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Molecules (Basel, Switzerland) Jun 2022Ascites is a common complication of decompensated liver cirrhosis, and yet relatively little is known about its biochemical composition. We conducted two metabolomic...
Ascites is a common complication of decompensated liver cirrhosis, and yet relatively little is known about its biochemical composition. We conducted two metabolomic investigations, comparing the profile of ascites from 33 cirrhotic patients and postoperative peritoneal drainage fluid from 33 surgical patients (Experiment 1). The profile of paired ascites and plasma was also compared in 17 cirrhotic patients (Experiment 2). Gas chromatography−mass spectrometry-based metabolomics identified 29 metabolites that significantly characterized ascites fluid, whether postoperative drainage fluid or plasma were used as controls. Ten elevated amino acids (glutamine, proline, histidine, tyrosine, glycine, valine, threonine, methionine, lysine, phenylalanine) and seven diminished lipids (laurate, myristate, palmitate, oleate, vaccenate, stearate, cholesterol) largely comprised the cirrhotic ascites metabolomic phenotype that differed significantly (adjusted p < 0.002 to 0.03) from peritoneal drainage fluid or plasma. The pattern of upregulated amino acids in cirrhotic ascites did not indicate albumin proteolysis by peritoneal bacteria. Bidirectional clustering showed that the more severe the cirrhosis, the lower the lipid concentration in ascitic fluid. The metabolomic compartment of ascites in patients with decompensated cirrhosis is characterized by increased amino acids and decreased lipids. These novel findings have potential relevance for diagnostic purposes.
Topics: Amino Acids; Ascites; Cholesterol; Humans; Liver Cirrhosis; Metabolomics
PubMed: 35745058
DOI: 10.3390/molecules27123935 -
Clinics and Research in Hepatology and... Apr 2022Hydrothorax in the presence of ascites is a serious condition, but it is not well studied, particularly in pediatrics. We aim to identify risk factors for having...
BACKGROUND
Hydrothorax in the presence of ascites is a serious condition, but it is not well studied, particularly in pediatrics. We aim to identify risk factors for having hydrothorax, compare morbidity and mortality, and report the prevalence of hepatic hydrothorax and non-hepatic hydrothorax in pediatric patients with diagnosis of ascites and hydrothorax.
METHODS
This is a retrospective study of pediatric patients under 22 years of age with both ascites and hydrothorax. Hydrothorax was categorized into hepatic and non-hepatic hydrothorax. Demographic data and clinical data including ascites grade, ascites etiology, treatments, length of stay, and death were collected and analyzed using logistic regression.
RESULTS
We identified 120 patients with ascites and hydrothorax, 63 (53%) being female. The median age was 13 years (IQR: 4-18). Patients 6 years of age or older (OR=1.90; 95% CI=1.16-3.17; p = 0.012), patients with higher grades of ascites (OR=1.77; 95% CI=1.27-2.47; p < 0.001), those treated with furosemide (OR=2.27; 95% CI=1.37-3.76; p = 0.001), and those with hepatorenal syndrome (OR=4.22; 95% CI=1.19-15.63; p = 0.025) had increased risk of hydrothorax. The underlying etiology of ascites was not associated with mortality, but it was associated with length of stay (p = 0.013), with veno-occlusive disease being the largest contributor. Hepatic versus non-hepatic hydrothorax was also not found to be associated with mortality, but length of stay was significantly greater in former (23 days; IQR=13-38) compared to the latter group (14 days; IQR=8-26) (p = 0.009).
CONCLUSIONS
With pediatric ascites, there are certain risk factors that are associated with having hydrothorax, and ascites etiology may be associated with morbidity.
Topics: Adolescent; Ascites; Child; Female; Humans; Hydrothorax; Liver Cirrhosis; Male; Pediatrics; Retrospective Studies
PubMed: 35038576
DOI: 10.1016/j.clinre.2022.101868 -
JAAPA : Official Journal of the... Nov 2023Patients with cirrhosis have a 50% to 60% chance of developing ascites within 10 years of diagnosis. Once ascites has developed, patients have a predicted 50% mortality...
