Gastric and Ectopic Varices
Fig. 11.1 Classification of gastric varices. Gastroesophageal varices: lesser curve GOV1 and fundal GOV2. Isolated gastric varices; fundal IGV1 and other IGV2. Reproduced with permission from John Wiley and Sons…
Portal Vein Thrombosis
Grade 1. Cross-sectional obstruction of less than 50 % of the portal vein lumen Minimal or absent extension into the superior mesenteric vein Grade 2. Cross-sectional obstruction of more than…
Ethical Issues in End-Stage Liver Disease: A Framework for Assessment and the Challenges
A. Obtain an advance directive; if not available and the patient is competent, encourage one be executed B. Begin planning ahead for end-of-life issues C. Anticipate and schedule regular reevaluation…
Palliative Care in Cirrhosis
Poor performance status (palliative performance scale and Karnofsky scale) Advanced age Malnutrition Comorbid illness Increasing organ dysfunction Hospitalization for acute decompensation Principles of Palliative Care Palliative care is rooted in…
Noninvasive Markers of Fibrosis in the Assessment of Cirrhosis
Highly sensitive and specific to identify different stages of fibrosis Applicable to the monitoring of disease progression or regression as part of the natural history of liver disease or treatment…
Measurement of Portal Pressure and Transjugular Liver Biopsy
Fig. 7.1 A typical tracing of a hepatic venous pressure gradient (HVPG). Equilibration of WHVP requires over 20 s. The HVPG is calculated as the difference between WHVP and free hepatic…
Promoting a Healthy Lifestyle, Managing Hyperlipidemia, Diabetes Mellitus, Hypertension, and Immunizations in Patients with Cirrhosis
Vaccine Before transplantation After transplantation Influenza Inactivated Live attenuated Recommended (yearly) If inactivated not available (2 weeks before transplantation) Recommended (yearly) Not recommended Hepatitis B Recommended if seronegative (3–4 high-dose…
Assessment and Management of the Patient with Cirrhosis Undergoing Surgery
Clinical feature One point Two points Three points Total bilirubin (mg/dL) < 2 2–3 > 3 Albumin (g/dL) > 3.5 2.8–3.5 < 2.8 INR < 1.7 1.7–2.3 > 2.3 Ascites None Mild Moderate to severe Encephalopathy…
Liver Transplantation
Indications for liver transplantation Acute liver failure due to Acetaminophen overdose Idiosyncratic drug-induced liver injury Acute fatty liver of pregnancy Toxin exposure—Amanita phalloides (mushroom poisoning) Acute viral hepatitis—hepatitis A–E, herpes…
Acute-on-Chronic Liver Failure
Organ/system 0 1 2 3 4 Liver (bilirubin, mg/dL) < 1.2 ≥ 1.2 to ≤ 1.9 ≥ 2 to ≤ 5.9 ≥ 6 to < 12 ≥ 12 Kidney (creatinine,…
