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Clinical and Molecular Hepatology Jan 2023The development of refractory ascites in approximately 10% of patients with decompensated cirrhosis heralds the progression to a more advanced stage of cirrhosis. Its... (Review)
Review
The development of refractory ascites in approximately 10% of patients with decompensated cirrhosis heralds the progression to a more advanced stage of cirrhosis. Its pathogenesis is related to significant hemodynamic changes, initiated by portal hypertension, but ultimately leading to renal hypoperfusion and avid sodium retention. Inflammation can also contribute to the pathogenesis of refractory ascites by causing portal microthrombi, perpetuating the portal hypertension. Many complications accompany the development of refractory ascites, but renal dysfunction is most common. Management starts with continuation of sodium restriction, which needs frequent reviews for adherence; and regular large volume paracentesis of 5 L or more with albumin infusions to prevent the development of paracentesisinduced circulatory dysfunction. Albumin infusions independent of paracentesis may have a role in the management of these patients. The insertion of a covered, smaller diameter, transjugular intrahepatic porto-systemic stent shunt (TIPS) in the appropriate patients with reasonable liver reserve can bring about improvement in quality of life and improved survival after ascites clearance. Devices such as an automated low-flow ascites pump may be available in the future for ascites treatment. Patients with refractory ascites should be referred for liver transplant, as their prognosis is poor. In patients with refractory ascites and concomitant chronic kidney disease of more than stage 3b, assessment should be referred for dual liver-kidney transplants. In patients with very advanced cirrhosis not suitable for any definitive treatment for ascites control, palliative care should be involved to improve the quality of life of these patients.
Topics: Humans; Ascites; Quality of Life; Liver Cirrhosis; Albumins; Hypertension, Portal; Sodium; Portasystemic Shunt, Transjugular Intrahepatic; Paracentesis
PubMed: 35676862
DOI: 10.3350/cmh.2022.0104 -
Journal of Veterinary Emergency and... 2015To review the current literature in reference to the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats. (Review)
Review
OBJECTIVE
To review the current literature in reference to the pathophysiology, diagnosis, and treatment of pyothorax in dogs and cats.
ETIOLOGY
Pyothorax, also known as thoracic empyema, is characterized by the accumulation of septic purulent fluid within the pleural space. While the actual route of pleural infection often remains unknown, the oral cavity and upper respiratory tract appear to be the most common source of microorganisms causing pyothorax in dogs and cats. In human medicine, pyothorax is a common clinical entity associated with bacterial pneumonia and progressive parapneumonic effusion.
DIAGNOSIS
Thoracic imaging can be used to support a diagnosis of pleural effusion, but cytologic examination or bacterial culture of pleural fluid are necessary for a definitive diagnosis of pyothorax.
THERAPY
The approach to treatment for pyothorax varies greatly in both human and veterinary medicine and remains controversial. Treatment of pyothorax has classically been divided into medical or surgical therapy and may include administration of antimicrobials, intermittent or continuous thoracic drainage, thoracic lavage, intrapleural fibrinolytic therapy, video-assisted thoracic surgery, and traditional thoracostomy. Despite all of the available options, the optimal treatment to ensure successful short- and long-term outcome, including the avoidance of recurrence, remains unknown.
PROGNOSIS
The prognosis for canine and feline pyothorax is variable but can be good with appropriate treatment. A review of the current veterinary literature revealed an overall reported survival rate of 83% in dogs and 62% in cats. As the clinical presentation of pyothorax in small animals is often delayed and nonspecific, rapid diagnosis and treatment are required to ensure successful outcome.
Topics: Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Critical Care; Dog Diseases; Dogs; Empyema, Pleural; Paracentesis; Prognosis; Thoracotomy; Veterinary Medicine
PubMed: 25582193
DOI: 10.1111/vec.12274 -
Alimentary Pharmacology & Therapeutics Jun 2015Spontaneous bacterial peritonitis (SBP) is a severe and often fatal infection in patients with cirrhosis and ascites. (Review)
Review
BACKGROUND
Spontaneous bacterial peritonitis (SBP) is a severe and often fatal infection in patients with cirrhosis and ascites.
AIM
To review the known and changing bacteriology, risk factors, ascitic fluid interpretation, steps in performing paracentesis, treatment, prophylaxis and evolving perspectives related to SBP.
METHODS
Information was obtained from reviewing medical literature accessible on PubMed Central. The search term 'spontaneous bacterial peritonitis' was cross-referenced with 'bacteria', 'risk factors', 'ascites', 'paracentesis', 'ascitic fluid analysis', 'diagnosis', 'treatment', 'antibiotics', 'prophylaxis', 'liver transplantation' and 'nutrition'.
RESULTS
Gram-positive cocci (GPC) such as Staphylococcus, Enterococcus as well as multi-resistant bacteria have become common pathogens and have changed the conventional approach to treatment of SBP. Health care-associated and nosocomial SBP infections should prompt greater vigilance and consideration for alternative antibiotic coverage. Acid suppressive and beta-adrenergic antagonist therapies are strongly associated with SBP in at-risk individuals.