Patients with cirrhosis have a 50% to 60% chance of developing ascites within 10 years of diagnosis. Once ascites has developed, patients have a predicted 50% mortality within 3 years. This article discusses the pathophysiology of ascites caused by cirrhosis, standards in diagnosing ascites, and the recommendations and guidelines for treating ascites. Properly managing patients with decompensated cirrhosis can improve their quality of life and longevity and minimize additional complications.
Topics: Humans; Ascites; Quality of Life; Liver Cirrhosis
PubMed: 37884049
DOI: 10.1097/01.JAA.0000979508.71082.33 -
Anticancer Research Feb 2024Malignant ascites is a common condition in patients with terminal cancer. Treatments, such as diuretics, percutaneous drainage of ascites, and abdominal vein shunting... (Observational Study)
Observational Study
BACKGROUND/AIM
Malignant ascites is a common condition in patients with terminal cancer. Treatments, such as diuretics, percutaneous drainage of ascites, and abdominal vein shunting have been advocated. However, these treatments have not achieved sufficient palliative effects. Therefore, the development of innovative therapies is mandated, especially for new therapies that require the creation of a fluid simulation of malignant ascites. However, there have been no previous studies on the physical properties of malignant ascites, including viscosity, which are necessary for the development of such a fluid. Therefore, we prospectively investigated the physical properties of malignant ascites.
PATIENTS AND METHODS
This single-center, prospective, observational study included 30 patients between November 2021 and January 2023. The primary endpoint was the viscosity of the malignant ascites, and the secondary endpoints included other viscosity studies, biochemical tests, and the presence of malignant cells in the ascites.
RESULTS
The median viscosity was 1.105 mPa*S. The viscosity of malignant ascites tended to decrease with increasing temperature, which is common for liquids. Malignant ascites fluid containing malignant cells tended to be more viscous than ascites fluid without malignant cells; furthermore, albumin levels tended to be higher in the former than in the latter.
CONCLUSION
Malignant ascites' median viscosity was 1.105 mPa*S. Correlation between viscosity and temperature showed a decreasing trend. These findings contribute valuable insights for future malignant ascites management and device development.
Topics: Humans; Ascites; Prospective Studies; Viscosity; Ascitic Fluid; Peritoneal Neoplasms
PubMed: 38307583
DOI: 10.21873/anticanres.16841 -
Digestive Diseases and Sciences Jun 2022Clinically significant ascites in acute pancreatitis (AP) is rarely encountered and is a result of multifactorial pathogenesis. Early reactionary ascites in AP usually... (Review)
Review
Clinically significant ascites in acute pancreatitis (AP) is rarely encountered and is a result of multifactorial pathogenesis. Early reactionary ascites in AP usually does not require any treatment and resolves spontaneously in majority of patients. A diagnostic analysis should be performed in case of ascites developing in the latter stages with increasing pain or worsening organ failure. Low serum albumin-ascites gradient ascites with amylase > 1000 U/l is highly suggestive of pancreatic ascites that is usually associated with duct disruption. A combination of nasojejunal feeding, subcutaneous octreotide, endoscopic drainage and rarely, surgery are employed in managing this difficult to treat condition. There is a need of further studies to better understand the clinical role of ascites as well as contribution of other factors like hypoalbuminemia and portal hypertension to its development in AP.
