Interventional radiologist Josef Rosch is recognized as the creator of the TIPS procedure. In 1969, while performing transjugular cholangiography, he inadvertently initiated the approach.1 Transjugular cholangiography is a procedure where a catheter is introduced into the jugular vein and advanced through the superior vena cava, the right atrium and directed into the hepatic vein. Using the catheter, a needle is then introduced through the hepatic vein, into the liver and passed into the bile ducts. The goal is to administer contrast into the biliary system to evaluate it. This method was believed to be safer for the patient than puncturing the liver capsule because patients often experienced bleeding, ascites and obstructive jaundice …show more content…
The idea of shunting the portal system was born and currently is used to treat portal hypertension, ascites and variceal hemorrhage.2
Anatomy and physiology Normal liver vascularity includes the portal vein transporting blood into the liver along with the hepatic artery. The portal vein is responsible for supplying about two-thirds of the blood volume to the liver.3 In the diseased liver, often the blood flow into the liver is compromised due to fibrotic changes. The resistance in the liver increases which then increases the portal flow resistance. Over a period of time, the portal circulation is altered and portal hypertension occurs. The resulting effects are debilitating and progressive. Portal hypertension creates a process where blood is shunted away from the
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“Ascites is the most common major complication of cirrhosis and is associated with a poor quality of life, increased risks of infections, renal failure and a poor long-term outcome.”7 Ascites is primarily triggered by vasodilatation of the splanchnic arteries. Portal hypertension initiates the release of nitric oxide, a vasodilator. As the vasodilator acts, the arterial pressure and blood volume decrease dramatically. This then triggers the release of vasoconstrictors that will raise the arterial pressure again, the simple homeostatic response of the body. This vasoconstriction results in sodium and fluid retention. Excessive fluid is retained in the abdominal cavity and this is referred to as
...h a type of surgery called Cholecystectomy. The Non-Surgical approaches are used only in specific situations such as when a patient’s condition prevents using an anesthetic. In such cases, Oral dissolution therapy is used.
They can be enumerated as difficult entry to the right hypochondrium owing to the adhesions, difficulty in exposure can also arise due to diseased gallbladder and Liver ,acutely inflamed and tense gallbladder ,gallbladder packed with stones ,thick walled gallbladder ,fibrotic gallbladder ,gallbladder mass and abnormality can also arise due to anomalous anatomy of hepatobiliary system like situs inversus, malposition of the gallbladder, arterial anomalies and short cystic duct, a huge stone impacted in the cystic duct, Hartmann’s pouch adherent to the common hepatic duct and anomalous insertion of the cystic duct.
Out of 22 patients 15 had multiple stone removal less than 1 cm, On the other hand out of the 7 patients with stone more than 1cm. Balloon dilation of biliary sphincter (n=28) in most of the patient Dilatation caliber (9*12)-(10*12) mm, Biliary stent placement isn made of plastic caliber ranging from 10-French 5-cm to 9-French 7-cm in 45 ERCP.
Upper gastrointestinal bleeding originates in the first part of the GIT, affecting the esophagus, stomach or duodenum. The symptoms of upper GI bleeding are hematemesis, coffee ground vomiting, melena, hematochezia (maroon coloured stool) if the hemorrhage is severe, severe syncope, chest pain, shortness of breath and anemia. Esophageal varices, esophagitis, Mallory-Weiss tears, esophageal ulcers or even esophageal cancers may cause esophageal bleeding. Esophageal varices are defined as extremely dilated and tortuous sub-mucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly secondary to liver cirrhosis. They are asymptomatic until they rupture leading to massive hemorrhage. Half of the cases of the rupture may subside spontaneously but however 20-30% die during the first attack. Treatments to stop bleeding due to this case include using elastic bands to tie off bleed...
Characterized by progressive tissue injury and scarring, cirrhosis is among the leading causes of chronic liver failure in the United States. Recent research conducted by the National Institutes of Health indicated that the prevalence of cirrhosis, especially in clients diagnosed with Hepatitis C, has increased steadily throughout the past decade and will likely continue to increase in the future (Kanwal et al., 2011). Caused by recurrent tissue damage and inflammation, cirrhosis occurs as healthy hepatocytes (liver cells) are replaced by fibrotic and non-functional scar tissue through natural healing processes. Although liver tissue is normally very resilient, sustained injury eventually outpaces restorative capacity and a majority of functional tissue is replaced with collagenous tissue and liver failure occurs. In the United States, cirrhosis is most commonly caused by Hepatitis C, alcoholism, fatty liver disease, and biliary obstruction (Kanwal et al., 2011). Due to the increase in prevalence and the seriousness of the condition, cirrhosis represents a significant healthcare issue. The treatment and care of clients diagnosed with cirrhosis is complex. The following information addresses several of the major aspects of nursing care associated with the treatment of clients diagnosed with cirrhosis. Additionally, current studies regarding the treatment of cirrhosis will be evaluated in an effort to assess their readiness to be incorporated into current evidenced-based nursing practice.
