Liver Cirrhosis Ascites Research Articles

Hypoalbuminemia contributes to ascites formation via sodium and water retention: Evidence from clinical date and albumin deficient mice

Albumin infusions improve circulatory and renal function in patients with decompensated cirrhosis. However, there is no convincing evidence that hypoalbuminemia contributes to ascites formation in liver cirrhosis. The aim of our study is to determine the exact role of hypoalbuminemia in the formation of ascites caused by liver cirrhosis and its underlying mechanism. Clinical profiles of patients with liver cirrhosis retrospectively analyzed. The details of albumin involved in ascites formation were investigated in rat model and murine model. Statistical analysis demonstrated hypoalbuminemia was an independent risk factor for ascites formation in patients with liver cirrhosis (OR = 0.722, P < 0.001). In carbon tetrachloride (CCl4)-induced rat model of liver cirrhosis, a significant reduction in serum albumin was observed in rats with ascites (13.37 g/L) compared with rats without ascites (21.43 g/L, P < 0.001). In thioacetamide (TAA)-treated mice, ascites amount of heterozygous albumin (Alb+/−) mice (112.0 mg) was larger than that of wild-type (Alb+/+) mice (58.46 mg, P < 0.001). In CCl4-induced chronic liver injury, ascites amounts of Alb+/− or Alb+/+ mice were 80.00 mg or 48.46 mg (P = 0.001). Further study demonstrated 24-h urinary sodium excretion in Alb+/− mice was lower than that of Alb+/+ mice in TAA/CCl4-induce murine models of liver cirrhosis. Additionally, serum sodium concentration of Alb+/− mice was lower than that of Alb+/+ mice. In cirrhotic mice, higher level of antidiuretic hormone was observed in Alb+/− mice compared with the control; and renal aquaporin (AQP2) expression in Alb+/− mice was significantly higher than that of WT mice. These revealed hypoalbuminemia contributed to the occurrence of ascites in liver cirrhosis through sodium and water retention.

Parameters of the Component Composition of the Body and Their Relationship with the Development of Ascites in Liver Cirrhosis

Parameters of the Component Composition of the Body and Their Relationship with the Development of Ascites in Liver Cirrhosis

Spectrally separated dual-label upconversion luminescence lateral flow assay for cancer-specific STn-glycosylation in CA125 and CA15-3

Multiplexed lateral flow assays (LFAs) offer efficient on-site testing by simultaneously detecting multiple biomarkers from a single sample, reducing costs. In cancer diagnostics, where biomarkers can lack specificity, multiparameter detection provides more information at the point-of-care. Our research focuses on epithelial ovarian cancer (EOC), where STn-glycosylated forms of CA125 and CA15-3 antigens can better discriminate cancer from benign conditions. We have developed a dual-label LFA that detects both CA125-STn and CA15-3-STn within a single anti-STn antibody test line. This utilizes spectral separation of green (540 nm) and blue (450 nm) emitting erbium (NaYF4:Yb3+, Er3+)- and thulium (NaYF4: Yb3+, Tm3+)-doped upconverting nanoparticle (UCNP) reporters conjugated with antibodies against the protein epitopes in CA125 or CA15-3. This technology allows the simultaneous detection of different antigen variants from a single test line. The developed proof-of-concept dual-label LFA was able to distinguish between the ascites fluid samples from diagnosed ovarian cancer patients (n = 10) and liver cirrhosis ascites fluid samples (n = 3) used as a negative control. The analytical sensitivity of CA125-STn for the dual-label LFA was 1.8 U/ml in buffer and 3.6 U/ml in ascites fluid matrix. Here we demonstrate a novel approach of spectrally separated measurement of STn-glycosylated forms of two different cancer-associated protein biomarkers by using UCNP reporter technology.Graphical

Clinical Research Progress of Traditional Chinese Medicine Compound in the Treatment of Liver Cirrhosis Ascites

Clinical Research Progress of Traditional Chinese Medicine Compound in the Treatment of Liver Cirrhosis Ascites

Research Progress on the Treatment of Ascites in Liver Cirrhosis with Traditional Chinese Medicine

Research Progress on the Treatment of Ascites in Liver Cirrhosis with Traditional Chinese Medicine

Current treatment options of refractory ascites in liver cirrhosis - A systematic review and meta-analysis.