Topics: Acute Disease; Amylases; Ascites; Humans; Pancreatic Diseases; Pancreatitis
PubMed: 34036465
DOI: 10.1007/s10620-021-07063-6 -
Veterinary Medicine and Science Jul 2022This review covers the challenges of broiler chickens at high altitude, with the focus on growth performance and physiological response. The review also sheds light on... (Review)
Review
This review covers the challenges of broiler chickens at high altitude, with the focus on growth performance and physiological response. The review also sheds light on nutritional and management interventions that help overcome the challenges raised at high altitude. Reduced concentration of atmospheric oxygen is by far the biggest challenge that remarkably affect growth performance and livability of broiler chickens reared in high altitude area. Broiler chickens have endured intensive genetic selection, which potentially predispose them to several metabolic disorders. Hypoxia is an overriding factor that may increase the incidence of metabolic disorders, mainly ascites syndrome at high altitude. Commercial broiler strains cannot fully achieve their genetic potential when raising at highland regions. Careful nutrition and management considerations are required to prevent metabolic disorders when raising broilers at high altitude. In ovo or in-feed nutraceuticals such as l-carnitine and guanidinoacetic acid as well as pharmaceuticals, texture of feed and the use of proper sources and levels of dietary energy and protein are important factors that need to be carefully considered for rearing broiler chickens at high altitude. Management strategies such as lighting programs have been shown to be effective to circumvent ascites prevalence. Special breeding programs may also be considered to develop strains with resistance to ascites.
Topics: Altitude; Animals; Ascites; Chickens; Diet
PubMed: 35290706
DOI: 10.1002/vms3.784 -
Pancreatology : Official Journal of the... Jan 2021Pancreatic ascites (PA) and pleural effusion (PPE) are rarely encountered in children. They develop due to disruption of the pancreatic duct (PD) or leakage from an...
BACKGROUND
Pancreatic ascites (PA) and pleural effusion (PPE) are rarely encountered in children. They develop due to disruption of the pancreatic duct (PD) or leakage from an associated pancreatic fluid collection (PFC). The literature on childhood PA/PPE and its management is scarce.
METHODS
A retrospective review of children with PA/PPE diagnosed and managed at our center over the last 4 years was performed. The clinical, biochemical, radiological and management profiles were analyzed. Conservative management included nil per oral, octreotide and drainage using either percutaneous catheter or repeated paracentesis. Endotherapy included endoscopic retrograde cholangiopancreatography (ERCP) and transpapillary stenting.
RESULTS
Of the 214 children with pancreatitis, 15 (7%) had PA/PPE. Median age was 9 years with a third under 2 years. Median ascitic fluid amylase was 8840 U/L and all had elevated protein (>2.5 g/dl) and low serum ascites-albumin gradient ascites (<1.1). While PA/PPE was the first manifestation of underlying chronic pancreatitis (CP) in 10 children (67%), trauma was seen in 4 (26%) and hypertriglyceridemia in 1 (7%). On imaging, PD disruption could be identified in 10 (67%) children. ERCP and stenting was done in 10 children. Conservative management alone (n = 4) and endotherapy (n = 10) was successful in 93% with only one requiring surgery. The younger children (n = 4), were managed conservatively and only 1 of them required surgery. Resolution of PA/PPE was achieved in all with no recurrences.
CONCLUSIONS
Conservative management and ERCP plus transpapillary stenting results in resolution of majority of pediatric PA/PPE. Children presenting with PA/PPE needs to be evaluated for CP.
Topics: Ascites; Child; Child, Preschool; Drainage; Female; Humans; Infant; Male; Pancreatic Ducts; Pancreatitis; Pleural Effusion; Retrospective Studies
PubMed: 33349510
DOI: 10.1016/j.pan.2020.12.010 -
Gastroenterologia Y Hepatologia Nov 2022Ascites is the fluid accumulation in the peritoneal cavity, and it is the consequence of a wide variety of entities, being liver cirrhosis the most common one. In this... (Review)
Review
Ascites is the fluid accumulation in the peritoneal cavity, and it is the consequence of a wide variety of entities, being liver cirrhosis the most common one. In this kind of patients, the development of ascites results from splanchnic vasodilation; decreased effective circulating volume; the activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system; and a systemic inflammatory process. Its management is diverse and depends on the severity of the hemodynamic disturbance and other clinical manifestations. In recent years, therapeutic strategies have been developed, but they tend to result unconventional, so new evidence demonstrates the advantages of non-selective beta-blockers for the survival rate of patients with end-stage cirrhosis and ascites.
