Peritonitis –Prophylaxis and Treatment
74
Abstract
74
Definition and Clinical Importance
74
Pathogenesis and Risk Factors
75
Prophylaxis
77
Therapy
83
References
87
Clinical Implications of Hyponatremia inCirrhosis
92
Abstract
92
Hyponatremia in Cirrhosis: Pathophysiology
92
Prognostic Significance of Sodium in Cirrhosis and Liver Transplantation
93
Hyponatremia in Cirrhosis: Treatment Options
95
Should We Treat Cirrhotic Hyponatremia?
96
References
98
Vaptans for Ascites – Chances and Risks
100
Abstract
100
The Clinical Problem
100
Therapeutic Limitations in the Management of Refractory Ascites
101
Recent Novel Therapeutic Agents for the Management of Ascites
101
The Vaptans
102
Vaptans in the Management of Hyponatremia in Cirrhosis
105
Vaptans in the Management of Ascites in Cirrhosis
106
Vaptans – the Chances
107
Vaptans – the Risks
107
The Future
108
References
109
Cardiorenal Syndrome – A New Entity?
111
Abstract
111
Hepatic Decompensation and Hemodynamic Derangements in Cirrhosis
112
Renal Failure in Cirrhosis – The Clinical Problem
114
Cardiac Dysfunction
114
Cardiorenal Axis in Cirrhosis
115
Conclusions and Future Developments
118
References
119
Renal Failure in Cirrhosis
121
Abstract
121
Acute Kidney Injury
122
Chronic Kidney Disease
124
Management of Acute Kidney Injury
125
Management of Chronic Kidney Disease
128
Selection of Candidates for Combined Liver and Kidney Transplantation
128
Conclusions
128
References
129
Novel Definition of Hepatorenal Syndrome:Clinical Consequences
131
Abstract
131
Hepatorenal Syndrome: Concept, Clinical Types and Diagnostic Caveats
131
New Definition of Hepatorenal Syndrome
135
Definition of Acute Kidney Injury in Cirrhosis
136
References
137
Role of Infections in Hepatorenal Syndrome
139
Abstract
139
Epidemiology and Prognosis of Bacterial Infections and Associated Renal Failure inCirrhosis
139
Key Events for Development of Renal Dysfunction in Advanced Cirrhosis withEmphasis on Bacterial Infections and Pathological Bacterial Translocation
141
General Assessment
145
Therapeutic Considerations for Bacterial Infections and Their Role for Developmentof Hepatorenal Syndrome
145
Clinical Problems and Future Developments
146
References
147
TIPS for HRS
151
Abstract
151
Rationale for TIPS in HRS
152
Results of TIPS in Patients with HRS
153
Conclusions
155
References
156
Vasoconstrictor Therapy for HepatorenalSyndrome
158
Abstract
158
Pathophysiological Bases of Pharmacological Therapy in Hepatorenal Syndrome
159
Clinical Use of Vasoconstrictors in Hepatorenal Syndrome Type 1
163
Clinical use of Vasoconstrictors in Hepatorenal Syndrome Type 2
167
Conclusions
168
References
169
Terlipressin for Hepatorenal Syndrome:The US Experience
172
Abstract
172
Rationale for the Use of Terlipressin for Type 1 HRS
172
Summary of the Study Design
173
Outcomes with Terlipressin Treatment
174
Primary Endpoint
175
Impact on Renal Function
175
Time Course of Changes in Renal Function
176
Factors Predictive of Response to Terlipressin
177
Impact on Survival
178
Impact on Liver Transplantation
178
Conclusion
178
References
179
Terlipressin for Hepatorenal Syndrome:Predictors of Response
181
Abstract
181
Terlipressin for Hepatorenal Syndrome
182
Predictors of Response
182
References
186
Safety of Terlipressin for HepatorenalSyndrome
187
Abstract
187
Pharmacokinetics and Receptor Affinity
188
Adverse Events Reported in Trials on the Hepatorenal Syndrome
188
Cardiac and Pulmonary Adverse Events
191
Skin Ischemia
192
Gastrointestinal Adverse Events
193
Hyponatremia and Hypokalemia
194
Contraindications to Terlipressin and Prevention of Side Effects
194
Dealing with Side Effects
195
Conclusions
196
References
196
Terlipressin for Hepatorenal Syndrome:Novel Strategies and Future Perspectives
198
Abstract
198
Novel Strategies
198
Future Perspectives
202
Septic Shock
203
Conclusions
203
References
204
Hepatorenal Syndrome and LiverTransplantation
207
Abstract
207
References
214
Author Index
217
Subject Index
218
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