Podcasts about ascites

Ascites is the accumulation of fluid in the peritoneal cavity that causes abdominal distention. It is a common complication of cirrhosis but can also occur in other conditions such as cancer, heart failure, tuberculosis, and dialysis. Ascites can lead to significant problems for your patient, including respiratory compromise, hypotension, and even peritonitis. Hit play on this episode to learn:  The pathophysiology of ascites Signs and symptoms of ascites Ascites diagnostic tests Complications of ascites Ascites treatment And, to wrap it all up, we'll go through an ascites case study together! ___________________ Full Transcript - Read the article and view references  FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! Med Surg Solution - Are you looking for a more effective way to learn Med Surg? Enroll in Med Surg Solution and get lessons on 57 key topics and out-of-this-world study guides.  Study Sesh - Change the way you study with this private podcast that includes dynamic audio formats that help you review and test your recall of important nursing concepts on-the-go. Free yourself from your desk with Study Sesh! Clinical Success Pack - One of the best ways to fast-track your clinical learning is having the right tools. This pack includes report sheets, sheets to help you plan your day, a clinical debrief form, and a patient safety cheat sheet.

To have your question featured in a future video, please email: questions@drmdc.health

In this episode of My Thyroid Health, we learn if hypothyroidism can be the reason behind ascites, a buildup of fluid in the abdomen. What you will learn: What is ascites? Does hypothyroidism cause ascites? When should you suspect ascites? Treating ascites: case studies A note from Paloma ⁠Check out our blog and read the full article here.⁠ About Paloma Health: ⁠⁠⁠Paloma Health⁠⁠⁠ is an online medical practice focused exclusively on treating hypothyroidism. From online visits with your provider to easy prescription management and lab orders, we create personalized treatment plans for you.  ⁠⁠⁠Become a member⁠⁠⁠, or try our at-home test kit and experience a whole new level of hypothyroid care. Use code PODCAST to save $30 at checkout. Disclaimer: The $30 discount is only valid for first-time Paloma Health members and test kit users. Coupon must be entered at the time of checkout. 

In today's VETgirl online veterinary CE podcast, we're going to review a study by Morey et al out of University of Missouri entitled “N-terminal brain natriuretic peptide, cardiac troponin-I, and point-of-care ultrasound in dogs with cardiac and noncardiac causes of nonhemorrhagic ascites.”

Today we have one tip for shocky patients on the floor supplemented by some info from the Management of the Hospitalized Patient 2023 (more coming in the future!), and a bunch of tips including TIPS for managing upper GI bleeds, Ascites, SBP, and HRS. | 00.00 Opening & TOC | | 01.02 Consider vasopressors via PIV - JHM 2022, Surviving Sepsis 2021 | | 04.15 Upper GI bleeding - ACG 2021 | | 05.26 Ascites, SBP - AASLD 2021 | | 07.32 Hepatorenal Syndrome | | 08.04 Closing | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness. All information contained in this episode are the opinions of the respective speakers and not necessarily the views their respective institutions or UCSF, and is only provided for information purposes, not to diagnose or treat.] Additional Credits: Contents by the Clinical Knowledge Communicty Dispatch. Music by Amit Apte. Drip Vectors by Vecteezy

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and Fitness Updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and fitness updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and fitness updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Thank you for listening to this episode of "Health and Fitness" from the Nezpod Studios! Enjoy your night or the start of your day, spiced by our top-notch health and fitness/wellness updates coined from the best sources around the globe: made only for your utmost enjoyment and enlightenment… Click on subscribe to get more spicy episodes for free! See you again soon on the next episode of Health and fitness updates! Learn more about your ad choices. Visit megaphone.fm/adchoices

Following the SOAP approach, we review Subjective, Objective, Assessment & Plan for Ascites & Peritonitis. Exudative versus Transudative classification compared to new SAAG-based classification are discussed for differential diagnosis. Values of SAAG in relation to Protein content, Cell count, LDH and Glucose and pH values as well as major risk factors are discussed to differentiate primary (spontaneous) versus 2ndary bacterial peritonitis. and management guidelines provided. Needs some mathematical understanding of SAAG formula and couple exceptions to the rules (as discussed).

In this episode, we review the high-yield topic of Ascites ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Gastrointestinal section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Joanne e Ingrid Froehner falam sobre indicações de albumina, como prescrever e quando não usar.

Ascites is the final consequence in a series of anatomic, pathophysiologic, and biochemical abnormalities and one of the most common complications of advanced cirrhosis.This EASL Studio will be discussing:Is it all about portal pressure?Which treatment option for which patient?Which trials are needed?FacultyProf. Thomas Reiberger (Moderator)Prof. Benjamin Maasoumy (Faculty)Prof. Virginia Hernández-Gea (Faculty)Prof. Cristina Ripoll (Faculty)All EASL Studio Podcasts are available on EASL Campus.

This is what I would do if I had ascites. Dr. Berg's Keto and IF Lab: https://www.facebook.com/groups/drbergslab/ How to Bulletproof your Immune System FREE Course: https://bit.ly/39Ry3s2 FREE MINI-COURSE ➜ ➜ Take Dr. Berg's Free Keto Mini-Course! ADD YOUR SUCCESS STORY HERE: https://bit.ly/3z9TviS Find Your Body Type: https://www.drberg.com/body-type-quiz Talk to a Product Advisor to find the best product for you! Call 1-540-299-1557 with your questions about Dr. Berg's products. Product Advisors are available Monday through Friday 8 am - 6 pm and Saturday 9 am - 5 pm EST. At this time, we no longer offer Keto Consulting and our Product Advisors will only be advising on which product is best for you and advise on how to take them. Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. Dr. Berg's Website: http://bit.ly/37AV0fk Dr. Berg's Recipe Ideas: http://bit.ly/37FF6QR Dr. Berg's Reviews: http://bit.ly/3hkIvbb Dr. Berg's Shop: http://bit.ly/3mJcLxg Dr. Berg's Bio: http://bit.ly/3as2cfE Dr. Berg's Health Coach Training: http://bit.ly/3as2p2q Facebook: https://www.facebook.com/drericberg Messenger: https://www.messenger.com/t/drericberg Instagram: https://www.instagram.com/drericberg/ YouTube: http://bit.ly/37DXt8C Pinterest: https://www.pinterest.com/drericberg/

