Portal Hypertension - ECAB
Portal Hypertension - ECAB

Author: Abraham Koshy

Publisher: Elsevier Health Sciences

Published: 2012-06-07

Total Pages: 119

ISBN-13: 813123181X

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Defined as a portal pressure of 12 mmHg or more, portal hypertension results from a combination of increased intrahepatic vascular resistance and increased blood flow through the portal venous system. Esophagogastric varices is the most important complication of severe portal hypertension because of the high risk of bleeding and mortality associated with them. Ascites is another important complication which may at times be refractory to treatment and may also get complicated by spontaneous bacterial peritonitis and hepatorenal syndrome. Portal hypertension is a predictable and preventable condition but has no definite cure. An aggressive approach to prevention and treatment of portal hypertension is therefore warranted. Treatment of portal hypertension is evolving rapidly and many changes in the therapeutic protocols have been incorporated in recent times. Endoscopic treatment of the bleeding varices and prophylactic role of beta-blockers to prevent rebleeding are well-established therapeutic options. The measurement of the hepatic venous pressure gradient may identify a suboptimal response to beta-blockers in patients at risk of bleeding from varices. However, the costeffectiveness of routine hepatic venous pressure gradient measurements to guide primary prophylaxis has not been examined. Besides these, there is a definite role of somatostatin analogs and shunt surgeries in the treatment of portal hypertension and its complications. This book is designed to update the reader on all such issues related to diagnosis, treatment and complications of portal hypertension along with supportive typical case scenarios. Thus it provides an excellent opportunity to widen one’s perspective in this area.

Portal Hypertension
Portal Hypertension

Author: Arun J. Sanyal

Publisher: Springer Science & Business Media

Published: 2007-11-10

Total Pages: 513

ISBN-13: 1592598854

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A cutting-edge review of the latest findings on key scientific topics and the best strategies for evaluation and management of portal hypertension in the clinic. Writing in an easy-to-read style, the authors review its pathobiology, the progress being made in its experimental understanding, the methodologies to assess it in humans, the treatment of its complications (esophageal varices, ascites, and hepatorenal syndrome), and its treatment in special circumstances (during pregnancy, in children, or when the portal vein is blocked). They also provide in-depth coverage of the pros and cons of the various therapeutic choices available to the clinician managing patients with complicated portal hypertension.

Portal Hypertension
Portal Hypertension

Author: Wael E.A. Saad

Publisher: Thieme

Published: 2017-09-07

Total Pages: 876

ISBN-13: 1626233268

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The definitive work on the diagnosis and treatment of portal hypertension Previously published by the Society for Interventional Radiology (SIR), this fully revised and updated third edition of Portal Hypertension: Imaging, Diagnosis, and Endovascular Management is the first volume in collaboration between Thieme and the SIR. Edited by Wael Saad and written by internationally recognized experts, this authoritative volume is a comprehensive guide to the diagnosis and interventional management of portal hypertension. A potentially serious condition, portal hypertension presents considerable clinical challenges due to the delicate nature of the impacted organs, veins, and vessels. From pathophysiology to the latest state-of-the-art approaches, five major sections encompass diagnostic, medical, endoscopic, non-vascular, surgical, percutaneous, endovascular, and balloon-occluded methodologies, including indications, complications, and clinical trial results. Throughout this book's 33 chapters, a Who's Who of world-renowned interventional radiologists share clinical pearls and step-by-step procedural guidance. Several techniques have undergone significant advances since the second edition was published, including Transjugular Intrahepatic Portosystemic Shunt (TIPS), Balloon-Occluded Retrograde Transvenous Obliteration (BRTO), Balloon-Occluded Antegrade Transvenous Obliteration (BATO), and variations on TIPS, and all these are featured herein. Key Highlights Hepatic and portal venous anatomy relative to procedural approaches Nearly 250 figures elucidate anatomical structures and technical methodologies TIPS: patient selection, effects on kidney and liver function, hemodynamic changes, intravascular ultrasound guidance, Doppler surveillance, and utilization for Budd-Chiari Syndrome and liver transplantation TIPS clinical study outcomes for variceal bleeding, ascites, and hydrothorax BRTO and BATO techniques, clinical study outcomes, and utilization for gastric varices Management of mesenteric and portal vein stenosis, thrombosis, and hypersplenism This remarkable book is a must-have tool for interventional radiologists and for all those who care for patients with portal hypertension, from residents to practicing clinicians.