Refractory ascites is a severe complication of liver cirrhosis and treatment options consist in large volume paracentesis, transjugular intrahepatic portosystemic shunt, alfapump®, peritoneovenous shunt and permanent indwelling peritoneal catheter. Our aim was to assess the efficacy, mortality and complications of each treatment. We performed a systematic review using Pubmed and Embase. Frequencies were summarized with Comprehensive Meta-Analysis Software. Seventy-seven studies were included. In patients with transjugular intrahepatic portosystemic shunt, 1-year mortality was 33% (95% CI 0.29-0.39, I2=82.1; τ2=0.37; p<0.001) with lower mortality in newer studies (26% vs. 44%). At 6 months, mortality in patients with alfapump® was 24% (95% CI 0.16-0.33, I2=0.00; τ2=0.00; p=0.83), 31% developed acute kidney injury (95% CI 0.18-0.48, I2=44.0; τ2=0.22; p=0.15). Mortality at 12 months was 44% (95% CI 32%-58%, I2=76.7, τ2=0.44, p<0.001) in peritoneovenous shunts and 45% (95% CI 38%-53%, I2=61.4, τ2=0.18, p=0.003) in large volume paracentesis, respectively. Overall mortality in patients with permanent indwelling catheters was 66% (95% CI 33%-89%, I2=82.5, τ2=1.57, p=0.001). Mortality in patients with transjugular intrahepatic portosystemic shunt was lower in newer studies, probably due to a better patient selection. Acute kidney injury was frequent in patients with alfapump®. Permanent indwelling catheters seemed to be a good option in a palliative setting.

Chlortalidone

Chlortalidone

Preventive and Treatment Interventions for Abdominal Ascites of Patients with Liver Cirrhosis: A Systematic Review of Randomized Controlled Trials.

AIMThis systematic review aimed to evaluate the efficacy of preventive and therapeutic approaches used in the management of ascites in liver cirrhosis.METHODLiterature review was done in “Scopus, Web of Science, CINAHL, ScienceDirect, PubMed MEDLINE, Ulakbim National Database, and Cochrane Library” databases using the keywords, “ascites, refractory ascites, liver cirrhosis, intervention, prophylaxis, treatment, nursing management, prevention, ascites management, randomized controlled trials,” and 2,447 articles were obtained. The studies with low bias risk were included. This systematic review was planned by following the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement.RESULTSA total of 11 randomized controlled trials were included. When the included studies were examined, ascites treatment approaches were evaluated in all of the studies; however, preventive approaches were not evaluated. It was found that mannitol, a diuretic drug, helps ascites management by contributing to weight loss, decrease in abdominal circumference, and urinary sodium excretion. The automatic low-flow ascites pump also reduced the need for large-volume paracentesis. There was a decrease in weight and abdominal circumference measurements when band compression was applied to the umbilicus.CONCLUSIONTherapeutic approaches were found to be effective. It was thought that the lack of nursing practices and the prevention of ascites formation in the abdomen was an important deficiency. Randomized controlled trials were recommended for the prevention of abdominal ascites formation and the side effects of treatment on the patient.

Ascites et causa hepatic cirrhosis

Cirrhosis of the liver is the end result of irreversible hepatocellular injury causing fibrosis and nodular regeneration of the liver. One of the complications of hepatic cirrhosis is ascites. The most common causes of ascites in liver cirrhosis are portal hypertension, hypoalbuminemia and kidney dysfunction which will result in the accumulation of the fluid in the peritoneum. Ascites in cirrhosis is truly important as it is highly associated with mortality, and significantly requires liver transplantation as a therapeutic option. This article reports an SIA woman, 68 years old, diagnosed with ascites e.c hepatic cirrhosis who was treated due to an enlarged abdomen. The patient received diuretic therapy but there were no significant changes. The patient also received an ascitic fluid puncture procedure. Cirrhosis of the liver is a condition where the extracellular matrix or scar tissue accumulates as a response to acute or chronic liver injury. Ascites is the most likely complication occurred in cirrhosis patients. The occurrence of ascites in cirrhosis is very important which is correlated to the patient’s mortality. Adequate ascites therapy will levitate the quality of life for cirrhosis patients and prevent complications.