  What no oncology patient wants to see or hear... "New lesions. One here... another new lesion here... here... here." "Ascites and another new pocket of fluid here." I'm relying on treatment and some sort of crazy positive... possible outcome. One that, I'm not sure really at this point what to expect. I honestly believe... I am just fooling myself. I had an e-visit this morning to go over things with my hospital specialists and let's face it... things don't look very promising. After I got off that e-visit... I just cried. More so out of frustration. Lately, I have become more angry at myself... for deciding to save myself six years ago. Maxing out the gold standard so to speak, oncology treatments. They didn't even work. Instead, I was released with a five year prognosis. Right now, I feel as if my specialists are just joining me along on this crazy ride to spare me... a bit more time. I'm not even sure if a bit more time is worth this roller-coaster ride?.  Then my specialists assistant calls to go over new medication to help control the pain, that let's face it... has gotten a hell of a lot worse. Hearing recent scan reports, it's no wonder and should it really come as a shock?.. No. More PA forms and other red flags, hurdles for even hospital specialists to jump through with the insurance company. Now since I have two different insurance plans... we are crossing fingers things get approved much sooner! I was hit with a lot of tough questions and decisions that will need answered during my next hospital visit. Five weeks to be precise. I'd be crazy to think... I have no fears. My five year prognosis has come and gone. I then made it past the six year mark. Now as I was told, "Things are progressing and so are secondary complications. Your pain is going to continue getting worse. Do you have all of your wishes in writing?"  I made a phone call after my e-visit to an attorney that the scheduling nurse gave me. If only to make sure I do have all of my wishes correctly, legally documented. I had to make, once again, changes over the past few months. Maybe... I need to make a few other changes?. I'm not sure, but that's why the nurse felt it is good to just sit down and go over everything with an attorney. If I can't physically meet, at least the law office offers video appointments. I have a lot of concerns... obvious fears regarding the path my health is taking. The pain itself concerns me. Especially, because it is starting to radiate in areas that it has yet to reach. The "It's going to continue getting worse part." That is what scares me, because no one wants to be in pain 24/7 that only continues getting worse, not better. Not having much, if any kind of appetite lately, at least makes perfect sense now. You can't get past the reports. Medical reports don't lie. What you can't see with the naked eye.  There were three very valid questions that were asked of me. Decisions that will need to be answered. At least... I have five weeks, soul searching.  For now, at least I am still able to get out on the daily. Walking has always been a way to help free my mind, any stress and to reset myself. At least, I am still able to do so with my beloved Snoreo. He has truly stepped it up since Blue's passing. If there was ever a soul dog... Snoreo is mine. I promised him, we will stick together till the end.  ❣️

Ascites is a condition in which fluid collects in spaces within our abdomen. As fluid collects in the abdomen, it can affect our lungs, kidneys, and other organs. Ascites cause abdominal pain, swelling, nausea, vomiting, and other difficulties. Ascites is a common phenomenon in many cancer types and require a structured approach to deal with. In the last episode, we have discussed what is Ascites, who get affected by it, and what are the implications of Ascites? In today's episode, we have discussed the probable treatment or management options for Ascites. Hope this helps. See you soon. Jai Hind

Ascites is a condition in which fluid collects in spaces within our abdomen. As fluid collects in the abdomen, it can affect our lungs, kidneys, and other organs. Ascites cause abdominal pain, swelling, nausea, vomiting, and other difficulties. Ascites is a common phenomenon in many cancer types and require a structured approach to deal with. In today's podcast, we have discussed what is Ascites, who get affected by it, and what are the implications of Ascites? Hope this helps. See you soon. Jai Hind

Go online to PeerView.com/XNU860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, an expert on refractory ascites and esophageal variceal hemorrhage (EVH) discusses evidence-based strategies to improve patient outcomes. Upon completion of this activity, participants should be better able to: Summarize the prevalence, pathophysiology, and consequences of decompensated cirrhosis and portal hypertension (eg, refractory ascites and EVH), Evaluate the latest evidence for current and emerging approaches to managing patients with refractory ascites and EVH.

Go online to PeerView.com/XNU860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, an expert on refractory ascites and esophageal variceal hemorrhage (EVH) discusses evidence-based strategies to improve patient outcomes. Upon completion of this activity, participants should be better able to: Summarize the prevalence, pathophysiology, and consequences of decompensated cirrhosis and portal hypertension (eg, refractory ascites and EVH), Evaluate the latest evidence for current and emerging approaches to managing patients with refractory ascites and EVH.

Go online to PeerView.com/XNU860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, an expert on refractory ascites and esophageal variceal hemorrhage (EVH) discusses evidence-based strategies to improve patient outcomes. Upon completion of this activity, participants should be better able to: Summarize the prevalence, pathophysiology, and consequences of decompensated cirrhosis and portal hypertension (eg, refractory ascites and EVH), Evaluate the latest evidence for current and emerging approaches to managing patients with refractory ascites and EVH.

Go online to PeerView.com/XNU860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, an expert on refractory ascites and esophageal variceal hemorrhage (EVH) discusses evidence-based strategies to improve patient outcomes. Upon completion of this activity, participants should be better able to: Summarize the prevalence, pathophysiology, and consequences of decompensated cirrhosis and portal hypertension (eg, refractory ascites and EVH), Evaluate the latest evidence for current and emerging approaches to managing patients with refractory ascites and EVH.

Go online to PeerView.com/XNU860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, an expert on refractory ascites and esophageal variceal hemorrhage (EVH) discusses evidence-based strategies to improve patient outcomes. Upon completion of this activity, participants should be better able to: Summarize the prevalence, pathophysiology, and consequences of decompensated cirrhosis and portal hypertension (eg, refractory ascites and EVH), Evaluate the latest evidence for current and emerging approaches to managing patients with refractory ascites and EVH.

Go online to PeerView.com/XNU860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, an expert on refractory ascites and esophageal variceal hemorrhage (EVH) discusses evidence-based strategies to improve patient outcomes. Upon completion of this activity, participants should be better able to: Summarize the prevalence, pathophysiology, and consequences of decompensated cirrhosis and portal hypertension (eg, refractory ascites and EVH), Evaluate the latest evidence for current and emerging approaches to managing patients with refractory ascites and EVH.

Go online to PeerView.com/XNU860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, an expert on refractory ascites and esophageal variceal hemorrhage (EVH) discusses evidence-based strategies to improve patient outcomes. Upon completion of this activity, participants should be better able to: Summarize the prevalence, pathophysiology, and consequences of decompensated cirrhosis and portal hypertension (eg, refractory ascites and EVH), Evaluate the latest evidence for current and emerging approaches to managing patients with refractory ascites and EVH.

Go online to PeerView.com/XNU860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, an expert on refractory ascites and esophageal variceal hemorrhage (EVH) discusses evidence-based strategies to improve patient outcomes. Upon completion of this activity, participants should be better able to: Summarize the prevalence, pathophysiology, and consequences of decompensated cirrhosis and portal hypertension (eg, refractory ascites and EVH), Evaluate the latest evidence for current and emerging approaches to managing patients with refractory ascites and EVH.

Today's Episode Dr. Daniel Chao reviews the case of a 43 year old male who presents to clinic one week after hospitalization with new onset ascites. Today's Host Dr. Daniel Chao is a gastroenterologist at the VA in Loma Linda, California. He completed his fellowship at the University of Irvine, after completing his medical school and residency at the University of Massachusetts. About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj www.BeyondThePearls.net The Dr. Raj Podcast Dr. Raj on Twitter Dr. Raj on Instagram Want more board review content? Crush Step 1 Step 2 Secrets Physiology by Physeo Step 1 Success Stories The InsideTheBoards Study Smarter Podcast The InsideTheBoards Podcast Study on the go for free! Download the Audio QBank by InsideTheBoards for free on iOS or Android. If you want to upgrade, you can save money on a premium subscription by customizing your plan until your test date on our website! Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing info@arslonga.media. Produced by: Christopher Breitigan Executive Producer: Patrick C. Beeman, MD Legal Stuff InsideTheBoards is not affiliated with the NBME, USMLE, COMLEX, or any professional licensing body. InsideTheBoards and its partners fully adhere to the policies on irregular conduct outlined by the aforementioned credentialing bodies. The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

A grab bag of stuff gleaned from the DHM crew @ SHM in Nashville. All sources in this episode can be found in the April 2022 CKC dispatch e-mail dated 4/19/2022. | 00:00 Intro | | 00:39 TOC | | 01:27 HFrEF management | | 02:42 AC monotherapy in stable CAD+Afib | | 03:28 Upper GI bleed management | | 04:15 ID updates (GNR Bacteremia and MRSA) | | 05:22 Ascites, SBP, HRS in Cirrhosis | | 06:23 Post-op complications in elective surgery done peri-COVID | | 07:00 Peri-op LMWH bridging | | 08:03 Midodrine and vasovagal syncope | | 09:05 Closing | [The appearance of external hyperlinks does not constitute endorsements by UCSF of the linked websites, or the information, products, or services contained therein. UCSF does not exercise any editorial control over the information found therein, nor does UCSF make any representation of their accuracy or completeness.]

