TIPS for the treatment of refractory ascites, hepatorenal syndrome and hepatic hydrothorax: a critical update

Episode von Medizin - Open Access LMU - Teil 17/22 von Ludwig-Maximilians-Universität München · 1. Januar 2010

Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. Large volume paracentesis and pleurodesis are regarded as first-line treatments in patients who do not respond adequately to diuretics. These treatments, however, do not prevent recurrence and carry the risk of worsening of the circulatory dysfunction leading to hepatorenal syndrome. The transjugular intrahepatic portosystemic shunt ( TIPS) has been proposed as an alternative to paracentesis. TIPS reduces the rate of ascites recurrence mainly due to the reduction in the filtration pressure. In addition, TIPS results in a positive effect on renal function, including hepatorenal syndrome, demonstrated by a rapid increase in urinary sodium excretion, urinary volume, and improvement in plasma creatinine concentration. Furthermore, plasma renin activity, aldosterone, and noradrenalin concentrations improve gradually after TIPS insertion suggesting a positive effect on systemic underfilling, the factor of hepatorenal syndrome. As demonstrated recently in two meta-analyses including five randomised studies, TIPS also improves survival when compared with paracentesis. However, the evidence is based on relatively few studies with only 305 patients included. The positive effects of the TIPS are opposed by an increased frequency and severity of episodes of hepatic encephalopathy which may be reduced by both patient selection and reduced shunt diameter. Based on the present knowledge the recommended hierarchy of treatments for refractory ascites may be reconsidered upgrading TIPS in suitable candidates.

Weitere Episoden von „Medizin - Open Access LMU - Teil 17/22“

• 200 years Organon of Medicine - A comparative Review of its six editions (1810-1842) 1. Januar 2010
• A powerful transgenic tool for fate mapping and functional analysis of newly generated neurons 1. Januar 2010
• Air temperature and inflammatory and coagulation responses in men with coronary or pulmonary disease during the winter season 1. Januar 2010
• Ambient particulate pollution and the world-wide prevalence of asthma, rhinoconjunctivitis and eczema in children: Phase One of the International Study of Asthma and Allergies in Childhood (ISAAC) 1. Januar 2010
• Amiloride reduces portal hypertension in rat liver cirrhosis 1. Januar 2010
• Association between exposure to radiofrequency electromagnetic fields assessed by dosimetry and acute symptoms in children and adolescents: a population based cross-sectional study 1. Januar 2010
• Bone Morphogenetic Protein (BMP)-7 expression is decreased in human hypertensive nephrosclerosis 1. Januar 2010
• Colitis induced in mice with dextran sulfate sodium (DSS) is mediated by the NLRP3 inflammasome 1. Januar 2010
• Deqi sensations without cutaneous sensory input: results of an RCT 1. Januar 2010
• Diagnostic indices for vertiginous diseases 1. Januar 2010
• How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials 1. Januar 2010
• Impact of the indexed effective orifice area on mid-term cardiac-related mortality after aortic valve replacement 1. Januar 2010
• Increased expression of 5-hydroxytryptamine(2A/B) receptors in idiopathic pulmonary fibrosis: a rationale for therapeutic intervention 1. Januar 2010
• LEF-1 and TCF4 expression correlate inversely with survival in colorectal cancer 1. Januar 2010
• Minocycline is cytoprotective in human corneal endothelial cells and induces anti-apoptotic B-cell CLL/lymphoma 2 (Bcl-2) and X-linked inhibitor of apoptosis (XIAP) 1. Januar 2010

Alle Episoden von Medizin - Open Access LMU - Teil 17/22 · Mehr Bildung-Podcasts