Revista de Gastroenterología de México (English Edition),
Journal Year:
2024,
Volume and Issue:
89(3), P. 418 - 441
Published: July 1, 2024
Management
of
the
patient
with
cirrhosis
liver
that
requires
surgical
treatment
has
been
relatively
unexplored.
In
Mexico,
there
is
currently
no
formal
stance
or
expert
recommendations
to
guide
clinical
decision-making
in
this
context.
The
present
position
paper
reviews
existing
evidence
on
risks,
prognoses,
precautions,
special
care,
and
specific
management
procedures
for
patients
require
interventions
invasive
procedures.
Our
aim
provide
by
an
panel,
based
best
published
evidence,
consequently
ensure
timely,
quality,
efficient,
low-risk
care
group
patients.
Twenty-seven
were
developed
address
preoperative
considerations,
intraoperative
settings,
postoperative
follow-up
care.
assessment
major
should
be
overseen
a
multidisciplinary
team
includes
anesthesiologist,
hepatologist,
gastroenterologist,
nutritionist.
With
respect
decompensated
patients,
nephrology
specialist
may
required,
given
kidney
function
also
parameter
involved
prognosis
these
El
terreno
del
paciente
con
cirrosis
que
requiere
de
una
intervención
quirúrgica
ha
sido
poco
explorado.
En
México,
la
fecha
contamos
un
posicionamiento
o
recomendaciones
expertos
ayuden
toma
decisiones
clínicas
en
este
contexto.
Revisar
evidencia
existente
sobre
el
riesgo,
pronóstico,
precauciones,
cuidados
especiales
y
manejo
proceder
específico
para
los
pacientes
requieren
ser
intervenidos
quirúrgicamente
mediante
procedimientos
invasivos,
emitir
por
panel
experto,
basadas
mejor
publicada
atención
oportuna,
calidad,
eficiente
menor
riesgo
posible
grupo
pacientes.
Se
obtuvieron
27
recomendaciones,
donde
se
abordan
preoperatorio,
escenario
transoperatorio
seguimiento
postoperatorios.
La
valoración
cuidado
procedimiento
quirúrgico
invasivo
mayor,
debe
estar
cargo
equipo
multidisciplinario
brinde
soporte
al
cirujano,
durante
todo
perioperatorio,
incluir
anestesiólogo,
hepatólogo,
gastroenterólogo,
nutriólogo
clínico.
descompensado,
puede
necesario
involucrar
especialistas
nefrología
ya
función
renal
es
parámetro
implicado
también
pronóstico
estos
Pharmaceuticals,
Journal Year:
2025,
Volume and Issue:
18(3), P. 339 - 339
Published: Feb. 27, 2025
Ascites
is
the
most
common
complication
from
cirrhosis
related
to
portal
hypertension
and
depicts
onset
of
hepatic
decompensation.
Ranging
uncomplicated
refractory
ascites,
progression
carries
prognostic
value
by
reflecting
deterioration
underlying
hypertension.
Diuretics
have
been
mainstay
treatment
control
but
side
effects
heighten
when
dosage
escalated.
Non-selective
beta-blockers
(NSBBs)
are
widely
used
nowadays
prevent
decompensation
variceal
hemorrhage.
However,
with
worsening
systemic
vasodilation
inflammation
ascites
progresses,
patients
on
NSBBs
at
risk
hemodynamic
collapse
leading
renal
hypoperfusion
thus
hepatorenal
syndrome.
Long-term
albumin
infusion
was
studied
ascites.
results
were
conflicting.
Sodium-glucose
cotransporter-2
inhibitors
under
investigation
With
that,
may
require
regular
large-volume
paracentesis.
an
aging
population,
more
put
anti-thrombotic
agents
their
risks
in
decompensated
invasive
procedures
be
considered.
In
general,
poses
multiple
issues
pharmacological
treatment.
present
review,
we
discuss
challenges
controversies
Liver International,
Journal Year:
2024,
Volume and Issue:
unknown
Published: Nov. 28, 2024
ABSTRACT
Introduction
The
safety
of
continuing
anticoagulation
therapy
during
endoscopic
variceal
ligation
(EVL)
remains
controversial.