Aditi Kothari is back to host a thorough review of ascites – how to evaluate, diagnose, and manage ascites from various causes. If you don't remember how to calculate SAAG, this episode is for you. After tuning in to this episode, you'll definitely have a belly full of knowledge. Get it?

Topics covered: Case Study – Ascites – Herbs, Diet, Treatment Discussion on all liver disorders in general Ayurveda practitioners given rights for prescribing some allopathic medicines Turning the medical syllabus into an integrated system combined with Ayurveda and Allopathy? Turning Vegan -> how to cope up with energy deficiency? Eye drops to clear icterus?

Here's what you can do if you have a huge belly that's not actually fat. Join my "Fasting February" Challenge today by clicking here: https://bit.ly/28dayfasting FREE COURSE ➜ ➜ https://courses.drberg.com/product/how-to-bulletproof-your-immune-system/ FREE MINI-COURSE ➜ ➜ Take Dr. Berg's Free Keto Mini-Course! ADD YOUR SUCCESS STORY HERE: https://bit.ly/3z9TviS Talk to a Dr. Berg Product Advisor today and get the help you need on your journey (free consultation). Call 1-540-299-1557 with your questions about Keto, Intermittent Fasting, or the use of Dr. Berg products. Advisors are available Monday/Thursday/Friday 8 AM to 10 PM EST, Tuesday/Wednesday 8 AM to 6:30 PM, Saturday/Sunday 9 AM to 5 PM EST. Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. Dr. Berg's Website: http://bit.ly/37AV0fk Dr. Berg's Recipe Ideas: http://bit.ly/37FF6QR Dr. Berg's Reviews: http://bit.ly/3hkIvbb Dr. Berg's Shop: http://bit.ly/3mJcLxg Dr. Berg's Bio: http://bit.ly/3as2cfE Dr. Berg's Health Coach Training: http://bit.ly/3as2p2q Facebook: https://www.facebook.com/drericberg Messenger: https://www.messenger.com/t/drericberg Instagram: https://www.instagram.com/drericberg/ YouTube: http://bit.ly/37DXt8C

Here's what you can do if you have a huge belly that's not actually fat. FREE COURSE ➜ ➜ https://courses.drberg.com/product/how-to-bulletproof-your-immune-system/ FREE MINI-COURSE ➜ ➜ Take Dr. Berg's Free Keto Mini-Course! ADD YOUR SUCCESS STORY HERE: https://bit.ly/3z9TviS Talk to a Dr. Berg Keto Consultant today and get the help you need on your journey (free consultation). Call 1-540-299-1557 with your questions about Keto, Intermittent Fasting, or the use of Dr. Berg products. Consultants are available Monday through Friday from 8 AM to 10 PM EST. Saturday & Sunday from 9 AM to 6 PM EST. USA Only. Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. Dr. Berg's Website: http://bit.ly/37AV0fk Dr. Berg's Recipe Ideas: http://bit.ly/37FF6QR Dr. Berg's Reviews: http://bit.ly/3hkIvbb Dr. Berg's Shop: http://bit.ly/3mJcLxg Dr. Berg's Bio: http://bit.ly/3as2cfE Dr. Berg's Health Coach Training: http://bit.ly/3as2p2q Facebook: https://www.facebook.com/drericberg Messenger: https://www.messenger.com/t/drericberg Instagram: https://www.instagram.com/drericberg/ YouTube: http://bit.ly/37DXt8C

In this episode, we provide a concise overview of the diagnosis and treatment of hepatorenal syndrome-acute kidney injury (HRS-AKI) with a focus on the new HRS-1 definition (now called HRS-AKI), new data with terlipressin, and the AASLD 2021 guidelines. Key Concepts At a basic level, HRS-AKI is caused by portal hypertension leading to systemic vasodilation and a prerenal state.  Our treatment focuses on increasing vascular volume (usually with albumin) and vasoconstriction to increase renal perfusion. The newest HRS-AKI definition borrows most of the AKI definitions from the KDIGO criteria for AKI.  HRS-AKI requires cirrhosis, ascites, AKI, and an exclusion of other etiologies of AKI. In AKI and HRS-AKI, concentrated (25%) albumin is given. A dose of 1 gm/kg/day (max 100 gm) for two days is used for AKI.  For HRS-AKI, a dose of 20-50 grams/day is recommended. The preferred vasoconstrictor in HRS-AKI is terlipressin; however, it is not available in the US. Norepinephrine (if in the ICU) is second-line.  If not in the ICU, midodrine and octreotide are recommended.  Therapy is continued until renal function recovers, if there is no improvement at 4 days, or if a full 14 days of therapy has been given. References Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014-1048. doi:10.1002/hep.31884 European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406-460. doi:10.1016/j.jhep.2018.03.024

Global Liver Institute Founder, President and CEO Donna Cryer and her fellow patient and patient advocate Terri Milton join Stephen Harrison, Louise Campbell and Roger Green to discuss the ground-breaking NASH Patient-Focused Drug Development meeting held on November 4, 2021 and some personal experiences that made PFDD such a priority.In this conversation, patient and patient advocate Terri Milton shares her 20-year experience with NASH, cirrhosis, HCC (hepatocellular carcinoma) and how related effects like hepatic encephalopathy and the issue of waiting for a liver transplant affect her life. Stephen Harrison laments that he was not Terri's physician and describes the phenomenon of "peak and shriek" when a surgeon opens a patient's midsection and finds previously unknown evidence of cirrhosis. Finally, Louise Campbell discusses the story of Keiron Dyer, a former English national team player currently awaiting a liver transplant for primary sclerosing cholangitis.

Did you know, that the development of ascites in cirrhosis heralds a poor prognosis, with increased morbidity and mortality in these patients? Following up on our series of lectures on cirrhosis, Dr Kevin Teh, Associate Consultant Gastroenterologist, speaks about ascites in chronic liver disease - how we should evaluate for ascites, and how we manage patients with symptomatic ascites secondary to chronic liver disease. We also discuss the indications behind large volume paracentesis, prophylaxis for spontaneous bacterial peritonitis, and some TIPS to lose that water weight. 

