Are you looking for read ebook online? Search for your book and save it on your Kindle device, PC, phones or tablets. Download Portal Hypertension - ECAB PDF full book. Access full book title Portal Hypertension - ECAB by Abraham Koshy. Download full books in PDF and EPUB format.
Author: Abraham Koshy Publisher: Elsevier Health Sciences ISBN: 813123181X Category : Medical Languages : en Pages : 119
Book Description
Defined as a portal pressure of 12 mmHg or more, portal hypertension results from a combination of increased intrahepatic vascular resistance and increased blood flow through the portal venous system. Esophagogastric varices is the most important complication of severe portal hypertension because of the high risk of bleeding and mortality associated with them. Ascites is another important complication which may at times be refractory to treatment and may also get complicated by spontaneous bacterial peritonitis and hepatorenal syndrome. Portal hypertension is a predictable and preventable condition but has no definite cure. An aggressive approach to prevention and treatment of portal hypertension is therefore warranted. Treatment of portal hypertension is evolving rapidly and many changes in the therapeutic protocols have been incorporated in recent times. Endoscopic treatment of the bleeding varices and prophylactic role of beta-blockers to prevent rebleeding are well-established therapeutic options. The measurement of the hepatic venous pressure gradient may identify a suboptimal response to beta-blockers in patients at risk of bleeding from varices. However, the costeffectiveness of routine hepatic venous pressure gradient measurements to guide primary prophylaxis has not been examined. Besides these, there is a definite role of somatostatin analogs and shunt surgeries in the treatment of portal hypertension and its complications. This book is designed to update the reader on all such issues related to diagnosis, treatment and complications of portal hypertension along with supportive typical case scenarios. Thus it provides an excellent opportunity to widen one’s perspective in this area.
Author: Abraham Koshy Publisher: Elsevier Health Sciences ISBN: 813123181X Category : Medical Languages : en Pages : 119
Book Description
Defined as a portal pressure of 12 mmHg or more, portal hypertension results from a combination of increased intrahepatic vascular resistance and increased blood flow through the portal venous system. Esophagogastric varices is the most important complication of severe portal hypertension because of the high risk of bleeding and mortality associated with them. Ascites is another important complication which may at times be refractory to treatment and may also get complicated by spontaneous bacterial peritonitis and hepatorenal syndrome. Portal hypertension is a predictable and preventable condition but has no definite cure. An aggressive approach to prevention and treatment of portal hypertension is therefore warranted. Treatment of portal hypertension is evolving rapidly and many changes in the therapeutic protocols have been incorporated in recent times. Endoscopic treatment of the bleeding varices and prophylactic role of beta-blockers to prevent rebleeding are well-established therapeutic options. The measurement of the hepatic venous pressure gradient may identify a suboptimal response to beta-blockers in patients at risk of bleeding from varices. However, the costeffectiveness of routine hepatic venous pressure gradient measurements to guide primary prophylaxis has not been examined. Besides these, there is a definite role of somatostatin analogs and shunt surgeries in the treatment of portal hypertension and its complications. This book is designed to update the reader on all such issues related to diagnosis, treatment and complications of portal hypertension along with supportive typical case scenarios. Thus it provides an excellent opportunity to widen one’s perspective in this area.
