Advertisement

Treatment of Liver Cirrhosis

  • J. T. Galambos
  • W. D. Warren
  • W. J. MillikanJr.
  • J. M. Henderson
  • D. Simon
  • W. S. Brooks
  • S. P. Riepe
Conference paper

Abstract

Morphologically, cirrhosis can be defined as an entity. However, the physiologic and clinical abnormalities produced by cirrhosis are heterogeneous. Cirrhosis cannot be used as a homogeneous entity in clinical studies without clear-cut definition of the type of patients involved and the manifestation of the severity of their disease. Neither the clinical illness nor death of cirrhotic patients is necessarily related to liver disease. For example, 40% of 4455 deaths in cirrhosis were due to causes other than hepatic or renal failure, GI bleeding, or infection. One of the best examples of the heterogeneity of the clinical manifestation of cirrhosis is provided by the data published recently by various investigators purporting to identify the key determinants which predict the prognosis for cirrhotic patients. Although the various investigators used similar statistical methods, what appeared to be prognostic in one institution was not in another, and vice versa [1–5].

Keywords

Central Venous Pressure Esophageal Varix Ascitic Fluid Variceal Bleeding Gastric Varix 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bradbear R, Jenkins WJ, Ashby D, Sherlock S (1985) Prognostic factors in alcoholic cirrhosis. J Hepatol [Suppl] 2: S199Google Scholar
  2. 2.
    Christensen E, Schlichting P, Andersen PK, et al. (1985) Prognostic index to update prognosis in cirrhosis. J Hepatol [Suppl] 2: S213Google Scholar
  3. 3.
    Gines P, Quintero E, Arroyo V, et al. (1985) Prognostic factors in compensated cirrhosis. J Hepatol [Suppl] 2: S242Google Scholar
  4. 4.
    Milani A, Marra L, Siciliano M, Rossi L (1985) Prognostic significance of clinical and laboratory parameters in liver cirrhosis. A multivariate statistical approach. Hepatogastroenterology 32: 270–272PubMedGoogle Scholar
  5. 5.
    D’Amico G, Morabito A, Pagliaro L, Marubini E (1986) Survival and prognostic indicators in compensated and decompensated cirrhosis. Dig Dis Sci 31: 468–475PubMedCrossRefGoogle Scholar
  6. 6.
    Wu GY, Wu CH (1983) Effect of 2-aminoethyl-L-cysteine on collagen accumulation in isolated hepatic granulomas. Proc Soc Exp Biol Med 174: 79–85PubMedGoogle Scholar
  7. 7.
    Tan EML, Ryhanen L, Uitto J (1983) Proline analogues inhibit human skin fibroblast growth and collagen production in culture. J Invest Dermatol 80: 261–276PubMedCrossRefGoogle Scholar
  8. 8.
    Millikan WJ Jr, Henderson JM, Potts JR III, Warren WD, Galambos J, Brooks WS, Riepe S (1984) Liver function and hemodynamic status 1 year into sclerotherapy for variceal bleeding. Gastroenterology 86:1184Google Scholar
  9. 9.
    Nordlinger BM, Nordlinger DF, Fulenwider JT, et al. (1980) Angiography in portal hypertension: clinical significance in surgery. Am J Surg 139:132–141PubMedCrossRefGoogle Scholar
  10. 10.
    Potts JR III, Henderson JM, Millikan WJ Jr, Warren WD (1984) Emergency distal splenorenal shunts for variceal hemorrhage refractory to non-operative control. Am J Surg 148: 813–816PubMedCrossRefGoogle Scholar
  11. 11.
    Warren WD (1983) Control of variceal bleeding. Reassessment of rationale. Am J Surg 145: 8–16PubMedCrossRefGoogle Scholar
  12. 12.
    Conn HO (1974) Therapeutic portacaval anastomosis: to shunt or not to shunt. Gastroenterology 67: 1065–1071PubMedGoogle Scholar
  13. 13.
    Editorial (1984) Bleeding esophageal varices. Lancet i: 139–141Google Scholar
  14. 14.
    Reynolds TB (1983) What to do about esophageal varices? N Engl J Med 309:1575–1577PubMedCrossRefGoogle Scholar
  15. 15.