CONCLUSIONS
Third-generation, broad-spectrum cephalosporins remain a good initial choice for SBP treatment. Levofloxacin is an acceptable alternative for patients not receiving long-term flouroquinolone prophylaxis or for those with a penicillin allergy. For uncomplicated SBP, early oral switch therapy is reasonable. Alternative antibiotics such as pipercillin-tazobactam should be considered for patients with nosocomial SBP or for patients who fail to improve on traditional antibiotic regimens. Selective albumin supplementation remains an important adjunct in SBP treatment. Withholding acid suppressive medication deserves strong consideration, and discontinuing beta-adrenergic antagonist therapy in patients with end-stage liver disease and resistant ascites is standard care. Liver transplant evaluation should be undertaken for patients who develop SBP barring contraindications.
Topics: Anti-Bacterial Agents; Ascites; Bacterial Infections; Cross Infection; Humans; Liver Cirrhosis; Liver Transplantation; Paracentesis; Peritonitis; Risk Factors
PubMed: 25819304
DOI: 10.1111/apt.13172 -
Chest Jun 2019
Topics: Paracentesis; Ultrasonography
PubMed: 31174648
DOI: 10.1016/j.chest.2019.02.337 -
Zhongguo Fei Ai Za Zhi = Chinese... May 2020Intraoperative aspiration is a common pulmonary complication in the surgery, anesthesia and position were main factors leading to the operative aspiration. In recent... (Review)
Review
Intraoperative aspiration is a common pulmonary complication in the surgery, anesthesia and position were main factors leading to the operative aspiration. In recent years, perioperative lung protection has attracted wide attention of thoracic surgeons and anesthetist; how to accelerate the process of postoperative rehabilitation, reduce the incidence of related complications and significantly improve the prognosis of patients, these have become a chief goal of surgical treatment. This article will center on operative aspiration and summarize it from anatomy, pathophysiology, manifestation, diagnosis, treatment and prevention.
Topics: Humans; Intraoperative Complications; Lung Neoplasms; Medical Errors; Paracentesis
PubMed: 32429641
DOI: 10.3779/j.issn.1009-3419.2020.101.22 -
The New England Journal of Medicine Dec 2020
Topics: Female; Humans; Informed Consent; Internship and Residency; Male; Paracentesis; Physician-Patient Relations; Students, Medical
PubMed: 33370515
DOI: 10.1056/NEJMp2003561 -
Journal of Clinical Pharmacy and... Aug 2021The purpose of this paper was to discuss the limitations of the studies serving as the evidence for recommendations in clinical practice guidelines concerning albumin... (Review)
Review
WHAT IS KNOWN AND OBJECTIVE
The purpose of this paper was to discuss the limitations of the studies serving as the evidence for recommendations in clinical practice guidelines concerning albumin use for cirrhosis-related complications, review relevant studies published since the guidelines and suggest directions for future investigations.
COMMENT
There are no recent comprehensive clinical practice guidelines concerning albumin. Instead, more recent albumin guidelines reflect areas of specialty practice such as those by American and European associations for the study of the liver and liver disease. Studies published since the guidelines are useful for helping to define the most appropriate indications for albumin with respect to cirrhosis-related complications, as well as directions for future research.
WHAT IS NEW AND CONCLUSION
Albumin has a long history of attempts to define appropriate uses by meta-analysis, but given the high cost and episodic shortages of albumin, there is a need for adequately powered randomized controlled trials using current state-of-the-art care evaluating the use of albumin to prevent or treat cirrhosis-related complications.
Topics: Albumins; Biomarkers; Comorbidity; Humans; Liver Cirrhosis; Liver Diseases; Paracentesis; Practice Guidelines as Topic; Randomized Controlled Trials as Topic
PubMed: 34101215
DOI: 10.1111/jcpt.13461 -
Chest Jul 2018Paracentesis is a commonly performed procedure and generally considered to be low risk. Despite its overall favorable safety profile, use of ultrasound has been... (Review)
Review
Paracentesis is a commonly performed procedure and generally considered to be low risk. Despite its overall favorable safety profile, use of ultrasound has been demonstrated to reduce the incidence of complications, especially in higher risk patients. Many individual ultrasound techniques have been described in the literature, each with the goal of making paracentesis safer. This article presents a systematic approach for incorporating many of these tools into bedside practice and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described.
Topics: Clinical Competence; Humans; Paracentesis; Point-of-Care Systems; Ultrasonography, Interventional
PubMed: 29630894
DOI: 10.1016/j.chest.2018.03.034 -
AORN Journal Jan 2017
Topics: Aged; Ascites; Female; Hemorrhage; Humans; Internship and Residency; Omentum; Paracentesis; Personnel Administration, Hospital; Tissue Adhesions; Ultrasonography, Interventional
PubMed: 28034390
DOI: 10.1016/j.aorn.2016.09.021 -
Liver Transplantation : Official... Nov 2020
Topics: Ascites; Humans; Liver Transplantation; Paracentesis; Quality of Life
PubMed: 32516850
DOI: 10.1002/lt.25816