1/188. Cirrhotic ascites, ovarian carcinoma, and CA-125.We describe two postmenopausal women with ascites and elevated CA-125 level, a serologic marker used to detect ovarian cancer. Both patients had unrecognized liver disease but underwent surgical exploration for suspected ovarian disease, which subsequently revealed benign pelvic organs. Elevated serum CA-125 levels have been reported in many patients with ascites due to liver disease and cirrhosis. Thus, the presence of both ascites and an elevated CA-125 level mandates a thorough elevation for liver disease as well as for a possibility of ovarian carcinoma. These cases outline the common finding and provide insight into the management of patients with ascites and elevated CA-125 values.- - - - - - - - - - ranking = 1keywords = ascites (Clic here for more details about this article) |
2/188. Markedly elevated CA125 in hepatic cirrhosis: two case illustrations and review of the literature.CA125 is the most widely used tumor marker presently available for use in patients with epithelial ovarian cancer. Although elevated in a high percentage of patients with ovarian cancer, serum CA125 levels have also been detected in patients with numerous benign and malignant nongynecologic disorders, including various diseases of the liver. Despite this well-publicized fact, it has become apparent that the association between CA125 elevation, particularly the degree of elevation, and liver disease may not be as widely recognized as one would suspect. When marked CA125 elevations occur, diagnostic confusion is common. We describe two cases illustrative of this point. Both cases involve middle-aged women who presented with massive ascites and due to markedly elevated serum CA125 levels underwent exploratory laparotomy with hysterectomy and/or bilateral salpingo-oopherectomy before their referral to our center. Because preservation of a woman's reproductive organs is a significant concern, it is imperative that both primary care physicians and specialists are aware of such associations and the proper use of tumor markers.- - - - - - - - - - ranking = 0.125keywords = ascites (Clic here for more details about this article) |
3/188. Refractory hepatic hydrothorax treated with transjugular intrahepatic portosystemic shunt.A 66-year-old cirrhotic woman was referred to our hospital for evaluation of refractory pleural effusion and dyspnea. Massive right sided-pleural effusion but no ascites was detected. She had been treated with diuretics and albumin, repeated thoracenteses, and pleural drainage with an intercostal catheter, all of which had failed to relieve her symptoms. The diagnosis of hepatic hydrothorax without ascites was made by injection of technetium-99m-sulfur colloid into the peritoneal cavity. A transjugular intrahepatic portosystemic shunt was placed and successfully reduced the pleural effusion, resulting in complete relief of her symptoms. The patient has been free of symptoms for 18 months after the procedure.- - - - - - - - - - ranking = 0.25keywords = ascites (Clic here for more details about this article) |
4/188. Cryptococcal peritonitis: report of a case and review of the literature.We describe a patient diagnosed with AIDS and cirrhosis who had recently suffered a self-limited and non-specific esophageal ulceration. After this, he was hospitalized because of an oral bleeding with fatal evolution, and cryptococcus neoformans was isolated from ascitic fluid during a routine paracenteses. We have reviewed the literature and, since 1963, only another 10 cases of cryptococcal peritonitis have been reported. A liver disease and not the AIDS (surprisingly, our case is the only report of cryptococcal peritonitis in a subject having both diseases) was the most common underlying disease (72.7%) and was associated with the worst prognosis (only one patient survived). An oral or upper gastrointestinal bleeding was the most common associated circumstance although recent steroid or antibiotic therapy has been also reported. Finally, diagnosis was delayed in many patients. The reasons for these delays are discussed.- - - - - - - - - - ranking = 0.32526901284118keywords = peritonitis (Clic here for more details about this article) |
5/188. A successful surgical repair of the hepatic hydrothorax using pneumoperitoneum: report of a case.A successful surgical repair of a right hepatic hydrothorax in the absence of ascites is reported. A technetium-99m scintigram that was injected intraperitoneally provided evidence of a one-way flow of fluid from the peritoneal to pleural cavity. To identify any possible minute defects in the diaphragm, carbon dioxide was insufflated into the peritoneal cavity during the operation. We performed a direct suture of the defect observed on the diaphragm. The pleural effusion subsequently vanished after the operation.- - - - - - - - - - ranking = 0.125keywords = ascites (Clic here for more details about this article) |
6/188. Wischnewski ulcers and acute pancreatitis in two hospitalized patients with cirrhosis, portal vein thrombosis, and hypothermia.Accidental hypothermia has been described in the forensic literature but reports of occurrence in hospitalized patients are rare. Associated anatomic lesions include acute hemorrhagic pancreatitis and characteristic acute gastric ulcers termed Wischnewski ulcers. We report here two patients with cirrhosis and ascites; one also had hepatocellular carcinoma. portal vein thrombosis, acute hemorrhagic pancreatitis and Wischnewski ulcers were present in both. The clinical records documented hypothermia that progressed over several days. temperature nadirs of 31.0 degrees C (87.8 degrees F) and 32.2 degrees C (90.0 degrees F) were recorded in each patient, respectively, one day before death, although each transiently reached temperatures that did not register on standard monitoring devices. This is the first report that chronicles antemortem body temperatures in hypothermic patients with Wischnewski ulcers and pancreatitis at autopsy. Also, the association of these findings with portal vein thrombosis and cirrhosis has not been previously described. We discuss this constellation of findings with regard to possible mechanistic interrelations.- - - - - - - - - - ranking = 0.125keywords = ascites (Clic here for more details about this article) |
