Suchergebnisse

Background: The clinical picture in cirrhosis is dominated by the classical complications such as ascites, bleeding varices, portal hypertension and encephalopathy. Cardiac dysfunction in patients with cirrhosis, which contributes significantly to the morbidity and, mortality though prevalent, is less studied and not widely recognized entity since it is largely asymptomatic at rest, with overt heart failure seen mainly during pharmacological stress, transjugular intrahepatic portosystemic shunt, liver transplantation. Methods: It is a cross sectional study done on patients admitted in wards or attending to outpatient department of Liver unit, Bir Hospital, between May 2015 to May 2016. Diagnosis of cirrhosis was based on clinical examination, lab parameters, ultrasound examination, endoscopy and/or liver biopsy. Cirrhotic patients after assessing the exclusion criteria were recruited for the study. Child Pugh and model for end stage liver disease scores were calculated to assess the liver function. Cardiac function was evaluated by resting pulse, mean arterial pressure, electrocardiography, and 2 dimensional echocardiography. Results: Diastolic dysfunction was seen in 61.9%(48) and was more common in alcoholic group (63.2% Vs 58.6%). Systolic dysfunction was seen in 6.6% of alcoholic patients only. 51.4% had cirrhotic cardiomyopathy according to the criteria (proposed by World congress of gastroenterology in 2005). Prolonged QTc of >0.44 seconds was noted in 79%, mainly in child pugh C, with model for end stage liver disease score >10.Conclusions: Cardiac dysfunction is prevalent with sizeable number of patients with cirrhosis especially in the form of diastolic dysfunction independent of etiology. QTc prolongation might be an early indicator of cardiac dysfunction and is directly correlated with child pugh and model for end stage liver disease scores.Keywords: Chronic liver disease; cardiac dysfunction; MELD score; QTc.

The relationship between alcohol consumption and liver cirrhosis has long been contested by doctors and medical professionals, creating numerous implications for the public reputation of alcohol in Britain. Despite this, it was not until the 1970s that cirrhosis came to be understood as an 'alcoholic disease'. This book contextualises developments in this debate through the twentieth century by examining the significant influence that medical expertise had on policy responses to alcohol misuse, as well as the social reputation of alcohol consumption. It demonstrates how the degree to which drinking was seen to be responsible for liver disease directly shaped how different groups, such as the temperance movement and the drinks industry, exaggerated or downplayed the destructive properties of alcohol. Covering a series of themes including the science of disease causation, the social standing of medical expertise, and alcohol and public health policy, this book argues that in order to properly understand the trajectory of debates around drinking we need to consider the twentieth-century 'alcohol problem' as primarily a medical issue. Contrary to the tendency by existing works to disassociate perceptions and responses to alcohol use from the objective knowledge of its effects on the body, this book shows that medical understandings of liver disease influenced how alcohol was conceptualised in relation to its harms. Offering a fresh perspective on the interaction between scientific knowledge and policy during the twentieth century, this book provides insights for those researching the social, political and cultural history of modern Britain, as well as historians of medicine and health. Ryosuke Yokoe is a JSPS Postdoctoral Fellow based in the Graduate School of Economics at the University of Tokyo, Japan. He is a historian of medicine and previously studied and taught at the University of Sheffield in the UK.

Background: Studies have shown that patients with liver cirrhosis are more susceptible to tuberculosis because of immune dysfunction; however there are only limited data. We carried out this study to know the prevalence and clinical characteristics of tuberculosis in patients with liver cirrhosis.Methods: In this retrospective study, medical files of 200 consecutive patients admitted with diagnosis of liver cirrhosis in the medical ward of liver unit, Bir Hospital from January 2011 to December 2014 were evaluated for the presence of TB and clinical characteristics of these patients were analyzed.Results: Eighteen patients were diagnosed to have tuberculosis with a prevalence of 9%. The median age of patients with tuberculosis and liver cirrhosis was 53 (35–71) years and M: F ratio was 2:1. 67%, P=0.01). Median CTP score of patients were 8.5 (5–12) (CTP A: B: C: 3:7:8). Extra pulmonary tuberculosis was more common (67%) than pulmonary (33%). In extra pulmonary tuberculosis, distribution was as pleural effusion (n=4), abdominal (n=4), intestinal (n=2), peritoneal (n=9), and pott's spine (n=2). Conclusions: Tuberculosis is prevalent in patients with liver cirrhosis. Extra pulmonary tuberculosis was more compared to pulmonary tuberculosis. Tuberculosis was common in decompensated liver cirrhosis than compensated liver cirrhosis .

The incidence of cirrhosis is rising, and identification of these patients prior to undergoing any surgical procedure is crucial. The preoperative risk stratification using validated scores, such as Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease, perioperative optimization of hemodynamics and metabolic derangements, and postoperative monitoring to minimize the risk of hepatic decompensation and complications are essential components of medical management. The advanced stage of cirrhosis, emergency surgery, open surgeries, old age, and coexistence of medical comorbidities are main factors influencing the clinical outcome of these patients. Perioperative management of patients with cirrhosis warrants special attention to nutritional status, fluid and electrolyte balance, control of ascites, excluding preexisting infections, correction of coagulopathy and thrombocytopenia, and avoidance of nephrotoxic and hepatotoxic medications. Transjugular intrahepatic portosystemic shunt may improve the CTP class, and semielective surgeries may be feasible. Emergency surgery, whenever possible, should be avoided.

Abstract

Aims
up to 80% of patients with alcohol use disorder display cognitive impairments. Some studies have suggested that alcohol-related cognitive impairments could be worsened by hepatic damage. The primary objective of this study was to compare mean scores on the Brief Evaluation of Alcohol-Related Neurocognitive Impairments measure between alcohol use disorder patients with (CIR+) or without cirrhosis (CIR−).


Methods
we conducted a prospective case–control study in a hepatology department of a university hospital. All patients were assessed using the Evaluation of Alcohol-Related Neuropsychological Impairments test.


Results
a total of 82 patients (50 CIR+, 32 CIR−) were included in this study. CIR− patients were significantly younger than CIR+ patients (respectively, 45.5 ± 6.8 vs 60.1 ± 9.0; P < .0001). After adjusting for age and educational level, the mean Evaluation of Alcohol-Related Neuropsychological Impairments total scores in the CIR+ group were significantly lower than in the group of CIR− patients (14.1 ± 0.7 vs 7.8 ± 0.4, respectively, P < .0001). The mean subscores on delayed verbal memory, alphabetical ordination, alternating verbal fluency, visuospatial abilities, and ataxia subtests were also significantly lower in the CIR+ than in the CIR− group (respectively, 1.9 ± 0.2 vs 2.8 ± 0.2; 1.8 ± 0.2 vs 2.7 ± 0.2; 2.2 ± 0.2 vs 3.6 ± 0.2; 0.7 ± 0.2 vs 1.6 ± 0.2; 0.7 ± 0.2 vs 3.1 ± 0.2; P < .0001 for all comparisons).


Conclusions
in the present study, alcohol use disorder patients with cirrhosis presented more severe cognitive impairments than those without cirrhosis. Longitudinal studies are needed to investigate how cirrhosis can influence cognitive impairments.