    Conn HO (1983) Endoscopic sclerotherapy: an analysis of variants. Hepatology 3: 769–771PubMedCrossRefGoogle Scholar
  16. 16.
    Terblanche J (1985) The long term management of patients after an oesophageal variceal bleed: the role of sclerotherapy. Br J Surg 72: 88–90PubMedCrossRefGoogle Scholar
  17. 17.
    Crafoord C, Frenckner P (1939) New surgical treatment of varicose veins of the esophagus. Acta Otolaryngol (Stockh) 27: 422–429CrossRefGoogle Scholar
  18. 18.
    Resnick RH, Chalmers TC, Ishihara AM, et al. (1969) A controlled study of the prophylactic portacaval shunt: a final report. Ann Intern Med 70: 675–688PubMedGoogle Scholar
  19. 19.
    Jackson FC, Perrin EB, Felix WR, Smith AG (1971) A clinical investigation of the portacaval shunt. V. Survival analysis of the therapeutic operation. Ann Surg 174: 672–701PubMedCrossRefGoogle Scholar
  20. 20.
    Resnick RH, Iber FL, Ishihara AM, Chalmers TC, Zimmerman H (1974) A controlled study of the therapeutic portacaval shunt. Gastroenterology 67: 843–857PubMedGoogle Scholar
  21. 21.
    Rueff B, Prandi D, Degos F, et al. (1976) A controlled study of therapeutic portacaval shunt in alcoholic cirrhosis. Lancet i: 655–659CrossRefGoogle Scholar
  22. 22.
    Reynolds TB, Donovan AJ, Mikkelsen WP, Redeker AG, Turrill FL, Weiner JM (1981) Results of a 12-year randomized trial of portacaval shunt in patients with alcoholic liver disease and bleeding varices. Gastroenterology 80:1005–1011PubMedGoogle Scholar
  23. 23.
    Johnston GW, Rodgers HW (1973) A review of 15 years’ experience in the use of sclerotherapy in the control of acute hemorrhage from esophageal varices. Br J Surg 60: 797–800PubMedCrossRefGoogle Scholar
  24. 24.
    Macdougall BRD, Westaby D, Theodossi A, Dawson JL, Williams R (1982) Increased long-term survival in variceal hemorrhage using injection sclerotherapy. Results of a controlled trial. Lancet i: 124–127CrossRefGoogle Scholar
  25. 25.
    Terblanche J, Northover JMA, Bornman P, et al. (1979) A prospective controlled trial of sclerotherapy in the long term management of patients after esophageal variceal bleeding. Surg Gynecol Obstet 148: 323–333PubMedGoogle Scholar
  26. 26.
    Paquet KJ (1982) Prophylactic endoscopic sclerosing treatment of the esophageal wall in varices - a prospective controlled randomized trial. Endoscopy 14: 4–5PubMedCrossRefGoogle Scholar
  27. 27.
    Mitchell KJ, Macdougall BRD, Silk DBA, Williams R (1982) A prospective reappraisal of emergency endoscopy in patients with portal hypertension. Scand J Gastroenterol 17: 965–968PubMedGoogle Scholar
  28. 28.
    Novis BH, Duys P, Barbezat GO, Clain J, Bank S, Terblanche J (1976) Fibreoptic endoscopy and the use of the Sengstaken tube in acute gastrointestinal haemorrhage in patients with portal hypertension and varices. Gut 17: 258–263PubMedCrossRefGoogle Scholar
  29. 29.
    Johnson AG, Simms JM, Stoddard CJ (1982) Is there a role for injection sclerotherapy in the presence of active bleeding? In: Westaby D, Macdougall BRD, Williams R (eds) Varieeal bleeding. Pitman, LondonGoogle Scholar
  30. 30.
    Cello JP, Grendell JH, Crass RA, Trunkey DD, Cobb EE, Heilbron DC (1984) Endoscopic sclerotherapy versus portacaval shunt in patients with severe cirrhosis and varieeal hemorrhage. N Engl J Med 311:1589–1594PubMedCrossRefGoogle Scholar
  31. 31.
    Terblanche J, Yakoob HI, Bornman PC, et al. (1981) Acute bleeding varices. A five-year prospective evaluation of tamponade and sclerotherapy. Ann Surg 194: 521–530PubMedCrossRefGoogle Scholar
  32. 32.
    TTie Copenhagen Esophageal Varices Sclerotherapy Project (1984) Sclerotherapy after first varieeal hemorrhage in cirrhosis. A randomized multicenter trial. N Engl J Med 311: 1594–1600CrossRefGoogle Scholar
  33. 33.