Biochemical evaluation of processed ascites in patients undergoing cell-free and concentrated ascites reinfusion therapy.

The biochemical composition of processed ascites is not well researched and may differ among institutions. This prospective study was conducted to evaluate the biochemical characteristics of processed ascites of 11 patients with liver cirrhosis and carcinoma who underwent cell-free and concentrated ascites reinfusion therapy. The ascites due to carcinoma were more acidic and had higher lactate dehydrogenase activity than those due to liver cirrhosis. The ascites due to liver cirrhosis contained a higher amount of immunoglobulin than those due to carcinoma. Immunoglobulin preparations were approximately 2.95% IgG in liver cirrhosis ascites and 2.25% IgG in carcinoma ascites. Moreover, the concern about IgA infusion in the patient with IgA deficiency made it important to identify the source of the ascites. The present study provided fundamental information regarding the safety of cell-free and concentrated ascites reinfusion therapy.

Acute Abdomen From Umbilical Hernia Rupture to Flood Syndrome: A Case Report and Review of Literature

Flood syndrome is caused by spontaneous rupture of an umbilical hernia in a patient with tense, long-standing ascites. It is a rare complication of hepatic cirrhosis and has a high mortality rate. Flood syndrome is so named because a rush of ascitic fluid often follows the spontaneous umbilical hernia rupture. We present a case of a 39-year-old male patient with a history of alcoholic liver cirrhosis and recurrent ascites who underwent multiple abdominal paracentesis prior to developing an umbilical hernia that eventually ruptured, causing flood syndrome. The authors would like to discuss flood syndrome with a focus on management options. J Med Cases. 2019;10(10):309-311 doi: https://doi.org/10.14740/jmc3375

Unexpected cyst within ascites

A 59-year-old man, with known alcohol-induced liver cirrhosis and diuretic refractory ascites, was seen in General Internal Medicine clinic for a therapeutic paracen­tesis. The tense large volume ascites caused abdominal pain, which had been previously relieved with paracen­tesis on several occasions. In preparation for paracen­tesis, routine POCUS was performed to landmark for the procedure.

Up to date treatment of ascites in liver cirrhosis

Up to date treatment of ascites in liver cirrhosis

Dialytic peritoneal ultrafiltration versus large-volume paracentesis in the treatment of marked ascites in cirrhotic patients

Background and aim: Ascites in liver cirrhosis is associated with a poor prognosis and impairment of the quality of life. The clinical efficacy and safety of large-volume paracentesis in comparison to dialytic peritoneal ultrafiltration in the treatment of marked ascites were evaluated. Patients and methods: A total of 96 cirrhotic patients with marked ascites were divided into two groups: group I 48 patients treated with dialytic ultrafiltration group IIa 31 patients treated with LVP without albumin and IIb 17 patients treated with LVP plus albumin infusion. Results: Mean arterial pressure of patients in the studied groups show significant decrease immediately after the different procedures and start to rise within 24 hours and reach readings similar to those before ascites drainage especially with peritoneal ultrafiltration. Improvement in plasma albumin concentration has been reported after dialytic ultrafiltration. There is statistically significant decrease in serum creatinine after 48 hours of the different treatments. The average volume of ascites removed was (9.04 ± .04) in the dialytic ultrafiltration group versus (4.45 ± 0.51) in large volume paracentesis without albumin group and (6.06 ± 0.83) in large-volume paracentesis plus albumin infusion. After treatment all patients experienced a relief of ascites which is better with larger amounts of fluids removed as occurred in dialytic ultrafiltration group. Conclusion: Dialytic ultrafiltration is an effective and relatively safe alternative to large-volume paracentesis in the treatment of marked ascites in cirrhotic patients. Blood pressure is well maintained, kidney functions are preserved. Dialytic ultrafiltration has the advantages of cost and time saving and avoidance of blood-borne infection associated with intravenous transfusion of blood products such as albumin.

Continuing Medical Education Questions: January 2019.

To receive CME/MOC credit for this activity, please go to: http://acgjournalcme.gi.org/Article Title: Refractory Ascites in Liver Cirrhosis.

