By Ian Beckingham
Queen's clinical Centre, Nottingham, united kingdom. presents an outline of the ailments of the liver, pancreas, and gall bladder. For citizens, clinical scholars, and common practitioners. Covers universal and infrequent stipulations and comprises algorithms for prognosis and therapy. colour illustrations. Softcover.
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Extra resources for ABC of liver, pancreas and gall bladder
8 Hypertensive portal gastropathy 21 7 Portal hypertension—2. Ascites, encephalopathy, and other conditions J E J Krige, I J Beckingham Ascites Ascites is caused by cirrhosis in 75% of cases, malignancy in 10%, and cardiac failure in 5%; other causes account for the remaining 10%. In most patients the history and examination will give valuable clues to the cause of the ascites—for example, signs of chronic liver disease, evidence of cardiac failure, or a pelvic mass. The formation of ascites in cirrhosis is due to a combination of abnormalities in both renal function and portal and splanchnic circulation.
The combination of gastrointestinal haemorrhage and hepatic encephalopathy indicates a poor prognosis. A small proportion of cases are precipitated by excess dietary protein, hypokalaemic alkalosis, constipation, and deterioration of liver function secondary to drugs, toxins, viruses, or hepatocellular carcinoma. The treatment of hepatic encephalopathy is empirical and relies largely on establishing the correct diagnosis, identifying and treating precipitating factors, emptying the bowels of blood, protein, and stool, attending to electrolyte and acid-base imbalance, and the selective use of benzodiazepine antagonists.
Despite intensive search, no effective drug has been developed to prevent the development of severe pancreatitis. Several new drugs including antagonists of platelet activating factor (Lexipafant) and free radical scavengers that may limit propagation of the cytokine cascade hold theoretical promise, but initial clinical trials have been disappointing. Patients who deteriorate despite maximum support pose a difficult management problem. The possibility of infection in the necrotic process should be considered, particularly when deterioration occurs after the first week.