This is what I would do if I had ascites. DATA: https://www.ncbi.nlm.nih.gov/books/NB... ADD YOUR SUCCESS STORY HERE: https://bit.ly/3z9TviS FREE COURSE: https://bit.ly/3tFipFK FREE MINI-COURSE ➜ ➜ Take Dr. Berg's Free Keto Mini-Course! Talk to a Dr. Berg Keto Consultant today and get the help you need on your journey (free consultation). Call 1-540-299-1557 with your questions about Keto, Intermittent Fasting, or the use of Dr. Berg products. Consultants are available Monday through Friday from 8 AM to 10 PM EST. Saturday & Sunday from 9 AM to 6 PM EST. USA Only. Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. Dr. Berg's Website: http://bit.ly/37AV0fk Dr. Berg's Recipe Ideas: http://bit.ly/37FF6QR Dr. Berg's Reviews: http://bit.ly/3hkIvbb Dr. Berg's Shop: http://bit.ly/3mJcLxg Dr. Berg's Bio: http://bit.ly/3as2cfE Dr. Berg's Health Coach Training: http://bit.ly/3as2p2q Facebook: https://www.facebook.com/drericberg Messenger: https://www.messenger.com/t/drericberg Instagram: https://www.instagram.com/drericberg/ YouTube: http://bit.ly/37DXt8C

In this episode, hepatologist Dr. Parvez Mantry joins our host Dr. Christopher Beck to discuss portal hypertension and ascites, two complications that arise from liver diseases and have a large effect on patients’ quality of life. Dr. Mantry starts the episode by sharing statistics on Chronic Liver Disease (CLD) and specifically highlights the burden of CLD on the U.S. population. He discusses various causes of CLD, including Hepatitis C, Alcohol Liver Disease, and Non-Alcoholic Steatohepatitis. Next, Dr. Mantry takes us through his diagnostic workup, including his physical examination, cross-sectional imaging, percutaneous and transjugular liver biopsies, and serological workup. He checks for complications such as portal hypertension, ascites, pedal edema, and hepatic encephalopathy. We also discuss the diagnosis of Hepatocellular Carcinoma (HCC). Then, we transition to strategies for managing ascites and portal hypertension through diuretics, paracentesis, Transjugular Intrahepatic Portosystemic Shunts (TIPS), liver transplantation, and a few experimental treatments that he is currently researching. Overall, Dr. Mantry advocates for close monitoring of symptoms and making treatment modifications as needed. Finally, when focusing on the patient experience, Dr. Mantry offers troubleshooting tips, especially for patients who struggle with leakage from the paracentesis site. To close, he gives insights on how physicians can best support chronically-ill patients who are awaiting transplantation. RESOURCES MENTIONED: Methodist Transplant Specialists- https://www.theliverinstitutetx.com/ Information about Dr. Mantry’s transplant center and its satellite locations in the Dallas-Ft. Worth Community. American Association for the Study of Liver Diseases (AASLD) Practice Guidelines- https://www.aasld.org/publications/practice-guidelines Management of HCC- https://www.journal-of-hepatology.eu/article/S0168-8278(12)60009-9/pdf The Management of Ascites in Cirrhosis- https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1053/jhep.2003.50315 Guidelines set by the International Ascites Club BackTable Endovascular Podcast, Ep. 123- TIPS University Freshman Year: Referrals and Pre-Op Workup- https://www.backtable.com/podcast/123/tips-university-freshman-year-referrals-pre-op-workup

Let's talk about Cirrhosis! Learn about the signs and symptoms, the complications, and what you, as the nurse, can do about it.Over 44,000 people die every year from cirrhosis, so it’s the 9th leading cause of death in the US. Cirrhosis is an incurable form of liver disease that happens slowly due to inflammation and scarring of the liver tissue. When you think of cirrhosis, think of scarring, or “Scarosis”. The main cause is chronic hepatitis C. The other two causes are: drinking too much alcohol, and nonalcoholic fatty liver disease. Nonalcoholic fatty liver disease is when too much fat gets stored in the liver cells, and this can be from obesity or diabetes.So the liver cells get damaged, they try to fix themselves, but just wind up making scar tissue instead. So instead of having a nice, smooth liver, you’ve got a lumpy mess of a liver with constrictive bands that cut off the flow of blood and bile. Remember bile is made in the liver, and then has to go to the gallbladder to be stored. So why do we care so much about the liver? What does it do for us?Our liver detoxifies alcohol and drugs. It breaks down proteins and carbs, and steroid hormones. It makes blood clotting factors, so if your liver isn’t working, you’re gonna have a decrease in every coagulation factor, except factor 8. The liver makes blood proteins, like Albumin, and if you remember, Albumin is the main protein in your blood, and the main thing regulating your oncotic pressure, or the thing that’s keeping your fluids in your blood vessels, and not seeping out into the tissue. So when the liver isn’t making enough Albumin, we’re gonna see edema and ascites. Ascites is when too much fluid builds up in the peritoneal cavity, causing a big swollen belly. A normal liver will store glucose as glycogen for later use, but with an impaired liver, we could see hypoglycemia or hyperglycemia cause the body’s having a hard time regulating the glucose levels. The liver makes bile, and bile absorbs fat and gets rid of bilirubin. Bilirubin is a yellow pigment that’s a byproduct of your old red blood cells getting broken down. A healthy liver will take that bilirubin and put it in your poop with bile to get rid of it. This is what makes your poop brown. So without that bile, your poop is gonna be pale and clay-colored, because you’re not getting rid of the bilirubin pigment, and that bilirubin is gonna keep building up building up and make your skin and the whites of your eyes yellow. 

Alcoholism damages the liver and this can cause ascites, a condition whereby the abdominal cavity gets filled with fluid. In today’s show, you’ll learn more about what happens in the liver for this condition to be caused, and the role of not just alcohol but fat in causing liver damage.

Pathophysiology, causes, investigation, treatment, complication

Listen to the story of Viveka Dubey, a brave woman who defeated malignant Ascites three times with her strong willpower and determination. ZenOnco.io - Making quality integrative oncology cancer care accessible to all. If you or your loved one has been diagnosed with cancer recently, and need guidance on treatment or have any doubts or queries, please call ZenOnco.io on +91 99 30 70 90 00.

Ep. 87 Deep Dive Into Ascites with Dr. Rajeev Suri by BackTable

Episode 1186. Today, poultry veterinarian Dr. Maurice Pitesky, DVM will teach us how to perform a physical exam, and identify Ascites/Water Belly in chickens. Backyard Poultry with the Chicken Whisperer®, brought to you by Kalmbach Feeds, is a nationally broadcast web radio show and podcast all about keeping backyard poultry, commercial poultry, show poultry, heritage poultry, and living a self-sufficiant lifestyle. Each week, the Chicken Whisperer®, Editor In Chief of, Chicken Whisperer Magazine, Author of, The Chicken Whisperer's Guide To Keeping Chickens, and Chicken Fact or Chicken Poop, and National Spokesperson for the USDA-APHIS Biosecurity for Birds Program, welcomes experts in their field from around the country to share their knowledge about backyard poultry, commercial poultry, show poultry, heritage poultry, and living a self-sufficiant lifestyle. Regular guests include, poultry scientist Dr. Brigid McCrea, Ph.D., poultry veterinarian, Dr. Maurice Pitesky, DVM, MPVM, Dipl ACVPM, Alexandra Douglas, aka The Quail Lady, and more! Other guests include, but are not limited to, FFA members, 4H members, poultry club members, and the who's who in the backyard poultry, commercial poultry, show poultry, and self-sufficiant lifestyle industries. The Backyard Poultry with the Chicken Whisperer® web radio show has given away more chicken coops, and chicken related prizes than anyone else on the planet! Tune in to learn more about raising healthy poultry from the experts!