Study on the effect of applying syndrome differentiation and medicated diet in patients with liver cirrhosis ascites based on "Gu Ben Kai Qu" theory of TCM

Objective To explore the effect of applying syndrome differentiation and medicated diet in patients with liver cirrhosis as cites based on Gu Ben Kai Qu theory of TCM. Methods Seventy patients of liver cirrhosis as cites were randomly divided into observation group (35 cases) and control group (35 cases). The control group was cared with care routine of liver cirrhosis as cites, The observation group was based on care routine traditional nursing and implementation of dialectical medicalated meal which based on Gu Ben Kai Qu theory of TCM. The two groups of patients were used to assess the efficacy of liver cirrhosis as cites, urine volume, abdominal circumference, weight, TCM syndrome scale of liver disease. Results The urine volume on the 7th day, the 14th day, 2 weeks after discharge, the weight and the abdominal circumference on the 2 weeks after discharge from the patients in the observation group were respectively (1.90±0.52) L, (2.09±0.56) L, (2.02±0.35) L, (59.36±8.19) kg, (89.56±7.24) cm, while they were (1.63±0.36) L, (1.79±0.40) L, (1.82±0.38) L, (63.33±8.21) kg, (93.57±7.56) cm in the control group, the difference between the two groups was statistically significant (F=6.083, 6.484, 5.030, 4.108, 5.144, all P<0.05). The efficacy of liver cirrhosis as cites from the patients in the observation group were cured 40.0% (14/35), improved 42.9% (15/35), not cured 17.1% (6/35), while they were cured 22.9%(8/35), improved 40.0%(14/35), not cured 37.1%(13/35) , the difference between the two groups was statistically significant (Z=2.012, P<0.05). The efficacy of TCM Syndromes on liver disease from the patients in the observation group were respectively [significant effect 37.1%(13/35), valid 45.7%(16/35), invalid 17.2%(6/35)], [significant effect 60.0%(21/35), valid 28.6%(10/35), invalid 11.4%(4/35)], while they were respectively [significant effect 20.0%(7/35), valid 42.9%(15/35), invalid 37.1%(13/35)], [significant effect 40.0%(14/35), valid 25.7%(9/35), invalid 34.3%(12/35)], the difference between the two groups was statistically significant (Z=2.065, 2.104, all P<0.05). Conclusions Based on Gu Ben Kai Qu theory of TCM, the implementation of dialectical diet can effectively improve efficacy of liver cirrhosis as cites, reduction rate of TCM symptoms scale, urine volume, reduce the weight, shrink down the abdominal circumference, worthy of clinical application. Key words: Dialectical meal; Nursing care; Effect study

Extracorporal modified ascitic fluid reinfusion in treatment of resistant ascites in liver cirrhosis

OBJECTIVE. The aim of the study was to estimate the efficacy of new method of reinfusion of extracorporeal modified ascitic fluid in therapy of diuretic resistance ascites in patients with liver cirrhosis and portal hypertension syndrome. MATERIAL AND METHODS. An analysis of treatment was made in 83 patients, who underwent laparocentesis and ascitic fluid evacuation. The patients were divided into two groups. Laparocentesis and fractional evacuation of ascitic fluid were carried out for the patients of the first group (n=40). This procedure was followed by intravenous infusion of 25 % albumin (10 g of albumin on each 2 litres of removed fluid) in order to make up losses of protein. Laparocentesis and ascitic fluid evacuation with following extracorporal processing and reinfusion were performed for the second group of patients (n=43). RESULTS. There was noted an increase of day diuresis from (620,0 ± 110,0) ml to (2,2 ± 0,4) l compared with the first group from (780 ± 80) ml to (1,2 ± 0,5) l and rise of sodium excretion (132 ± 7) mmol/l compared with the first group - (120 ± 6) mmol/l. An average molecular peptide concentration was decreased in blood plasma to (0,254 ± 0,098) units in the second group and it counted (0,298 ± 0,045) units in the first group. CONCLUSIONS. Reinfusion of extracorporeal modified ascitic fluid was more effective than conventional correction of albumin level and electrolytes disturbances against a background of ascitic fluid evacuation.

