Bacterial infection is frequently diagnosed in cirrhotic patients with variceal hemorrhage. The aim of this study was to assess the incidence failure control bleeding during first 5 days after episode relation diagnosis bacterial and use antibiotics. One hundred seventy-seven consecutive admissions for gastrointestinal 151 were evaluated prospectively. From them, 163 137 included main analysis. Bleeding managed a standardized protocol using octreotide or terlipressin sclerotherapy band...

Creation of a transjugular intrahepatic portasystemic stent shunt (TIPSS) was used as rescue treatment for patients with variceal bleeding refractory to standard medical and endoscopic treatment. Over 2-year period 242 episodes were treated emergency shunting performed on 20 uncontrolled (Pugh grade A, one; B, seven; C, 12). The procedure technically successful controlled in all patients. Six had early rebleeding within 5 days, further required two. Two late related occlusion TIPSS followed...

Routine coagulation tests do not necessarily reflect haemostasis in vivo cirrhotic patients, particularly those who have bleeding varices. Thrombelastography (TEG) can provide a global assessment of haemostatic function from initial clot formation to dissolution.To evaluate TEG changes patients with variceal and their association early rebleeding.Twenty active had serial routine daily for seven days. The variables before the day rebleeding (n = 6) were compared without 14).Baseline...

To identify the limitations in palliative care provision last year of life for people with liver cirrhosis and potential barriers to enablers care.Mixed methods, including a retrospective case note review, qualitative focus groups individual interviews.A tertiary referral centre south England (UK).Purposively selected notes 30 who attended died during an 18-month period; purposive sample 22 health professionals participated either or interviews.Data collected from included hospital...

Height of portal pressure correlates with severity alcoholic cirrhosis. Portal indices are not however used routinely as predictors survival.To examine the clinical value a single measurement in predicting outcome cirrhotic patients who have bled.A series 105 consecutively underwent hepatic venous were investigated. The main cause cirrhosis was (64.8%) and prior to admission all had bled from varices.During follow up period (median 566 days, range 10-2555), 33 died, 54 developed variceal...

The aim of this study was to determine the effects long-acting somatostatin analog, octreotide, on portal venous pressure and collateral blood flow in cirrhotic patients with hypertension during fasting postprandial states. In a double-blind, placebo-controlled study, we investigated octreotide hepatic pressures azygos 21 before after standard liquid meal containing 40 gm protein 250 ml. Octreotide significantly reduced from mean 499 +/- 65 ml/min 355 47 (p < 0.01), but it had no effect...

To determine the knowledge and practice patterns of a UK cohort relevant healthcare professionals (HCPs) about delivering palliative care in cirrhosis, to inform priorities for future research.An on-line questionnaire survey with closed open responses.HCPs identified from mailing list special interest groups hepatology gastroenterology (liver), general specialist (SPC) across UK.Of 6181 potential contacts identified, 517 HCPs responded. Most believed role exists SPC caring people but many...

Octreotide is thought to reduce splanchnic and variceal blood flow with minimal effects on the systemic circulation in cirrhotic patients portal hypertension. However, we noticed significant bradycardia some immediately after administration of bolus doses octreotide. Therefore, investigated effect intravenous octreotide hemodynamics 59 cirrhosis. In two double-blind, placebo-controlled protocols, 32 received a 25-micrograms 20 an infusion 50-micrograms/hr octreotide/placebo. Immediately dose...

Gerontologists are increasingly interested in the notion of perceived personal control because such perceptions can be threatened by age-related changes as declining health and loss loved ones. Although a great deal is known about central role healthy, successful aging, less its potential specific contexts use services. Our study examined link between patterns service among older individuals with arthritis. We assessed during an interview, using both domain-specific global measure,...

Aminoglycosides are frequently used to treat sepsis in patients with liver disease. However, it has been suggested that cirrhotic particularly sensitive aminoglycoside-induced renal dysfunction. We investigated the efficacy and incidence of impairment netilmicin plus mezlocillin compared ceftazidime 128 who required empirical treatment for sepsis. Renal developed 8 63 (13%) receiving 2 65 (3%) ( P &lt; .05); occurred despite regular monitoring trough levels. was present at time death 1 13...

It is not clear which therapy should be used in patients with bleeding esophageal varices that are controlled by emergency sclerotherapy. This a high-risk group reported mortality rates of between 70% and 90%. We report our 7-yr experience staple transection the esophagus this patient group. Of 168 (280 episodes) treated sclerotherapy, 22 had for failure to control bleeding. Bleeding was 20 (90%), 10 (45%) survived leave hospital, including 4 (40%) Pugh grade C liver disease. suggest an...

Changes in mucosal blood flow may be important the pathogenesis of many conditions. Study perfusion is difficult, and available methods have significant technical limitations. This study describes development an instrument for endoscopy, which indicates indirectly, by measuring quantity tissue oxygen that can diffuse from mucosa to a luminal surface electrode. The was used through endoscope patients with portal hypertension (n = 14), scleroderma 3), disease controls 7), normal 11). In...

Introduction Liver disease is the third largest cause of death in UK people under age 65. With predicted increases alcohol consumption, viral hepatitis and obesity, it anticipated that economic burden on healthcare system will continue to rise. Aim(s) method(s) To evaluate costs hospital admissions for patients with end-stage liver over 12 months prior obtained from records case-note audit. The analysis includes all incurred during admission, such as bed board, nursing, specialist...

Background and Aims: Liver health professionals have difficulty discussing liver cirrhosis its prognosis with patients families. Question Prompt Lists (QPLs), which are evidence-based lists of “recommended questions,” may improve communication but need to be designed specifically for the target population. This study aimed develop pilot a QPL cirrhosis. Methods: A mixed-methods design in 3 phases. In phase 1 (item generation), potential questions inclusion were identified from sources—a...

People with cirrhosis are encouraged to participate in shared decision-making their doctors, but studies suggest that doctors limit the amount of information is shared. In this study we explore presence medical power clinical encounters 2015 from a patient perspective and highlight its effects on healthcare interactions.Qualitative semi-structured interviews were conducted ten people attending tertiary liver transplant centre southern England. We explored understanding disease prognosis,...

Background: Bleeding from oesophageal varices is an uncommon but potentially fatal condition that often leads to expensive hospitalizations in intensive care or high-dependency units. Methods: To assess the clinical and economic impact of this condition, we have devised a management plan illustrating current practice UK. Results: Approximately £6.1 million NHS resources are devoted treatment 3000 acute hospital admissions for variceal bleeding every year. Vasoconstrictors like vasopressin...