Episode description Reza and Rabih tackle a case of Ascites. More about the RLR series here. Ascites Schema Episode Summary An elderly woman with a history of progressive weakness, falls, and recently diagnosed ascites presented with weight loss and functional decline. Her workup was notable for ascites with a low serum-ascites albumin gradient (SAAG), thrombocytosis, and… Read More »Episode 114: RLR #15 – Ascites (patient) and Tears (RR)

Talk to a Dr. Berg Keto Consultant today and get the help you need on your journey (free consultation). Call 1-540-299-1557 with your questions about Keto, Intermittent Fasting, or the use of Dr. Berg products. Consultants are available Monday through Friday from 8 AM to 10 PM EST. Saturday & Sunday from 9 AM to 6 PM EST. USA Only. Get Dr. Berg's Veggie Solution today! • Flavored (Sweetened) - https://shop.drberg.com/veggie-solution-flavored-sweetened?utm_source=Podcast&utm_medium=AGM(Anchor) • Plain (Unflavored) - https://shop.drberg.com/veggie-solution-plain?utm_source=Podcast&utm_medium=AGM(Anchor) Take Dr. Berg's Free Keto Mini-Course! In this podcast, Dr. Berg discussed the non-fat belly (Ascites), a condition where a person has a protruded stomach and it is not coming from fats but fluids. It is caused by a damaged liver that causes leakage of fluid and the accumulation of the protein fluid in the abdominal cavity. In this condition, there is a replacement of the normal healthy liver cells replaced with fibrous scar tissue that end up losing the function of the liver cells. Here's what you need to do: 1. Lower Carbohydrates 2. Stop all alcohol 3. Moderate protein / fat 4. Cruciferous vegetables – Fiber – Increase bile 5. Intermittent Fasting 6. Give it 3 years Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. FACEBOOK: fb.me/DrEricBerg?utm_source=Podcast&utm_medium=Anchor TWITTER: http://twitter.com/DrBergDC?utm_source=Podcast&utm_medium=Post&utm_campaign=Daily%20Post YOUTUBE: http://www.youtube.com/user/drericberg123?utm_source=Podcast&utm_medium=Anchor DR. BERG'S SHOP: https://shop.drberg.com/?utm_source=Podcast&utm_medium=Anchor MESSENGER: https://www.messenger.com/t/drericberg?utm_source=Podcast&utm_medium=Anchor DR. BERG'S VIDEO BLOG: https://www.drberg.com/blog?utm_source=Podcast&utm_medium=Anchor

In this episode, we welcome Dr Adam Lawson, Consultant Hepatologist, who discusses the management of ascites with Dr Rachel Saville.

Episode description  Rabih, Reza, Ryoko, Arsalan, and Sharmin share their approach to ascites Download CPSolvers App here Ascites Schema Patreon website

In this episode you'll hear about Ascites, what it is, and how Lupus can cause it. --- Send in a voice message: https://anchor.fm/susan-hendrix/message

Chylous Ascites

Ascites is the pathologic accumulation of fluid in the abdominal cavity. In this episode, we review the pathophysiology, clinical presentation, diagnosis and management of ascites, with a focus on ascites secondary to liver cirrhosis. Be sure to check out www.theinternatwork.com for our accompanying infographic.

[caption id="attachment_1113" align="alignright" width="300"] Plucked chickens ready to be examined along with healthy hearts, liver, and gizzard.[/caption] Episode 68, I help you identify poultry production problems from your gutting table. When your chickens are laying on your table naked and unafraid, they hold no secrets. It's the perfect time to observe them as a way to identify production problems. This episode examines the scratches, bruises, hearts, livers, gizzards, green muscle disease, ascites, and uneven growth and ties it back what happened during the growout period. Pastured Poultry News Round Up A Small Business Administration report identifies over $1 billion in bad loans for contract poultry barns. At issue is whether or not poultry contract growers are really independent businesses or just affiliates of the integrators. Spoiler alert. SBA calls them affiliates and therefore finds they aren't entitled to taxpayer subsidized and guaranteed loans. Read article. Ding. Dong. The Organic Livestock and Poultry Practices update to the NOP is officially dead. Fertrell announces a non-soy protein pellet that doesn't sacrifice growth. Check them out. Poultry Man developed a new universal, round kill cone for broilers, hens, ducks, geese, and heritage turkeys. Contact info@millsidefarm.com for details. Ascites (aka water belly) You identify ascites by the belly full of fluid and purple skin. Ascites likely happened weeks before and many times can be traced to a traumatic event in the brooder-at least for most pastured poultry producers. Scratches on Back of Broilers When the back of your broilers are scratched up, you have feeding problem. It's time to reevaluate your approach to feeding and management. Bruises and Dislocations Did you know that a bruise requires blood, and the color of a bruise is an indicator of the age of the bruise? It is. Many times you blame the plucker for breaking your chicken's wing, but if there is bruising, look at handling errors or other injuries in the field. Runts and Uneven Growth Of all the things I talk about on this episode, identifying the cause of uneven growth is the most difficult to diagnose. I share some common places to investigate. It's not always genetic, and it's not always your feed. Green Muscle Disease Also called deep pectoral myopathy. Green muscle is discovered by the green decaying tender of large breasted birds. You only see it when you cut open the bird. While green muscle is likely genetically predisposed, a high incidence rate is a signal that you should look for problems in the field. Healthy Hearts, Livers, and Gizzards Always examine the organs. Healthy livers have crisp edges, a uniform color, and are firm. Hearts should be firm, have a bit of fat on the tip, and muscular walls. The gizzard should be firm, large, and muscular. There's a good test when dealing the organs and judging their health. Ask yourself, "would I eat that?" If the answer is no, then there's a problem. ==> Download a live processing cost calculator that Mike uses to estimate equipment costs, labor costs, and total cost of processing your own chickens.  Have some feedback? mike@pasturedpoultrytalk.com

Dr David Johnson provides clinicians with an overview of the new guidelines from the American Association for the Study of Liver Diseases (AASLD) on hepatocellular carcinoma.

Announcing our upcoming contest! Does your hen look like its gone gangsta?  We thought maybe one of our hens had been talking to the local High School kids, and had started sagging her pants; but it turns out that she has ascites!  There are several conditions that can cause your hen to look like her abdomen is sagging.  Some of them are dire emergencies- none of them are good.  During the show we're going to explore the different conditions that cause this symptom, and what the treatments for these conditions are.  Treating ascites requires some special skills and tools, you'll want to know what these are so you can be ready in advance! We're not just talking about dire medical conditions like ascites though;  tune in to hear about our upcoming contest!  We've been working away on a special, unique project for lovers of arcane chicken lore.. Have you ever wondered if people did things differently when raising chickens 150 years ago?  Heres your chance to find out!  Listen to the show for all the details! Remember some time ago we mentioned that A French artist had closed himself up in a giant display case in an art museum where he was trying to brood a clutch of chicks?  Well, despite prognostications of doom from the "experts"; success!  What in the ever-lovin' what?!  We'll catch you up on this guys crazy experiment! And of course, not content to be merely on the cutting edge of all things medical and experimental  of a chicken nature, we also have you covered with obscure, chicken entertainment as well!  We found a highly entertaining music video and song we think really captures what the show is all about;  stay through to the end for Linus Lemon's glorious ode to his chickens! Where are you going to learn about ascites, watch a French artist try to hatch chicks with his body heat, and add to your ever-expanding collection of Odes to the Chicken?  -Twin Beaks Chicken Podcast -Of course!