Mean arterial pressure drop is an independent risk factor of death in patients with HBV-related cirrhosis ascites.

In patients with cirrhosis ascites, mean arterial pressure (MAP) is a credible sign of circulatory dysfunction. There are no studies on the relationship between MAP and long-term prognosis in hepatitis B virus (HBV)-related liver cirrhosis ascites. Therefore, we assessed the association between MAP and prognosis in patients with liver cirrhosis ascites. In total, 110 patients of HBV-related liver cirrhosis ascites were prospectively followed for 5 years. After their admission, the patients underwent laboratory tests and MAP measurements. Multivariate analysis was conducted using backward stepwise Cox proportional hazards regression. Receiver operator characteristic (ROC) curves were used to confirm the best cutoff value of several baseline parameters, including MAP, for predicting death in patients with liver cirrhosis ascites. In a follow-up period of 5 years, 60 (54.5%) patients survived. MAP (OR 1.176, 95% CI 1.045 to 1.326, p=0.003) was an independent risk factor of death, together with Child-Pugh score (OR 1.204, 95% CI 1.068 to 1.357, p=0.002) and model for end-stage liver disease score (OR 1.297, 95% CI 1.198 to 1.405, p=0.000). The area under the ROC curve of MAP was 0.819 at baseline (95% CI 0.741 to 0.897, p=0.000). A baseline MAP value of ≤83.5 mmHg was an independent risk factor of death. A decrease in MAP was a valuable predictor of death in patients with HBV-related liver cirrhosis ascites. MAP may be used for determining the prognosis and exploring new treatment measures directed at optimizing the treatment of liver cirrhosis ascites.

Association of umbilical hernia with volume of ascites in liver cirrhosis: a retrospective observational study.

Umbilical hernia is a common abdominal complication in cirrhotic patients with ascites. Our study aimed to evaluate the correlation of umbilical hernia with the volume of ascites. Cirrhotic patients that underwent axial abdominopelvic computed tomography (CT) scans at our hospital between June 2012 and June 2014 were eligible. All CT images were reviewed to confirm the presence of umbilical hernia. The volume of ascites was estimated by five-point method. One hundred and fifty-seven patients were enrolled into this study. Among them, 101 patients had ascites and 6 patients had umbilical hernia. Alkaline phosphatase (AKP) and serum sodium were significantly lower in patients with umbilical hernia (P = 0.008, P = 0.011, respectively). Child-Pugh scores and the volume of ascites were significantly higher in patients with umbilical hernia (P = 0.03, P < 0.0001, respectively). Correlation analysis demonstrated that the volume of ascites, Child-Pugh scores, and blood ammonia had positive correlations with umbilical hernia (r = 0.4579, P < 0.0001; r = 0.175, P = 0.03; r = 0.342, P = 0.001, respectively) and that serum sodium had a negative correlation with umbilical hernia (r = -0.203, P = 0.011). In patients with ascites ≥2000 mL, only AKP was significantly associated with umbilical hernia (P = 0.0497). No variables were significantly associated with umbilical hernia in a subgroup analysis of patients matched according to the volume of ascites. The volume of ascites has a positive correlation with umbilical hernia. However, the factors associated with umbilical hernia in patients with severe ascites remain unclear.

Treatment for cirrhotic ascites

Common complications of decompensated liver cirrhosis are esophageal varices, hepatic encephalopathy and ascites. After the onset of complications, the prognosis worsens. In patients with ascites, the 5-year mortality rate is 44%. Furthermore, hyponatremia, spontaneous bacterial translocation and hepatorenal syndrome also greatly worsen the prognosis. Effective treatment of cirrhotic ascites improves the quality of life and survival rate. Recently, the newly produced diuretic, tolvaptan (vasopressin V2 receptor antagonist), was reported to be effective in the treatment of refractory ascites in liver cirrhosis; however, there has not been an associated positive effect on the prognosis. There are various types of treatment for ascites, such as large-volume paracenteses, a cell-free and concentrated ascites reinfusion therapy, a transjugular intrahepatic portosystemic shunt, and a peritoneo-venous shunt. Although they improve the prognosis, liver transplantation remains the ultimate form of treatment. The present article discusses the therapeutic management of cirrhotic ascites.