    Conn HO (1985) Ideal treatment of portal hypertension in 1985. In: Benhamou J-P (ed) Clinics in gastroenterology: portal hypertension. Saunders, PhiladelphiaGoogle Scholar
  34. 34.
    Paquct KJ, Fleig WE (1981) Sclerotherapy of esophageal varices. In: Papp JP (ed) Endoscopic control of gastrointestinal hemorrhage. CRC, Boca RatonGoogle Scholar
  35. 35.
    Warren WD, Millikan WJ Jr, Henderson JM, et al. (1982) Ten years portal hypertensive surgery at Emory: results and new perspectives. Ann Surg 195: 530–542PubMedCrossRefGoogle Scholar
  36. 36.
    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Statist Assoc 53: 457–481CrossRefGoogle Scholar
  37. 37.
    Winer BJ (1971) Statistical principles in experimental design, 2nd edn. McGraw-Hill, New YorkGoogle Scholar
  38. 38.
    Westaby D, Macdougall BRD, Williams R (1985) Improved survival following injection sclerotherapy for esophageal varices: final analysis of a controlled trial. Hepatology 5: 827–830PubMedCrossRefGoogle Scholar
  39. 39.
    Westaby D, Melia WM, Macdougall BRD, Hegarty JE, Gimson AE, Williams R (1985) B1 selective adrenoreceptor blockade for the long term management of varieeal bleeding. A prospective randomised trial to compare oral metoprolol with injection sclerotherapy in cirrhosis. Gut 26: 421–425PubMedCrossRefGoogle Scholar
  40. 40.
    Lebrec D, Poynard T, Bernuau J, et al. (1984) A randomized controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a final report. Hepatology 4: 355–358PubMedCrossRefGoogle Scholar
  41. 41.
    Burroughs AK, Jenkins WJ, Sherlock S, et al. (1983) Controlled trial of propranolol for the prevention of recurrent varieeal hemorrhage in patients with cirrhosis. N Engl J Med 309: 1539–1542PubMedCrossRefGoogle Scholar
  42. 42.
    Knauer CM, Lowe HM (1967) Hemodynamics in the cirrhotic patient during paracentesis. N Engl J Med 276: 491–496PubMedCrossRefGoogle Scholar
  43. 43.
    Shear L, Ching S, Gabuzda GJ (1970) Compartmentalization of ascites and edema in patients with hepatic cirrhosis. N Engl J Med 282: 1391–1396PubMedCrossRefGoogle Scholar
  44. 44.
    Lieberman FL, Denison EK, Reynolds TB (1970) The relationship of plasma volume, portal hypertension, ascites, and renal sodium retention in cirrhosis: the overflow theory of ascites formation. Ann NY Acad Sci 170: 202–212CrossRefGoogle Scholar
  45. 45.
    Iwatsuki S, Reynolds TB (1973) Effect of increased intraabdominal pressure on hepatic hemodynamics in patients with chronic liver disease and portal hypertension. Gastroenterology 65: 294–299PubMedGoogle Scholar
  46. 46.
    Gordon ME (1960) The acute effects of abdominal paracentesis in Laennec’s cirrhosis upon exchanges of electrolytes and water, renal function, and hemodynamics. Am J Gastroenterol 33:15–37PubMedGoogle Scholar
  47. 47.
    Kao HW, Rakov NE, Savage E, Reynolds TB (1985) The effect of large volume paracentesis on plasma volume - a cause of hypovolemia? Hepatology 5: 403–407PubMedCrossRefGoogle Scholar
  48. 48.
    Quintero E, Gines P, Arroyo V, et al. (1985) Paracentesis versus diuretics in the treatment of cirrhotics with tense ascites. Lancet i: 611–612CrossRefGoogle Scholar
  49. 49.
    Carey WD, Kohne JC, Leatherman J, Paradis K (1983) Ascitic fluid removal: does it cause renal or hemodynamic decompensation? Cleve Clin Q 50: 397–400PubMedGoogle Scholar

Copyright information

© Springer-Verlag Heidelberg 1987

Authors and Affiliations

  • J. T. Galambos
    • 1
  • W. D. Warren
    • 1
  • W. J. MillikanJr.
    • 1
  • J. M. Henderson
    • 1
  • D. Simon
    • 1
  • W. S. Brooks
    • 1
  • S. P. Riepe
    • 1
  1. 1.Departments of Medicine and SurgeryEmory University School of MedicineAtlantaUSA

Personalised recommendations