Same as episode 68, but should load quicker on your podcast player. Zach Skow is founder of Marley’s Mutts Dog Rescue in Tehachapi, California. Several years ago, Zach was dying of liver and kidney failure from his struggles with alcoholism and drug addiction. Amazingly, several months after a very low point for him, Zach’s health improved. He longer required an organ transplant, and now lives alcohol and drug-free. His only drugs are Veg-E-Tables. Zach credits his survival to his rescue dogs Marley and Tug, along with his father’s love and support. As Zach says, “a pit bull saved my life.” Marley is a Rottweiler-Pit Bull mix. Marley’s Mutts has gained an active following on social media with over 500,000 followers on Facebook, and in today’s episode Zach discusses the many programs that Marley’s offers along with the future direction of the organization. If you want to learn more about Zach Skow and Marley’s Mutts, go to our show notes at http://thisispawprint.com/68.   Website http://www.marleysmutts.org Facebook, over 500,000 followers! https://www.facebook.com/MarleysMuttsDogRescue/?fref=ts Marley’s Instagram https://www.instagram.com/marleysmutts/ Hooch’s Instagram https://www.instagram.com/hooch_pooch/ Twitter https://twitter.com/mmdogrescue   DONATE to Marley’s Mutts http://www.marleysmutts.org/donate/ Pawsitive Prison Program http://www.marleysmutts.org/marleys-mutts-prison-program/ Miracle Mutts Program http://www.marleysmutts.org/the-miracle-mutts-program/   Special thanks to Cindy Young and Amy Klein for making the interview with Zach possible. Photo credits: Marley’s Mutts Dog Rescue   Ascites is the buildup up fluid in the stomach which can be caused by liver failure http://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/ascites Thanks to Dave Lee of the Modern Life Podcast Network for mentioning Zach to me over Twitter. https://modernlifepodcastnetwork.com For our Pit Bull Series, we are giving away some cool items like a collection of rescue-themed books, a dog goodie bag, and a cat goodie bag. Go to http://thisispawprint.com/giveaway to learn more. If you want to join our animal rescue community and receive two free bonus dog-training resources from Irith Bloom, positive reinforcement dog trainer, go to http://thisispawprint.com/ask. Irith can be found at http://www.thesophisticateddog.com/ All of Pawprint's music is composed by Luke Gartner-Brereton. Luke is a musician based in Australia, and he composes a wide variety of songs and musical loops http://vanillagroovestudios.com http://soundcloud.com/luke-gartnerbrereton If you want to learn more about Nancy and Harold, go to our About Us page at http://thisispawprint.com/about or listen to our introductory podcast episode, "Fifty Puppies and a Podcast." http://thisispawprint.com/000 Pawprint (or Paw Print) is a weekly podcast dedicated to animal rescue, adoption, and the heroes who make it happen. Volunteer, walk, adopt, or foster a dog, cat, rabbit, or other wonderful pet through your local shelter, humane society, SPCA, pound, and animal control. Stop abuse, and help increase animal protection, welfare, and rights.  http://thisispawprint.com http://animalrescuepodcast.com

Adventures of a Pus Whisperer.

Dr. Brian Beauerle covers the basics of cirrhosis including pathophysiology, symptoms and survival of patients with survival. He covers when and how to perform a paracentesis including interpretation of results. He discusses pharmacologic and dietary treatment of ascites and refractory ascites. He closes with complications of ascites including spontaneous bacterial peritonitis and hepatic hydrothorax.Disclaimer: http://LouisvilleLectures.org/disclaimer©2015 LouisvilleLectures.org

Heart failure (HF) is, after cirrhosis, the second-most common cause of ascites. Serum B-type natriuretic peptide (BNP) plays an important role in the diagnosis of HF. Therefore, we hypothesized that BNP would be useful in the differential diagnosis of ascites. Consecutive patients with new onset ascites were prospectively enrolled in this cross-sectional study. All patients had measurements of serum-ascites albumin gradient (SAAG), total protein concentration in ascitic fluid, serum, and ascites BNP. We enrolled 218 consecutive patients with ascites resulting from HF (n = 44), cirrhosis (n = 162), peritoneal disease (n = 10), and constrictive pericarditis (n = 2). Compared to SAAG and/or total protein concentration in ascites, the test that best discriminated HF-related ascites from other causes of ascites was serum BNP. A cutoff of >364 pg/mL (sensitivity 98%, specificity 99%, and diagnostic accuracy 99%) had the highest positive likelihood ratio (168.1); that is, it was the best to rule in HF-related ascites. Conversely, a cutoff ≤182 pg/mL had the lowest negative likelihood ratio (0.0) and was the best to rule out HF-related ascites. These findings were confirmed in a 60-patient validation cohort. Conclusions: Serum BNP is more accurate than ascites analyses in the diagnosis of HF-related ascites. The workup of patients with new onset ascites could be streamlined by obtaining serum BNP as an initial test and could forego the need for diagnostic paracentesis, particularly in cases where the cause of ascites is uncertain and/or could be the result of HF.

JAMAevidence Podcast

Joan Stephenson, PhD, discusses Ascites with Dr John W. Williams.

Dr. Fasiha Kanwal discusses her manuscript "The Quality of Care Provided to Patients With Cirrhosis and Ascites in the Department of Veterans Affairs."

Satavaptan, a vasopressin V2 receptor antagonist, has been shown to improve the control of ascites in cirrhosis in short-term phase II studies. The aim of this study was to evaluate the efficacy and safety of satavaptan in three different populations of patients with cirrhosis and ascites.

Treatment of Ascites, Portal Vein Thrombosis and Hepatic Encephalopathy in Patients with Cirrhosis of the Liver Background: Ascites, portal vein thrombosis and hepatic encephalopathy are important complications of cirrhosis of the liver. Guidelines for the treatment of ascites have recently been published. Method: This manuscript summarizes up-to-date recommendations on the basis of the DGVS S3 guideline and of other guidelines as well as of the authors' experience. Results and Conclusions: TIPS (transjugular intrahepatic porto-systemic shunt) is the preferred treatment for refractory or recidivant ascites unless there are contraindications. The therapy of hepatorenal syndrome type 1 with albumin and the vasoconstrictor Terlipressin has been proven effective. Treatment of portal vein thrombosis comprises a strategy of anticoagulation, TIPS and liver transplantation. The most important therapeutic strategy for hepatic encephalopathy is the search for as well as the treatment of trigger events. Rifaximin is being increasingly used for the treatment and prophylaxis of hepatic encephalopathy.

Refractory ascites is a frequent complication of advanced cirrhosis and is associated with hepatorenal syndrome and hepatic hydrothorax. Large volume paracentesis and pleurodesis are regarded as first-line treatments in patients who do not respond adequately to diuretics. These treatments, however, do not prevent recurrence and carry the risk of worsening of the circulatory dysfunction leading to hepatorenal syndrome. The transjugular intrahepatic portosystemic shunt ( TIPS) has been proposed as an alternative to paracentesis. TIPS reduces the rate of ascites recurrence mainly due to the reduction in the filtration pressure. In addition, TIPS results in a positive effect on renal function, including hepatorenal syndrome, demonstrated by a rapid increase in urinary sodium excretion, urinary volume, and improvement in plasma creatinine concentration. Furthermore, plasma renin activity, aldosterone, and noradrenalin concentrations improve gradually after TIPS insertion suggesting a positive effect on systemic underfilling, the factor of hepatorenal syndrome. As demonstrated recently in two meta-analyses including five randomised studies, TIPS also improves survival when compared with paracentesis. However, the evidence is based on relatively few studies with only 305 patients included. The positive effects of the TIPS are opposed by an increased frequency and severity of episodes of hepatic encephalopathy which may be reduced by both patient selection and reduced shunt diameter. Based on the present knowledge the recommended hierarchy of treatments for refractory ascites may be reconsidered upgrading TIPS in suitable candidates.

