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Evaluation and management of emergencies in the patient with cirrhosis. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2022; 87:198-215. [PMID: 35570104 DOI: 10.1016/j.rgmxen.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/28/2021] [Indexed: 01/10/2023] Open
Abstract
The approach to and management of critically ill patients is one of the most versatile themes in emergency medicine. Patients with cirrhosis of the liver have characteristics that are inherent to their disease that can condition modification in acute emergency treatment. Pathophysiologic changes that occur in cirrhosis merit the implementation of an analysis as to whether the overall management of a critically ill patient can generally be applied to patients with cirrhosis of the liver or if they should be treated in a special manner. Through a review of the medical literature, the available information was examined, and the evidence found on the special management required by those patients was narratively synthesized, selecting the most representative decompensations within chronic disease that require emergency treatment.
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Eken H, Cimen O, Cimen FK, Kurnaz E, Yildirim M, Tasova V, Kurt N, Pehlivanoglu K, Onk D, Bilgin AO. Effect of taxifolin on oxidative gastric injury induced by celiac artery ligation in rats. Acta Cir Bras 2019; 34:e201900404. [PMID: 31066786 PMCID: PMC6583928 DOI: 10.1590/s0102-865020190040000004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/12/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To examine the effect of taxifolin on I/R induced gastric injury in rats using biochemical and histopatholohical methods. METHODS Eighteen albino Wistar male rats equally grouped as; gastric I/R (I/R), 50 mg/kg taxifolin + gastric I/R (TAX+ I/R) and sham operation applied (SHAM). Ischemia induced for 1 hour, and reperfusion induced for 3 hours. RESULTS Oxidant parameters like, Malondialdehyde (MDA) and Hydroxyguanine (8-OHdG) were higher, whereas total glutathione (tGSH) was lower in the I/R group according to SHAM group, histopathological findings such as marked destruction, edema, and proliferated dilated congested blood vessels were observed severely in the I/R group, whereas there was not any pathological finding except mild dilated congested blood vessels in the TAX+ I/R group. CONCLUSION The taxifolin can be clinically beneficial in the treatment of gastric injury due to I/R procedure.
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Affiliation(s)
- Hüseyin Eken
- Assistant Professor, Department of General Surgery, Faculty of Medicine, Erzincan Binali Yildirim University, Turkey. Scientific, intellectual, conception and design of the study; manuscript preparation
| | - Orhan Cimen
- Assistant Professor, Department of General Surgery, Faculty of Medicine, Erzincan Binali Yildirim University, Turkey. Conception and design of the study, manuscript preparation
| | - Ferda Keskin Cimen
- Assistant Professor, Department of Pathology, Faculty of Medicine, Erzincan Binali Yildirim University, Turkey. Histopathological examinations, manuscript writing
| | - Eray Kurnaz
- MD, Department of General Surgery, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey. Technical procedures, manuscript preparation
| | - Murat Yildirim
- MD, Department of General Surgery, Zile State Hospital, Tokat, Turkey. Technical procedures, manuscript preparation
| | - Volkan Tasova
- MD, Department of General Surgery, Sabuncuoglu Serafettin Training and Research Hospital, Amasya University, Turkey. Technical procedures, manuscript preparation
| | - Nezahat Kurt
- PhD, Department of Biochemistry, Faculty of Medicine, Ataturk University, Erzurum, Turkey. Acquisition, analysis and interpretation of data; technical procedures
| | - Kamil Pehlivanoglu
- Assistant Professor, Department of General Surgery, Faculty of Medicine, Erzincan Binali Yildirim University, Turkey. Manuscript preparation
| | - Didem Onk
- Assistant Professor, Department of Anesthesiology and Reanimation, Faculty of Medicine, Erzincan Binali Yildirim University, Turkey. Technical procedures, critical revision
| | - Asli Ozbek Bilgin
- Assistant Professor, Department of Pharmacology, Faculty of Medicine, Erzincan Binali Yildirim University, Turkey. Statistics analysis, manuscript writing, critical revision, final approval