Author: Sheila Glennis Haworth Publisher: Elsevier Health Sciences ISBN: 8131231763 Category : Medical Languages : en Pages : 182
Book Description
Pulmonary hypertension is defined as a mean pulmonary artery pressure (mPAP) ≥25 mmHg, with Pulmonary Capillary Wedge Pressure ≤ 15 mmHg, measured by cardiac catheterization. The etiology of PH has a varied spectrum extending right from Drugs, toxins and portal hypertension to HIV, Collagen Vascular Diseases and Persistent Pulmonary Hypertension of Newborn, etc. The estimation of disease prevalence has been nearly impossible owing to the geographic distribution and economic diversity, along with significant regional variations in human development and healthcare infrastructure. A large number of patients with PH never reach the health centers capable of diagnosing the disease condition correctly. Advance pulmonary vascular disease as a result of uncorrected CHD is a major health challenge in the developing world. PH exists as a major component of many forms of cardiac and pulmonary disease. While breathlessness is the most common feature of PH, patients often also present with chest pain, syncope, fatigue, weakness and abdominal distension. The precordial signs include a right ventricular lift, accentuated pulmonary component of S2, a pansystolic murmur of Tricuspid regurgitation, a diastolic murmur of pulmonary regurgitation and a right ventricular S3. The standard diagnostic workup in developed countries includes a series of investigations to rule out the secondary causes. Additional tests are required to estimate the disease severity and plan the appropriate treatment. These include the cardiac catheterization, selective pulmonary angiography by direct injection of pulmonary arteries, high resolution CT scan, cardiac magnetic resonance, ABGs, nocturnal O2 saturation, etc. While most of the basic management is feasible in the Indian conditions, most of the newly introduced drugs are either not available or are available at costs that far exceed the paying capacity of an average citizen of a developing economy. An underdeveloped health insurance system adds further to the financial burden of the treatment. Measures like formulation of guidelines for diagnosis and treatment of PAH, educating clinicians and scientists and making medications affordable to poor patients might ensue a breakthrough in the overall management of pulmonary hypertension.
Author: Arun J. Sanyal Publisher: Springer Science & Business Media ISBN: 1592598854 Category : Medical Languages : en Pages : 538
Book Description
A cutting-edge review of the latest findings on key scientific topics and the best strategies for evaluation and management of portal hypertension in the clinic. Writing in an easy-to-read style, the authors review its pathobiology, the progress being made in its experimental understanding, the methodologies to assess it in humans, the treatment of its complications (esophageal varices, ascites, and hepatorenal syndrome), and its treatment in special circumstances (during pregnancy, in children, or when the portal vein is blocked). They also provide in-depth coverage of the pros and cons of the various therapeutic choices available to the clinician managing patients with complicated portal hypertension.
Author: Prabha Sawant Publisher: Elsevier Health Sciences ISBN: 8131231836 Category : Medical Languages : en Pages : 104
Book Description
Hepatic encephalopathy is the clinical syndrome resulting from increased ammonia levels in blood. The most common cause of HE is chronic liver disease. However, acute liver failure, Reye’s syndrome, or metabolic defects are other causes. The true prevalence of overt HE is difficult to establish because of the considerable heterogeneity in etiology and disease severity. However, HE has been reported to be present in around 50% of patients with cirrhosis or with porto-caval shunts at some time during their illness. It is less common in patients with portosystemic shunts without liver disease. Thirty percent of patients dying of end-stage liver disease experience significant encephalopathy, approaching coma. After TIPS placement, approximately 1/3 of patients will experience overt HE. Minimal HE (MHE) is difficult to diagnose due to lack of standard diagnostic tests. Its clinical significance with regards to progression to overt encephalopathy has however, not been established. Conventional treatment of hepatic encephalopathy relies primarily on reducing the production and absorption of ammonia. Identification and correction of the precipitating factors and general supportive measures are important management steps. There are very few randomized controlled trials (RCT) of therapies and even these are bugged by lack of a control group and small sample sizes.
Author: Pramod Kumar Garg Publisher: Elsevier Health Sciences ISBN: 8131231887 Category : Medical Languages : en Pages : 222
Book Description
Chronic pancreatitis (CP) is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis, areas of focal necrosis are typically associated with perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, and by the development of pseudocysts. Late in the course of the disease a progressive loss of endocrine and exocrine function occurs. In the past, chronic pancreatitis was considered to be mostly associated with chronic alcohol abuse. During the past 2 decades idiopathic chronic pancreatitis and, moreover, hereditary pancreatitis have been recognized as distinct disease entities. Usually the diagnosis is made by a combination of imaging procedures such as ultrasound and endoscopic retrograde cholangiopancreatography, and exocrine and endocrine function tests. Therapy is presently restricted to symptom control for the lack of a causal treatment strategy. Thirty to sixty percent of all patients develop disease-associated complications such as persistent pain, strictures of the common bile duct, or pancreatic duct stones that may require either endoscopic or surgical treatment. Chronic pancreatitis is a difficult condition to live with as well as to treat. Optimal care needs to be carried out in a multidisciplinary environment that can address both the physical and psychological aspects of the disease. It is commonly seen in alcohol-dependent individuals, but many other groups of individuals suffer with irreversible inflammatory destruction of the pancreas. Abdominal pain is the predominant feature and pain specialists are an important part of any pancreatic team. Exocrine and endocrine failure are addressed by appropriate nutrition with supplements and insulin, whilst the complications that are seen over time, may require a combination of endoscopic and surgical treatment. This clinical update has been designed to update the readers on the important aspects of CP. The book has stressed upon various aspects of the condition like the etiology, pathogenesis, diagnosis and evaluation along with an insight into the management approach of the patient. Supportive case scenarios have also been incorporated with relevance to the topics covered under the book. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.
