By Ian Beckingham
Queen's clinical Centre, Nottingham, united kingdom. presents an summary of the illnesses of the liver, pancreas, and gall bladder. For citizens, scientific scholars, and normal practitioners. Covers universal and infrequent stipulations and comprises algorithms for prognosis and remedy. colour illustrations. Softcover.
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Additional info for ABC of liver, pancreas and gall bladder
A polymorphonuclear neutrophil count > 500 · 106/l is indicative of spontaneous bacterial peritonitis. Treatment with intravenous broad spectrum antibiotics should be started while awaiting the results of culture of ascitic fluid. Although the mortality associated with acute spontaneous bacterial peritonitis decreases with early treatment, it is still high (about 50%) and is related to the severity of the underlying liver disease. 24 Summary points x Cirrhosis is the commonest cause of ascites (90%) x Ninety per cent of cases can be managed by sodium restriction and diuretics x Hepatic encephalopathy is most commonly precipitated by drugs or gastrointestinal haemorrhage x Non-steroidal anti-inflammatory drugs should be avoided in cirrhotic patients as they can cause renal failure Further reading Sherlock S, Dooley J.
The tract is dilated and an expandable metal stent inserted to create an intrahepatic portosystemic shunt. The success rate is excellent. Haemodynamic effects are similar to those found with surgical shunts, with a lower procedural morbidity and mortality. Transjugular intrahepatic portosystemic shunting is an effective salvage procedure for stopping acute variceal haemorrhage, controlling bleeding from gastric varices, and congestive gastropathy after failure of medical and endoscopic treatment.
N Engl J Med 1999;340:988-93 Prophylactic management Most patients with portal hypertension never bleed, and it is difficult to predict who will. Attempts at identifying patients at high risk of variceal haemorrhage by measuring the size or appearance of varices have been largely unsuccessful. blockers have been shown to reduce the risk of bleeding, and all patients with varices should take them unless contraindicated. Gastric varices and portal hypertensive gastropathy Summary points x Variceal bleeding is an important cause of death in cirrhotic patients x Acute management consists of resuscitation and control of bleeding by sclerotherapy or balloon tamponade x After a bleed patients require treatment to eradicate varices and lifelong surveillance to prevent further bleeds x All patients with varices should take blockers to reduce the risk of bleeding unless contraindicated by coexisting medical conditions x Surgery is now rarely required for acute or chronic control of variceal bleeding Gastric varices are the source of bleeding in 5-10% of patients with variceal haemorrhage.