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Wildman-Tobriner B, Enslow MS, Nelson RC. Hepatic Heterogeneity and Attenuation on Contrast-Enhanced CT in Patients With the Hypovolemic Shock Complex: Objective Classification Using a Contemporary Cohort. Curr Probl Diagn Radiol 2019; 48:224-228. [PMID: 29548724 DOI: 10.1067/j.cpradiol.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/03/2018] [Accepted: 02/08/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE When objectively measured on computed tomography (CT), does hepatic heterogeneity or overall liver attenuation predict the presence of shock? METHODS This retrospective study included 73 patients (mean age 33 years) with the hypoperfusion shock complex (HSC) on CT (cases) and 100 patients (mean age 43 years) with negative trauma CT scans (controls). Liver heterogeneity was calculated by using consistently sized regions of interest (ROIs) to measure the 2 highest and the 2 lowest areas of hepatic density (in Hounsfield units [HU]). The difference between the means of the 2 highest and 2 lowest ROIs was considered the heterogeneity. Attenuation was calculated using the mean of 3 randomly placed ROIs. Both heterogeneity and attenuation were then compared between cases and controls. RESULTS Median hepatic heterogeneity was 16.8 HU (IQR: 10.7-23.4) for the HSC group and 9.0 HU (IQR: 7.0-10.4) for the controls (P < 0.001). The area under the curve was 0.79, and a threshold of 30 HU yielded a specificity of 100%. Median hepatic attenuation was not significantly different between the HSC and the control groups, with an area under the curve of 0.56. CONCLUSIONS Increased hepatic heterogeneity may represent an objective marker of the HSC that performs in a similar manner to other established signs. By comparison, overall hepatic hypoattenuation is a poor indicator of the HSC.
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Affiliation(s)
| | - Michael S Enslow
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Rendon C Nelson
- Department of Radiology, Duke University Medical Center, Durham, NC
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Enslow MS, Preece SR, Wildman-Tobriner B, Enslow RA, Mazurowski M, Nelson RC. Splenic contraction: a new member of the hypovolemic shock complex. Abdom Radiol (NY) 2018; 43:2375-2383. [PMID: 29460045 DOI: 10.1007/s00261-018-1478-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The objective of the article is to assess changes in splenic volume in the setting of hypovolemic shock; splenic enhancement in hypovolemic shock is also assessed. MATERIALS/METHODS 71 consecutive adult patients with the hypovolemic shock complex on computed tomography (CT) were identified. Spleen volume and enhancement were compared to a baseline CT scan (without shock) or to height- and sex-corrected normal values and a control population when a comparison CT was unavailable. RESULTS Splenic volume was significantly lower in the setting of shock. Average splenic volume in adult patients with shock was 107 ± 63 cm3 compared to 220 ± 164 cm3 in the control population (P < 0.001). All shock patients with a comparison CT (n = 35) had decreased splenic volume in the setting of shock. The area under the receiver operating characteristic (ROC) curve for spleen volume predicting shock was 0.83. Splenic enhancement was also significantly lower in the setting of shock. Mean splenic attenuation value in our shock population was 105 ± 34 HU compared to 134 ± 25 HU in the control population (P < 0.001). Decreased splenic enhancement was present in 25 of 71 shock patients and in none of the control patients (P < 0.001). CONCLUSION Decreased splenic volume is a ubiquitous and reliable sign of hypovolemic shock and should be considered a member of the hypovolemic shock complex. It is of particular utility when a prior study is available. Splenic hypoenhancement has high specificity and a high positive predictive value for hypovolemic shock in the correct patient population.
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Gestalt for shock and mortality in the emergency department: A prospective study. Am J Emerg Med 2018; 36:988-992. [DOI: 10.1016/j.ajem.2017.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 10/29/2017] [Accepted: 11/02/2017] [Indexed: 12/26/2022] Open
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