Author: Gourdas Choudhuri Publisher: Elsevier Health Sciences ISBN: 8131231852 Category : Medical Languages : en Pages : 118
Book Description
Carcinoma gallbladder is the third most common GI malignancy and the most common biliary tract malignancy in North India. Of all the known risk factors, gallstones are most commonly associated with GBC. Bile stasis and chronic inflammation along with occupational exposure to heavy metals, dietary carcinogens, and radiation exposure have been found to be responsible for the increased incidence of GB neoplasms. Infections with S. typhii and S. paratyphii along with Helicobacter sp. have also been associated with GBC. p 53 and ras gene mutations are strongly associated with GBC. Early diagnosis of GBC still remains a challenge and is often diagnosed as a part of investigations of any other disease. Most GBCs are at advanced stage at presentation. USG and CT scan are the common modes for the preliminary diagnosis of GBC. Surgery remains the key treatment modality and the only hope for long-term survival. A large number of patients present at the unresectable stage of the tumor, and palliation remains the only alternative to ensure better quality of life.
Author: Sudeep Khanna Publisher: Elsevier Health Sciences ISBN: 8131231909 Category : Medical Languages : en Pages : 142
Book Description
Non-alcoholic fatty liver disease is a common cause of chronic liver disease, and its incidence is rising worldwide. Understanding its pathogenesis, biochemical parameters, histological grading and staging, and its management is a vital issue in today’s clinical practice. It appears to be linked directly to the growing epidemic of obesity in adults as well as in children. Thus, in a sense, NAFLD is a self-inflicted liver disease, much like alcoholic liver disease. The exact causes responsible for the development of NAFLD have not been established yet. However, some researchers consider that cluster of disorders that increases the risk of developing heart disease, diabetes, and stroke may be the factor behind development of NAFLD. Most patients with NAFLD have no symptoms or signs of liver disease at the time of diagnosis. In these patients, abnormal liver function tests are often discovered incidentally. Non-alcoholic steatohepatitis (NASH) is that stage of the spectrum that involves fat accumulation (steatosis), inflammation (hepatitis), and scarring (fibrosis) in the liver. Those who have fatty liver or hepatic steatosis with non-specific inflammation as fatty liver with non-specific inflammation generally have a benign longterm prognosis, whereas those who have NASH can progress to cirrhosis. NASH-related cirrhosis may have similar prognosis as cirrhosis from other causes. Hepatocellular carcinoma (HCC) is part of the spectrum of NAFLD, and screening for HCC seems reasonable in patients who have NASH-related cirrhosis. No established treatment is available for NAFLD. Some empiric treatment strategies have been suggested. Presumably, weight loss through exercise and diet modification along with insulinsensitizing agents will help reverse fatty infiltration of the liver. Its incidence is reportedly on the rise the world over as well as in India. Realizing its significance, there is now greater understanding of its etiology, pathogenesis, and management. The efforts of Elsevier have been directed toward addressing these aspects. Elsevier has thus pooled its existing resources with those of the internationally acclaimed Gastroenterologists of India who have chosen to share their rich clinical knowledge, experience, and expertize to serve the practitioners and patient community.
Author: Abraham Koshy
Author: Abraham Koshy
Author: Sheila Glennis Haworth
Author: Arun J. Sanyal
Author: Deepak Amarapurkar
Author: Abraham
Author: Prabha Sawant
Author: Pramod Kumar Garg
Author: Peush Sahni
Author: Gourdas Choudhuri
Author: Sudeep Khanna