Ascites, Hyponatremia, and Hepatorenal Syndrome: Progress in Treatment (Frontiers of Gastrointestinal Research)

Contents......Page 6
Preface......Page 8
Clinical Work-Up and Problems
......Page 10
Diagnostic Paracentesis and Ascitic Fluid Analysis......Page 12
Diagnostic Tests for Ascites......Page 13
Some Common Causes of Ascites......Page 16
Novel Aspects and Future Developments......Page 17
References......Page 18
Abstract......Page 20
Aldosterone Antagonists......Page 21
Other ‘Potassium-Sparing’ Diuretics
......Page 24
Loop Diuretics......Page 25
Diuretic Treatment Strategies in Decompensated Cirrhosis......Page 26
References......Page 30
Nomenclature Used in Assessment of Ascites......Page 32
Contraindications......Page 33
Paracentesis Techniques......Page 34
Large-Volume Paracentesis
......Page 35
Ascitic Fluid Analysis......Page 36
Coagulopathy in Liver Disease......Page 37
Complications......Page 38
References......Page 39
Large-Volume Paracentesis in Clinical Practice
......Page 41
Rationale for Using Plasma Volume Expansion......Page 42
Evidence Supporting the Use of Albumin for Plasma Expansion......Page 43
References......Page 47
Abstract......Page 49
Albumin in Liver Disease......Page 50
Albumin in Non- Liver Disease......Page 55
Functional Characteristics in Liver Disease and Failure – Albumin Is Dysfunctional, Why?......Page 57
References......Page 58
Abstract......Page 61
Treatment of Ascites......Page 62
Prediction of Post- TIPS Survival......Page 64
Post-TIPS Quality of Life......Page 69
Post-TIPS Hepatic Encephalopathy......Page 70
References......Page 71
Definition and Clinical Importance......Page 74
Pathogenesis and Risk Factors......Page 75
Prophylaxis......Page 77
Therapy......Page 83
References......Page 87
Hyponatremia in Cirrhosis: Pathophysiology......Page 92
Prognostic Significance of Sodium in Cirrhosis and Liver Transplantation......Page 93
Hyponatremia in Cirrhosis: Treatment Options......Page 95
Should We Treat Cirrhotic Hyponatremia?......Page 96
References......Page 98
The Clinical Problem......Page 100
Recent Novel Therapeutic Agents for the Management of Ascites......Page 101
The Vaptans......Page 102
Vaptans in the Management of Hyponatremia in Cirrhosis......Page 105
Vaptans in the Management of Ascites in Cirrhosis......Page 106
Vaptans – the Risks......Page 107
The Future......Page 108
References......Page 109
Abstract......Page 111
Hepatic Decompensation and Hemodynamic Derangements in Cirrhosis......Page 112
Cardiac Dysfunction......Page 114
Cardiorenal Axis in Cirrhosis......Page 115
Conclusions and Future Developments......Page 118
References......Page 119
Abstract......Page 121
Acute Kidney Injury......Page 122
Chronic Kidney Disease......Page 124
Management of Acute Kidney Injury......Page 125
Conclusions......Page 128
References......Page 129
Hepatorenal Syndrome: Concept, Clinical Types and Diagnostic Caveats......Page 131
New Definition of Hepatorenal Syndrome......Page 135
Definition of Acute Kidney Injury in Cirrhosis......Page 136
References......Page 137
Epidemiology and Prognosis of Bacterial Infections and Associated Renal Failure in Cirrhosis......Page 139
Key Events for Development of Renal Dysfunction in Advanced Cirrhosis with Emphasis on Bacterial Infections and Pathological Bacterial Translocation......Page 141
Therapeutic Considerations for Bacterial Infections and Their Role for Development of Hepatorenal Syndrome......Page 145
Clinical Problems and Future Developments......Page 146
References......Page 147
Abstract......Page 151
Rationale for TIPS in HRS......Page 152
Results of TIPS in Patients with HRS......Page 153
Conclusions......Page 155
References......Page 156
Abstract......Page 158
Pathophysiological Bases of Pharmacological Therapy in Hepatorenal Syndrome......Page 159
Clinical Use of Vasoconstrictors in Hepatorenal Syndrome Type 1......Page 163
Clinical use of Vasoconstrictors in Hepatorenal Syndrome Type 2......Page 167
Conclusions......Page 168
References......Page 169
Rationale for the Use of Terlipressin for Type 1 HRS......Page 172
Summary of the Study Design......Page 173
Outcomes with Terlipressin Treatment......Page 174
Impact on Renal Function......Page 175
Time Course of Changes in Renal Function......Page 176
Factors Predictive of Response to Terlipressin......Page 177
Conclusion......Page 178
References......Page 179
Abstract......Page 181
Predictors of Response......Page 182
References......Page 186
Abstract......Page 187
Adverse Events Reported in Trials on the Hepatorenal Syndrome......Page 188
Cardiac and Pulmonary Adverse Events......Page 191
Skin Ischemia......Page 192
Gastrointestinal Adverse Events......Page 193
Contraindications to Terlipressin and Prevention of Side Effects......Page 194
Dealing with Side Effects......Page 195
References......Page 196
Novel Strategies......Page 198
Future Perspectives......Page 202
Conclusions......Page 203
References......Page 204
Abstract......Page 207
References......Page 214
Author Index......Page 217
Subject Index......Page 218