Diagnosis and management of the Budd-Chiari Syndrome

Article Abstract:

Budd-Chiari syndrome is a rare but often fatal condition caused by obstruction of the outflow of venous blood from the liver with resulting liver enlargement, ascites (abnormal fluid collection within the abdomen), development of extensive collateral (secondary) blood vessels, and severe portal hypertension (elevated pressure in the portal vein of the liver). Budd-Chiari syndrome should be suspected in any patient with sudden development of massive ascites. In about 90 percent of cases, patients come in for treatment with this sudden appearance of ascites as well as tender, enlarged liver. Patients may also have abdominal pain, jaundice (yellow skin and sclera) or gastrointestinal hemorrhage. At this initial presentation the patient usually does not have evidence of any significant liver dysfunction. Both magnetic resonance imaging (MRI) and dynamic computed tomography (CT) are helpful in diagnosing Budd-Chiari syndrome. The most definitive test is hepatic venography (X-ray examination of the veins following injection of radio-opaque contrast dye) as well as venographic study of the inferior vena cava (the two large veins emptying into the heart). Information obtained from percutaneous liver biopsy and the venographic studies should be used in planning the appropriate surgical management of the patient. Most patients with Budd-Chiari syndrome can be treated surgically with shunting procedures, which redirects blood from the affected area. If there is more than 75 percent occlusion of the vena cava, then mesoatrial shunt should be performed; otherwise a mesocaval shunt is preferred, since it carries a lower risk of thrombosis (abnormal condition in which clotting elements and cell debris accumulate and attach to a point on the interior wall of the vein). Patients with cirrhosis or liver failure are best treated by liver transplantation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Blood vessels, Vena cava, Venae cavae, Hepatic vein thrombosis, Budd-Chiari syndrome

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Vascular complications after orthotopic liver transplantation

Article Abstract:

Liver transplants are a major surgical undertaking, and vascular complications can cause graft failure and death. These complications include thrombosis (clot formation) in the hepatic (liver) artery, thrombosis of the portal vein, and rupture of the hepatic artery. A study was undertaken to determine the incidence, available treatment options, and outcomes of these complications. Within a 57-month period, 430 liver transplants were performed on 372 patients. The incidence of vascular complications was 9 percent, and included 24 incidents of hepatic artery thrombosis (76 percent of all complications), six cases of portal vein thrombosis, three cases of combined hepatic artery and portal vein thrombosis, and five patients with a ruptured hepatic artery. Among the 140 children included in the study, the main reason for transplant was biliary atresia (absence or underdevelopment of one or more of the normal bile duct structures causing liver damage). Among the adults, the main indication for transplant was liver cirrhosis, degenerative disease of the liver in which the lobes are covered with fibrous tissue and the lobules are infiltrated with fat. Complications were signaled by liver failure, graft dysfunction, and bile infection; problems were also identified by screening ultrasound. Treatment of the complications included revascularization, revascularization and retransplantation, only retransplantation, and some patients were just closely observed. Four patients had infectious arteritis (inflammation of the artery). The six-month survival was 70 percent for patients who developed vascular complications following liver transplantation. It is concluded that early diagnosis of transplant failure is essential, and surgical intervention usually is the main treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Transplantation of organs, tissues, etc., Organ transplantation, Tissue transplantation, Transplantation

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Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer

Article Abstract:

Cancer of the head of the pancreas may be treated surgically by pancreaticoduodenectomy (excision of all or part of the pancreas, duodenum, and sometimes a portion of the stomach). Survival rates for these patients have recently improved significantly. A study was undertaken of 89 patients to determine the factors that influence long-term survival. All patients had cancer of the head of the pancreas and underwent pancreaticoduodenectomy between January 1969 and February 1990. The average patient age was 62 years. Eight patients (9 percent) died during hospitalization. However, for the last 60 cases (in the last eight years), the hospital mortality was only 1.9 percent. The average survival was 11.9 months with a five-year actuarial survival rate of 19 percent. Analysis of the 81 survivors indicated that negative lymph nodes and lack of invasion into the blood vessels favored long-term survival. The factor most predictive of long-term survival was no lymph node involvement; these patients survived an average of 55.8 months, compared with patients with lymph node involvement who survived an average of 11 months. Patients who received less than three blood transfusions had a better survival than those who received more transfusions (24.7 months compared with 10.2 months, respectively.) It is concluded that the most important determinant of long-term survival is the status of the tumor itself (lymph node involvement and blood vessel invasion). Surgical technique also influences survival; patients who require few blood or no transfusions during surgery have a better chance of survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prognosis, Pancreatic cancer, Pancreatectomy

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