Background. We have recently shown that the transjugular intrahepatic portosystemic shunt (TIPS) is more effective than paracentesis in the treatment of cirrhotic patients with severe ascites and can prolong survival in selected patients. Although an improved quality of life (QOL) has been suggested in these patients after the TIPS procedure, so far there are no data available to substantiate this assumption. Therefore, the aim of this study was to determine the effect of TIPS on the QOL in cirrhotic patients with refractory or recidivant ascites. Methods: 21 cirrhotic patients who underwent TIPS for refractory or recidivant ascites were investigated. All patients were pretreated with repeated paracentesis for at least 1 year. Before the procedure and at 3 and 6 months during follow-up, the patients themselves rated QOL, fatigue and physical performance on a visual analogue scale (range 0-100). Furthermore, QOL was determined by the QOL index (range 0-10) according to Spitzer. Results: Patients' rating of the QOL on the visual analogue scale significantly increased from 35 +/- 25 (baseline) to 64 +/- 28 (3 months), and 66 +/- 24 (6 months; p = 0.02). Similarly, the QOL index significantly increased from 6.9 +/- 2.0 (baseline) to 8.3 +/- 2.1 (3 months), and 8.6 +/- 1.7 (6 months; p < 0.001). The increase of QOL was more pronounced in patients with complete response to TIPS. Conclusions: We demonstrate that TIPS for refractory or recidivant ascites improves the QOL in patients with cirrhosis. Our data indicates that this improvement is dependent on the response to therapy. Copyright (C) 2002 S. Karger AG, Basel.

Sat, 1 Jan 1994 12:00:00 +0100 https://epub.ub.uni-muenchen.de/5989/1/Gerbes_Alexander_5989.pdf Schölmerich, J.; Gerbes, Alexander L. ddc:610, Medizin

Torasemide is a new loop diuretic with a longer half-life and longer action than furosemide in healthy subjects. In order to evaluate the pharmacodynamic effects, single oral doses of furosemide (80 mg) and torasemide (20 mg), which were equipotent in healthy subjects, were given to 14 patients with cirrhosis and ascites. Before the study patients underwent an equilibration period of 4 days without diuretics. The drugs were alternated following a randomized double-blind cross-over design after a wash-out period of at least 2 days. Urine was collected at defined intervals for 24 h after drug administration and blood samples were taken before, 6 h and 24 h after medication. Torasemide induced greater cumulative 24 h diuresis (2863 ± 343 vs. 2111 ± 184 ml, p < 0.01) than furosemide. Torasemide did not differ from furosemide for cumulative 0–6 h sodium excretion (96 ± 17 vs. 92 ± 23 mmol sodium) but caused a more pronounced cumulative 6–24 h natriuresis (38 ± 11 vs. 17 ± 4 mmol, p < 0.05). Five patients exhibited a weak response to furosemide (0–36 mmol sodium/24 h, median 24 mmol; 690–1460 ml urinary volume/24 h, median 1325 ml). These patients showed significantly higher natriuresis and diuresis following torasemide (26–136 mmol sodium/24 h, median 78 mmol, p < 0.05; 1670–3610 ml urinary volume/24 h, median 2200 ml, p < 0.05). Twenty-four hours after administration of both drugs there were no significant changes in hemodynamic, renal or hormonal parameters. No adverse effects were noted with either treatment. These findings suggest that torasemide might be more advantageous than furosemide in the treatment of ascites due to cirrhosis.

Fri, 1 Jan 1993 12:00:00 +0100 https://epub.ub.uni-muenchen.de/6065/1/6065.pdf Gerbes, Alexander L.; Paumgartner, Gustav ddc:610, Medizin

Medical treatment of cirrhotic ascites is essentially supportive, dictated by the patient's discomfort, impaired cardiovascular or respiratory function and potential for infection. Treatment of ‘simple’ ascites (moderate fluid accumulation, serum albumin > 3.5 g/dl, serum creatinine < 1.5 mg/dl, no electrolyte disturbance) is implemented sequentially. Only 10% of patients respond to dietary sodium restriction and bed rest; most require pharmacotherapy consisting of spironolactone, which increases the proportion of responding patients to 65% and loop diuretics, which may produce clinical improvement in an additional 20% (85% in all); in the remaining 15% of refractory patients, use of novel adjunctive therapies may be attempted. Patients with tense ascites, impaired renal function and electrolyte disturbances merit special consideration before diuretics are introduced. Spironolactone has long been a standard for the treatment of cirrhotic ascites because it directly antagonizes aldosterone. The loop diuretic most frequently added to spironolactone has been furosemide. However, there is preliminary evidence that torasemide may be more effective in some patients. Other investigational agents that may play a role in treatment of patients resistant to conventional drugs include ornipressin (a vasopressin analogue) and atrial natriuretic factor.

The existence of marked elevations of ascitic fluid cholesterol has been observed in patients with peritoneal carcinomatosis compared to patients with cirrhosis and has been found useful in differential diagnosis. This finding could be caused by an enhanced movement of plasma lipoproteins into the peritoneal cavity. To test this hypothesis we determined the fasting concentrations of total, high density lipoprotein (HDL)- and low density lipoprotein (LDL)-cholesterol, apolipoprotein-A1 (apo-A1) and apolipoprotein-B (apo-B) in serum and ascites of 17 patients with cirrhosis and 16 patients with peritoneal carcinomatosis. The movement of proteins from plasma to ascites was calculated from the ascites/serum concentration ratios of six different sized proteins with a molecular mass ranging from 54 kDa to 971 kDa. Mean values (mg/dl) for total cholesterol (92.6 vs. 21.0), HDL-cholesterol (15.6 vs. 1.8), LDL-cholesterol (63.4 vs. 16.1), apo-A1 (50.2 vs. 13.6) and apo-B (41.2 vs. 12.9) in ascites were significantly higher in peritoneal carcinomatosis than in cirrhosis. These differences could only partially be explained by the higher serum concentrations of these parameters in peritoneal carcinomatosis, but were mainly due to a lower selectivity for the movement of plasma proteins and lipoproteins into ascites (mean ascites/serum (A/S) ratio: 0.30–0.77) in peritoneal carcinomatosis as compared to cirrhosis (mean ascites/serum ratio: 0.11–0.21). In both groups about 85% of the total cholesterol in serum and ascites consisted of HDL- and LDL-cholesterol. These findings support the hypothesis that elevations in ascitic cholesterol in peritoneal carcinomatosis compared to cirrhosis are mainly caused by the increased movement of plasma HDL and LDL into the peritoneal cavity.