Topics: Humans; Ascites; Liver Cirrhosis; Renin-Angiotensin System; Vasodilation; Adrenergic beta-Antagonists; Splanchnic Circulation
PubMed: 35257809
DOI: 10.1016/j.gastrohep.2022.02.004 -
United European Gastroenterology Journal Mar 2024In recent years, advances have been made for treating ascites in patients with cirrhosis. Recent studies have indicated that several treatments that have been used for a... (Review)
Review
In recent years, advances have been made for treating ascites in patients with cirrhosis. Recent studies have indicated that several treatments that have been used for a long time in the management of portal hypertension may have beneficial effects that were not previously identified. Long-term albumin infusion may improve survival in patients with cirrhosis and ascites while beta-blockers may reduce ascites occurrence. Transjugular intrahepatic porto-systemic shunt (TIPS) placement may also improve survival in selected patients in addition to the control with ascites. Low-flow ascites pump insertion can be another option for some patients with intractable ascites. In this review, we summarize the latest data related to the management of ascites occurring in cirrhosis. There are still unanswered questions, such as the optimal use of albumin as a long-term therapy, the place of beta-blockers, and the best timing for TIPS placement to improve the natural history of ascites, as well as the optimal stent diameter to reduce the risk of shunt-related side-effects. These issued should be addressed in future studies.
Topics: Humans; Ascites; Treatment Outcome; Portasystemic Shunt, Transjugular Intrahepatic; Liver Cirrhosis; Albumins
PubMed: 38340308
DOI: 10.1002/ueg2.12539 -
Clinical and Experimental Medicine Mar 2024Cirrhosis is an advanced-stage liver disease that occurs due to persistent physiological insults such as excessive alcohol consumption, infections, or toxicity. It is... (Review)
Review
Cirrhosis is an advanced-stage liver disease that occurs due to persistent physiological insults such as excessive alcohol consumption, infections, or toxicity. It is characterised by scar tissue formation, portal hypertension, and ascites (accumulation of fluid in the abdominal cavity) in decompensated cirrhosis. This review evaluates how albumin infusion ameliorates cirrhosis-associated complications. Since albumin is an oncotic plasma protein, albumin infusion allows movement of water into the intravascular space, aids with fluid resuscitation, and thereby contributes to resolving cirrhosis-induced hypovolemia (loss of extracellular fluid) seen in ascites. Thus, albumin infusion helps prevent paracentesis-induced circulatory dysfunction, a complication that occurs when treating ascites. When cirrhosis advances, other complications such as spontaneous bacterial peritonitis and hepatorenal syndrome can manifest. Infused albumin helps mitigate these by exhibiting plasma expansion, antioxidant, and anti-inflammatory functions. In hepatic encephalopathy, albumin infusion is thought to improve cognitive function by reducing ammonia concentration in blood and thereby tackle cirrhosis-induced hepatocyte malfunction in ammonia clearance. Infused albumin can also exhibit protective effects by binding to the cirrhosis-induced proinflammatory cytokines TNFα and IL6. While albumin administration has shown to prolong overall survival of cirrhotic patients with ascites in the ANSWER trial, the ATTIRE and MACHT trials have shown either no effect or limitations such as development of pulmonary oedema and multiorgan failure. Thus, albumin infusion is not a generic treatment option for all cirrhosis patients. Interestingly, cirrhosis-induced structural alterations in native albumin (which lead to formation of different albumin isoforms) can be used as prognostic biomarkers because specific albumin isoforms indicate certain complications of decompensated cirrhosis.
Topics: Humans; Ascites; Ammonia; Liver Cirrhosis; Albumins; Protein Isoforms
PubMed: 38551716
DOI: 10.1007/s10238-024-01315-1