Pulmonary Hypertension - ECAB
Pulmonary Hypertension - ECAB

Author: Sheila Glennis Haworth

Publisher: Elsevier Health Sciences

Published: 2008-12-26

Total Pages: 182

ISBN-13: 8131231763

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Pulmonary hypertension is defined as a mean pulmonary artery pressure (mPAP) ≥25 mmHg, with Pulmonary Capillary Wedge Pressure ≤ 15 mmHg, measured by cardiac catheterization. The etiology of PH has a varied spectrum extending right from Drugs, toxins and portal hypertension to HIV, Collagen Vascular Diseases and Persistent Pulmonary Hypertension of Newborn, etc. The estimation of disease prevalence has been nearly impossible owing to the geographic distribution and economic diversity, along with significant regional variations in human development and healthcare infrastructure. A large number of patients with PH never reach the health centers capable of diagnosing the disease condition correctly. Advance pulmonary vascular disease as a result of uncorrected CHD is a major health challenge in the developing world. PH exists as a major component of many forms of cardiac and pulmonary disease. While breathlessness is the most common feature of PH, patients often also present with chest pain, syncope, fatigue, weakness and abdominal distension. The precordial signs include a right ventricular lift, accentuated pulmonary component of S2, a pansystolic murmur of Tricuspid regurgitation, a diastolic murmur of pulmonary regurgitation and a right ventricular S3. The standard diagnostic workup in developed countries includes a series of investigations to rule out the secondary causes. Additional tests are required to estimate the disease severity and plan the appropriate treatment. These include the cardiac catheterization, selective pulmonary angiography by direct injection of pulmonary arteries, high resolution CT scan, cardiac magnetic resonance, ABGs, nocturnal O2 saturation, etc. While most of the basic management is feasible in the Indian conditions, most of the newly introduced drugs are either not available or are available at costs that far exceed the paying capacity of an average citizen of a developing economy. An underdeveloped health insurance system adds further to the financial burden of the treatment. Measures like formulation of guidelines for diagnosis and treatment of PAH, educating clinicians and scientists and making medications affordable to poor patients might ensue a breakthrough in the overall management of pulmonary hypertension.

Hepatic Encephalopathy - ECAB
Hepatic Encephalopathy - ECAB

Author: Prabha Sawant

Publisher: Elsevier Health Sciences

Published: 2013-06-17

Total Pages: 104

ISBN-13: 8131231836

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Hepatic encephalopathy is the clinical syndrome resulting from increased ammonia levels in blood. The most common cause of HE is chronic liver disease. However, acute liver failure, Reye’s syndrome, or metabolic defects are other causes. The true prevalence of overt HE is difficult to establish because of the considerable heterogeneity in etiology and disease severity. However, HE has been reported to be present in around 50% of patients with cirrhosis or with porto-caval shunts at some time during their illness. It is less common in patients with portosystemic shunts without liver disease. Thirty percent of patients dying of end-stage liver disease experience significant encephalopathy, approaching coma. After TIPS placement, approximately 1/3 of patients will experience overt HE. Minimal HE (MHE) is difficult to diagnose due to lack of standard diagnostic tests. Its clinical significance with regards to progression to overt encephalopathy has however, not been established. Conventional treatment of hepatic encephalopathy relies primarily on reducing the production and absorption of ammonia. Identification and correction of the precipitating factors and general supportive measures are important management steps. There are very few randomized controlled trials (RCT) of therapies and even these are bugged by lack of a control group and small sample sizes.

Chronic Pancreatitis - ECAB
Chronic Pancreatitis - ECAB

Author: Pramod Kumar Garg

Publisher: Elsevier Health Sciences

Published: 2013-06-17

Total Pages: 222

ISBN-13: 8131231887

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Chronic pancreatitis (CP) is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis, areas of focal necrosis are typically associated with perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, and by the development of pseudocysts. Late in the course of the disease a progressive loss of endocrine and exocrine function occurs. In the past, chronic pancreatitis was considered to be mostly associated with chronic alcohol abuse. During the past 2 decades idiopathic chronic pancreatitis and, moreover, hereditary pancreatitis have been recognized as distinct disease entities. Usually the diagnosis is made by a combination of imaging procedures such as ultrasound and endoscopic retrograde cholangiopancreatography, and exocrine and endocrine function tests. Therapy is presently restricted to symptom control for the lack of a causal treatment strategy. Thirty to sixty percent of all patients develop disease-associated complications such as persistent pain, strictures of the common bile duct, or pancreatic duct stones that may require either endoscopic or surgical treatment. Chronic pancreatitis is a difficult condition to live with as well as to treat. Optimal care needs to be carried out in a multidisciplinary environment that can address both the physical and psychological aspects of the disease. It is commonly seen in alcohol-dependent individuals, but many other groups of individuals suffer with irreversible inflammatory destruction of the pancreas. Abdominal pain is the predominant feature and pain specialists are an important part of any pancreatic team. Exocrine and endocrine failure are addressed by appropriate nutrition with supplements and insulin, whilst the complications that are seen over time, may require a combination of endoscopic and surgical treatment. This clinical update has been designed to update the readers on the important aspects of CP. The book has stressed upon various aspects of the condition like the etiology, pathogenesis, diagnosis and evaluation along with an insight into the management approach of the patient. Supportive case scenarios have also been incorporated with relevance to the topics covered under the book. Overall, the book presents to the readers an excellent compilation of clinically applicable literature sourced from the most acclaimed physicians in the country.

Carcinoma Gallbladder - ECAB
Carcinoma Gallbladder - ECAB

Author: Gourdas Choudhuri

Publisher: Elsevier Health Sciences

Published: 2012-07-05

Total Pages: 118

ISBN-13: 8131231852

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Carcinoma gallbladder is the third most common GI malignancy and the most common biliary tract malignancy in North India. Of all the known risk factors, gallstones are most commonly associated with GBC. Bile stasis and chronic inflammation along with occupational exposure to heavy metals, dietary carcinogens, and radiation exposure have been found to be responsible for the increased incidence of GB neoplasms. Infections with S. typhii and S. paratyphii along with Helicobacter sp. have also been associated with GBC. p 53 and ras gene mutations are strongly associated with GBC. Early diagnosis of GBC still remains a challenge and is often diagnosed as a part of investigations of any other disease. Most GBCs are at advanced stage at presentation. USG and CT scan are the common modes for the preliminary diagnosis of GBC. Surgery remains the key treatment modality and the only hope for long-term survival. A large number of patients present at the unresectable stage of the tumor, and palliation remains the only alternative to ensure better quality of life.