We
performed
a
systematic
review
and
meta‐analysis
to
evaluate
the
in
EVL.
Methods
systematically
searched
four
electronic
databases
from
their
inception
until
1
June
2024,
for
studies
that
evaluated
use
risk
rebleeding
among
patients
undergoing
primary
endpoint
was
after
secondary
endpoints
were
post‐banding
ulcer
bleeding
(PBUB)
eradication
rate.
PROSPERO
registration
number
is
CRD42024556094.
Results
A
total
5617
participants
nine
(eight
cohort
one
randomised
trial)
included.
most
common
type
low‐molecular‐weight
heparin,
followed
by
warfarin
direct
oral
anticoagulants
(DOAC).
pooled
10.9%
(95%CI:
6.3–16.5;
I
2
=
65.5%).
Concurrent
EVL
did
not
increase
overall
(OR,
1.10;
95%CI:
0.85–1.42,
0%),
PBUB
1.04;
95%CI,
0.48–2.24;
24%)
or
severe
0.94;
0.31–2.85;
0%).
Variceal
rates
similar,
regardless
Conclusion
Anticoagulation
who
underwent
Since
certainty
evidence
low,
these
findings
should
be
confirmed
future
trials.
Seminars in Liver Disease,
Journal Year:
2024,
Volume and Issue:
unknown
Published: Oct. 23, 2024
Acute-on-chronic
liver
failure
(ACLF)
is
defined
as
a
clinical
syndrome
that
develops
in
patients
with
chronic
disease
characterized
by
the
presence
of
organ
and
high
short-term
mortality,
although
there
still
no
worldwide
consensus
on
diagnostic
criteria.
Management
ACLF
mainly
based
treatment
"precipitating
factors"
(the
most
common
are
infections,
alcohol-associated
hepatitis,
hepatitis
B
flare,
bleeding)
support
failure,
which
often
requires
admission
to
intensive
care
unit.
Liver
transplantation
should
be
considered
grades
2
3
potentially
life-saving
treatment.
When
transplant
not
indicated,
palliative
after
7
days
full
at
least
four
failures
or
CLIF-C
score
>70.
This
review
summarizes
current
knowledge
management
ACLF,
focusing
recent
advances.
Liver Transplantation,
Journal Year:
2024,
Volume and Issue:
unknown
Published: Aug. 2, 2024
Percutaneous
liver
procedures
are
frequently
performed
in
patients
with
abnormal
coagulation
tests.
Current
guidelines
suggest
prophylactic
transfusion
is
not
mandatory
all
disease
or
cirrhosis,
depending
on
the
risk
of
bleeding.
This
study
aims
to
describe
incidence
and
major
bleeding
after
percutaneous
procedure
without
cirrhosis.
retrospective
includes
who
underwent
biopsy
radiofrequency
microwave
ablation
lesions
at
3
centers
Spain.
A
protocol
was
considered
for
platelet
counts
<50,000
and/or
international
normalized
ratio
>1.5.
The
primary
outcome
total
1797
were
included
study,
316
having
cirrhosis
(18%)
1481
(82%).
Among
80
classified
as
Child
A,
most
frequent
(86%).
Fourteen
(0.8%)
experienced
bleeding,
0.4%
occurring
0.8%
biopsy.
Bleeding
occurred
0.6%
compared
those
(
p
=
ns).
No
clinical
procedural
variables
associated
Twenty-five
(1.4%)
had
an
>1.5,
22
(1.2%)
a
count
<50,000.
Only
24%
(6/25)
>1.5
transfused
fresh
frozen
plasma,
72%
(16/22)
received
transfusion.
Patients
more
(5.9%
vs.
1.5%).
None
met
criteria
regardless
whether
they
transfusion,
none
episode
criteria.
In
this
cohort,
<1%
patients,
making
it
low-risk
Although
uniformly
adopted,
current
still
led
unnecessary
blood
product
administration.