Moreover, I will let the patient become familiar with any instruments such as a speculum, and demonstrate the tools that will be used to obtain tissue samples that would be used during the examination. Explaining the procedure is also a significant step; this will allow the patient have a sense of control during the examination as we ask and answer questions about their current state, that would help disseminate any concern they may have. Meanwhile, they can learn about what may happen, related to any body sensations or feelings they can experience during the procedure, all while the provider continues to develop rapport and patient’s trust
The Hepatitis A Virus affects many different systems within the body. The first being the digestive system and the gastrointestinal system because Hepatitis A causes an acute liver infection. The liver’s job is to process nutrients, filter the blood and toxin from your body, and fight infections. It produces important blood components, proteins, and bile which helps you digest food. The liver also stores glucose and vitamins. The Hepatitis A Virus causes inflammation that interrupts the liver’s ability to perform these vital functions. Having a healthy liver is crucial to your health because it supports many other body systems. For example, one function of the liver is to produce bile which is needed to break down fats. The body stores bile in the gallbladder and then sends it to the beginning section of the small intestine. Bile is then combined with other digestive
The sonographic appearance varies depending on of the Hepatitis is acute or chronic. In acute hepatitis you will see a normal texture or portal veins will be more prominent. The liver appears hypoechoic. Attenuation might be present in acute Hepatitis. Gallbladder walls are thickened and hepatosplenomegaly. In chronic Hepatitis the parenchyma will appear coarsed with decreased brightness of the portal triad. Attentuaion is not as great in chronic Hepatitis. Fibrosis may occur with soft shadowing. The size of the liver is decreased and appears hyperechoic.
Liver disease resulting from alcohol affects more than two million Americans and is one of the primary causes of illness and death. The liver frees the body of harmful substances, such as alcohol. While the liver breaks down alcohol, it produces toxins that can be even more dangerous than the alcohol consumed (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 13). “These by-products damage liver cells, promote inflammation, and weaken the body’s natural defenses. Eventually, these problems can disrupt the body’s metabolism and impair the function of other organs” (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 13). A condition called steatosis is the result of fat build up in the liver and is the earliest stage of alcoholic liver disease. This condition causes the liver difficulty breaking down alcohol, potentially resulting in alcoholic hepatitis. Fibrosis of the liver, which is also related to heavy drinking, causes scar tissue to build up in the liver. The alcohol alters chemicals that the liver needs to break down this scar tissue, causing liver dysfunctions. If one does not refrain from drinking during the condition of fibrosis, the scar tissue can build up and create another condition, called cirrhosis. Cirrhosis is deterioration of the liver resulting from heavy scarring, causing the liver to not be able to function properly. If cirrhosis becomes severe, a liver transplant may be the only solution (“Beyond Hangovers: Understanding Alcohol's Impact Your Health” 14). It is difficult to calculate when a person would develop cirrhosis, because an alcoholic could never develop the disease, but someone who social drinks could. It is also unknown why cirrhosis is more prevalent in women (...
Blackwell, Wiley. "Alcoholic Cirrhosis Patients Had High Prevalence of Complications at Diagnosis." ScienceDaily. ScienceDaily LLC, Apr. 27,2010. Web. 4 Nov 2011. .
Results: There were 76 males (62.3%) and 46females (37.7%) with a mean age of 54.4 ± 23.7 days. The most common clinical finding was Jaundice that was seen in all patients (100%) .The onset of jaundice was the first day to the fifty two days of age, with an average age of 15.6 ± 16.1 days. Other findings included hepatomegaly in 92 patients (76.4%), claycolor stool in 54 (44.3%), and splenomegaly in 29 patients (23.8%). In this study, the most common causes of cholestasis were biliary atresia (30=24.6%), idiopathic neonatal hepatitis (30= 24.6%) and bile ducts paucity (16=10.3) .
Gaby, A. (2009). Nutritional approaches to prevention and treatment of gallstones. Alternative Medicine Review, 14(3), 258-267.
The liver plays central role in each of these phases of clotting process, as it synthesizes the majority of coagulation factors and proteins involved in fibrinolysis as well as thrombopoietin., which is responsible for platelet production from megakaryocytes. In cirrhosis, liver is badly get damaged. So the production of coagulation factors and proteins is impaired. Many pathological processes associated with cirrhosis, such as portal hypertension and endothelial dysfunction as well as co-morbid conditions, may also alter the coagulation process. Consequently, patients with liver disease as in cirrhosis, have a disturbed balance of procoagulant and anti- coagulant factors which deviates from the normal coagulation cascade.
This is the inflammation of the liver. The hepatitis virus is a major cause of hepatitis in humans. However, the condition can be induced by various infections and medical conditions, such as excess intake of alcohol, medications, toxins, and autoimmune disease. There are five types of hepatitis virus which include: hepatitis A, hepatitis B, hepatitis C, hepatitis D, hepatitis E. (“Hepatitis | NIH: National Institute of Allergy and Infectious Diseases,” 2015)
... that sodium ingestion (especially high contents) passes through extracellular compartments including the vascular system before getting eliminated by the kidneys. An acute increase of plasma sodium concentration can alter the mechanical properties of vascular endothelium, as long as aldosterone is present. Aldosterone not only plays a major role in adjusting sodium and potassium transport in kidneys but also on the cardiovascular system. Sodium accumulates in extracellular space when the kidneys cannot adequately adjust salt excretion to salt uptake and/or when the concentration of aldosterone is raised, leading to an increase in plasma sodium concentration. An important finding in these studies was the observed effects of amiloride, which acted to block sodium channels and prevented an increase in stiffness by reversing the increasing in cell volume and pressure.