7/188. laparoscopy extends the indications for liver resection in patients with cirrhosis.BACKGROUND: Clinical or biological evidence of liver failure is usually considered a contraindication to open liver surgery as it is associated with a prohibitive risk of postoperative death. methods: This report describes three patients who had resection of a superficial hepatocellular carcinoma suspected either to be ruptured, or at high risk of rupture, using the laparoscopic approach. All three patients had intractable ascites, in two superimposed on active hepatitis. Surgery was per- formed under continuous carbon dioxide pneumoperitoneum with intermittent clamping of the hepatic pedicle. RESULTS: Intraoperative blood loss was between 100 and 400 ml; no blood transfusion was required. The postoperative course was uneventful except for a transient leak of ascites through the trocar wounds. Duration of in-hospital stay was 6-10 days. liver function tests had returned to preoperative values within 1 month of surgery in all patients. CONCLUSION: The laparoscopic approach may enable liver resection in patients with cirrhosis and evidence of liver failure that would contraindicate open surgery.- - - - - - - - - - ranking = 0.25keywords = ascites (Clic here for more details about this article) |
8/188. Hepatic decompensation in patients with cirrhosis during infection with influenza A.BACKGROUND: patients with chronic liver disease can develop hepatic decompensation during systemic infections. Although gram-negative and gram-positive bacteria are well recognized as causes of decompensation, the effect of influenza virus infection on patients with chronic liver disease is poorly documented. methods: Retrospective analysis of patients with positive viral cultures who were seen at a liver transplantation clinic in a tertiary care referral center during the 1997-1998 influenza A (H3N2) epidemic in San Diego, Calif. RESULTS: Three patients with end-stage liver disease (1 with Wilson disease and 2 with alcoholic liver disease) developed hepatic decompensation and required hospitalization during infection with influenza A. Two patients had biochemical and clinical evidence of hepatic decompensation, including ascites, hepatic encephalopathy, and peripheral edema, and the third had acute hepatocellular damage, with elevated levels of aminotransferases. Viral hepatitis serologic test results, acetaminophen levels, drug and alcohol screening findings, and bacterial and fungal cultures were negative in all 3 patients. Hepatic decompensation resolved without the need for transplantation in the 2 patients with liver failure, and all patients recovered to their baseline liver function levels within 1 month of onset of acute illness. CONCLUSIONS: Influenza A infection can cause hepatic decompensation and hospitalization in patients having cirrhosis or who are awaiting liver transplantation. Effective prevention with vaccination and early recognition and treatment of influenza are strongly recommended in these individuals.- - - - - - - - - - ranking = 0.125keywords = ascites (Clic here for more details about this article) |
9/188. Delayed hemoperitoneum following large-volume paracentesis in a patient with cirrhosis and ascites.The diagnosis of early or late hemoperitoneum after large-volume paracentesis can be reached easily by a repeat tap, but gastrointestinal bleeding and other common causes of hypotension in cirrhotics must be ruled out first. When the hemoperitoneum is confirmed, imaging studies are often inconclusive and laparotomy should be considered when hemodynamic instability persists despite adequate fluid resuscitation. However, in instances of delayed hemoperitoneum, it must be anticipated that operation may not identify the bleeding site and result in further decompensation of the liver. OLT may well be the best therapeutic option in this rare, high-risk situation.- - - - - - - - - - ranking = 0.5keywords = ascites (Clic here for more details about this article) |
10/188. Transjugular intrahepatic portosystemic shunt for recurrent hepatic hydrothorax.For many years, pleural effusions have been recognized as a complication of cirrhosis, occurring in approximately 5.5% of patients. Recent studies have confirmed that small defects in the diaphragm allow for passage of ascitic fluid into the pleural space. Successful management of these patients is challenging, as many of the treatment options can be associated with increased morbidity. The initial treatment should focus on eliminating and preventing the recurrence of ascites with diuretics and water and salt restriction. For those patients who do not respond medically, more invasive techniques have been used including serial thoracentesis, chest tube placement, chemical pleurodesis, and peritoneovenous shunts. We present a patient with recurrent pleural effusions secondary to hepatic cirrhosis who was unsuccessfully treated medically, and subsequently treated with thoracentesis, chest tube drainage and pleurodesis, with ultimate resolution after transjugular intrahepatic portosystemic shunt placement.- - - - - - - - - - ranking = 0.125keywords = ascites (Clic here for more details about this article) |
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