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Ascites, Hyponatremia and Hepatorenal Syndrome: Progress in Treatment Frontiers of Gastrointestinal Research 28

:	A.L. Gerbes
:	Ascites, Hyponatremia and Hepatorenal Syndrome: Progress in Treatment Frontiers of Gastrointestinal Research 28
:	Karger
:	9783805595926
:	1
:	CHF 196.10
:

:	Klinische Fächer
:	English

:	220
:	DRM
:	PC/MAC/eReader/Tablet
:	PDF/ePUB

Ascites is the most frequent and hepatorenal syndrome the most lethal complication in liver cirrhosis. In recent years, major progress has been made regarding effective treatment of these complications, thus reducing mortality in patients.This publication highlights and critically appraises recent achievements and novel advances, and at the same time provides the background needed to grasp novel concepts. Topics treated include complications of paracentesis, the right choice of plasma expanders, and selection of patients who will experience survival benefit from transjugular intrahepatic portosystemic shunt. Hepatorenal syndrome, on the other hand, is responsible for a broad spectrum of manifestations caused by acute kidney injury, which until recently was considered a lethal condition. Drug treatments to improve renal function and prolong survival are therefore also discussed, including important issues for clinical outcome which are still under debate. Moreover, the role of combined kidney-liver transplantation versus conventional liver-only transplantation is addressed, as well as the use of vaptans in hyponatremia and their controversial role in the treatment of ascites.Renowned experts share their knowledge and expertise and provide an international perspective. Their contributions include up-to-date references and a bullet-point summary, making this publication most valuable for practitioners, clinicians and scientists in the field.

	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