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Liver Cirrhosis and Portal Hypertension: How to Deal with Esophageal Varices?
- Source :
-
The Medical clinics of North America [Med Clin North Am] 2023 May; Vol. 107 (3), pp. 491-504. Date of Electronic Publication: 2023 Feb 20. - Publication Year :
- 2023
-
Abstract
- The understanding of pathogenesis of portal hypertension in patients with liver cirrhosis continues to evolve. In addition to progressive fibrosis, cirrhosis is characterized by parenchymal extinction and vascular remodelling, causing architectural distortion. Existence of prothrombotic state and more recently, intestinal bacterial dysbiosis are recently described in the pathogenesis of portal hypertension. Clinically significant portal hypertension (CSPH) is an important prognostic milestone in patients with liver cirrhosis. This is a pre-symptomatic phase that predicts the development of varices, ascites and importantly increased risk of Hepatocellular carcinoma (HCC). CSPH is associated with significantly reduced survival. Endoscopic surveillance is necessary in these patients. Non-selective Beta-blocker is the preferred therapy for primary prophylaxis in the management of portal hypertension. Patients with acute variceal bleed should be resuscitated appropriately, followed by vasoactive drugs and endoscopic therapy. Early TIPS should be considered in those with refractory bleed or in endoscopic treatment failure. Application of artificial intelligence and machine learning may be useful in future for identifying patients at risk of variceal hemorrhage.<br /> (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Artificial Intelligence
Gastrointestinal Hemorrhage etiology
Gastrointestinal Hemorrhage therapy
Liver Cirrhosis complications
Esophageal and Gastric Varices diagnosis
Esophageal and Gastric Varices etiology
Esophageal and Gastric Varices therapy
Carcinoma, Hepatocellular complications
Liver Neoplasms complications
Hypertension, Portal complications
Hypertension, Portal diagnosis
Hypertension, Portal therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1557-9859
- Volume :
- 107
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The Medical clinics of North America
- Publication Type :
- Academic Journal
- Accession number :
- 37001949
- Full Text :
- https://doi.org/10.1016/j.mcna.2023.01.002