Dr Nancy Reau speaks with Dr David Kaplan, lead author of the most recent AASLD practice guidance, about new approaches to identifying and treating these common liver disease complications.
Professor, Department of Internal Medicine, Rush University; Richard B.
Imaging itself may confirm PH if one sees evidence such as periesophageal varices, hepatofugal flow in the portal vein, or a recanalized umbilical vein. based on large validation studies. However, we endeavored to make it clear that the guidance could be updated once alternative modalities for identifying clinically significant PH, such as magnetic resonance elastography, two-dimensional shear wave elastography, or point shear wave elastography, were better validated.
Due to prolonged half-life in cirrhosis, carvedilol can also be dosed once daily, preferably at night. When varices bleed and blood volume decreases, portal pressure decreases and variceal bleeding tends to attenuate. Overly aggressive resuscitation drives portal pressure back up and precipitates rebleeding. showed superior outcomes for conservative transfusion for Child-Pugh class A and B patients and equivalent outcomes for Child-Pugh class C. Patients who rebleed after initial hemostasis or fail initial hemostasis are going to die of hemorrhage without TIPS — this is salvage TIPS.
My experience is that non-hepatologists are deathly afraid of varices. There is an unfounded fear that placing a feeding tube or performing a transesophagealAn endoscope with a banding cap is much bigger than a Dobhoff tube, and we manipulate the scope up and down the esophagus when we are banding. A well-placed band will not be dislodged. Furthermore, transmural pressure causes bleeding from varices, not feeding tubes.
Gallbladder Disease Nonalcoholic Fatty Liver Disease NAFLD Non-Alcoholic Fatty Liver Disease Non-Alcoholic Fatty Liver Disease (NAFLD) MAFLD Metabolic Dysfunction-Associated Fatty Liver Dise Metabolic Associated Fatty Liver Disease Liver Disease Hepatic Impairment Varices Liver Variceal Bleeding Variceal Hemorrhage Hemorrhage Bleeding Hypertension
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