Human chorionic gonadotropin (hCG) is a clinically relevant marker of trophoblastic and nontrophoblastic malignancies. In the present studies, in addition to determining serum hCG, we investigated the presence and properties of hCG immunoreactivity in ascites of patients with nontrophoblastic malignant tumors and, for comparison, in ascites caused by cirrhotic liver disease. Total hCG immunoreactivity [hCG (+hCG-ß)] was found to be elevated above the reference value (>5 IU/liter) in the serum of 2 of 20 patients with cirrhosis and 11 of 20 patients with malignant tumors. For comparison, in ascites, hCG (+hCG-ß) concentrations were frequently higher than in the corresponding serum samples and exceeded 10 IU/liter in 0 of 20 cirrhotic samples and in 16 of 20 malignant samples. In order to elucidate the nature of the hCG immunoreactive material, all samples were then assessed by immunoradiometric assays specific for the intact hCG molecule (holo-hCG) and the free hCG-ß subunit, respectively. In the holo-hCG assay, elevated values were detected in 0 of 20 (0 of 20) cirrhotic ascites (serum) samples and 0 of 20 (1 of 20) malignant ascites (serum) samples. In the free hCG-ß assay, on the other hand, no positive results were obtained in the ascites or serum of 20 patients with liver cirrhosis; however, 8 of 20 serum samples and 16 of 20 ascites samples derived from tumor patients were positive. In accord with the immunological data, gel chromatographical studies of malignant ascites revealed the abundance of free hCG-ß subunit rather than that of holo-hCG. In contrast to malignancy-related ascites, in ascites of patients receiving hCG injections for treatment of infertility, holo-hCG was more abundant than free hCG-ß immunoreactivity. Incubation experiments of purified holo-hCG in ascites for 24 h at -20, 20, or 37°C showed no substantial dissociation of the hCG molecule and release of free hCG-ß immunoreactivity, thus arguing against production of free hCG-ß by degradation of holo-hCG and in favor of its tumor-related secretion. In conclusion, hCG-ß immunoreactivity is frequently elevated in malignancy-related ascites and appears to be related to the presence of free ß subunit of hCG rather than that of the intact hCG molecule. Interestingly, hCG-ß determination in ascites proved to be clearly superior to serum measurement in discriminating between tumor and cirrhosis. Thus, hCG-ß might be a useful marker of malignancy-related ascites and should be prospectively assessed for possible clinical use in comparison with other well-established parameters, such as cytology and protein determination. For this purpose, according to our results, only assays that exhibit a high sensitivity for free hCG-ß subunit appear to be suitable.

The authors tried to differentiate malignancy-related from nonmalignant ascites with a sequence of sensitive followed by specific ascitic-fluid parameters. There were four results of this study. First, of nine parameters investigated in a first series of 48 patients, 28 with nonmalignant and 20 with malignancy-related ascites, ascitic-fluid cholesterol and fibronectin yielded the best negative predictive value of 92% each. Carcinoembryonic antigen (CEA) and cytologic examination both showed a positive predictive value of 100%. Second, combining cytologic examination (sensitivity, 70%) and CEA determination (sensitivity, 45%) increased the sensitivity to 80%. Third, cytologic findings were negative in all ascitic-fluid samples with a cholesterol concentration below the cutoff value of 45 mg/100 ml. Fourth, based on the results of the first series of 48 patients, the diagnostic sequence with cholesterol as a sensitive parameter, followed by the combination of cytologic examination and CEA determination as specific parameters, was tested in a second series of 71 patients, 37 with nonmalignant and 34 with malignancy-related ascites. Again cytologic examination was negative in all samples with cholesterol levels below 45 mg/100 ml. In the total of 119 patients, this diagnostic sequence did not identify 9% of patients with malignancy-related ascites, and 82% of samples classified as malignancy related by cholesterol levels above 45 mg/100 ml were confirmed by positive cytologic examination and/or CEA level above 2.5 ng/ml. Thus, a diagnostic sequence with ascitic-fluid cholesterol determination, followed by cytologic examination and CEA determination, in samples with cholesterol levels above 45 mg/100 ml should permit a cost-efficient routine differentiation of malignancy-related from nonmalignant ascites.

Tue, 1 Jan 1991 12:00:00 +0100 https://epub.ub.uni-muenchen.de/6064/1/6064.pdf Gerbes, Alexander L. ddc:610, Medizin

The renal response to atrial natriuretic factor is blunted in cirrhosis with ascites. This might be due to alterations of renal receptors for atrial natriuretic factor. Therefore density and affinity of glomerular atrial natriuretic factor binding sites of bile duct-ligated rats with ascites (n = 10) and of sham-operated controls (n = 10) were determined. Glomerular atrial natriuretic factor binding sites were identified to be of the B-(biologically active) and C-(clearance) receptor type. Discrimination and quantitative determination of B and C receptors for atrial natriuretic factor were achieved by displacement experiments with atrial natriuretic factor(99-126) or des(18-22)atrial natriuretic factor(4-23), an analogue binding to C receptors only. Density of total glomerular atrial natriuretic factor binding sites was significantly increased in bile duct-ligated rats (3,518 ± 864 vs. 1,648 ± 358 fmol/mg protein; p < 0.05). This was due to a significant increase of C-receptor density (3,460 ± 866 vs. 1,486 ± 363 fmol/mg protein; p < 0.05), whereas density of B receptors was not significantly different in bile duct-ligated rats (58 ± 11 vs. 162 ± 63 fmol/mg protein). Affinity of atrial natriuretic factor to its glomerular binding sites did not differ significantly between both groups. These data suggest that an altered glomerular atrial natriuretic factor receptor density could be involved in the renal resistance to atrial natriuretic factor in cirrhosis with ascites.

Sun, 1 Jan 1989 12:00:00 +0100 https://epub.ub.uni-muenchen.de/6098/1/6098.pdf Arendt, Rainer M.; Xie, Yining; Vollmar, Angelika M.; Gerbes, Alexander L.

Fri, 1 Jan 1988 12:00:00 +0100 https://epub.ub.uni-muenchen.de/6093/1/6093.pdf Liebermeister, R.; Paumgartner, Gustav; Sauerbruch, Tilman; Silz, S.; Arendt, Rainer M.; Gerbes, Alexander L. ddc:610, Medizin

The density and affinity of beta-2-adrenoceptors on mononuclear cells from peripheral blood were studied in fifteen patients with cirrhosis of different severity and in thirteen controls. There was no significant difference between cirrhotic patients and controls in density or affinity of beta-2 binding sites. Within the cirrhotic group, however, the number of binding sites per cell was significantly lower in patients with severe ascites than in patients with mild to moderate or no ascites. This down-regulation of beta-adrenoceptors could influence the haemodynamic response to beta-blockers.

Ascitic fluid concentrations of cholesterol, triglycerides and phospholipids, were compared with ascitic fluid total protein in 40 patients with chronic liver disease, 51patients with various neoplasms and 1 patient with cardiac failure. Seven patients withboth chronic liver disease and malignancy were considered separately. The first 54 patients (23 cirrhotic and 31 with malignancy) were used to determine median values and ranges and to define the most suitable cutoff concentrations between both groups. Median values for cholesterol (75 mg per dl), phospholipids (0.79 mmole per liter), triglycerides (75 mg per dl) and protein (3.8 gm per dl)were higher in malignant ascites compared to ascitic fluid concentrations of cholesterol (20 mg per dl), phospholipids (0.33 mmole per liter), triglycerides (51 mg per dl) and protein (1.9 gm per dl) in patients withcirrhosis. The best discrimination values were 48 mg per dl for cholesterol, 0.6 mmole per liter for phospholipids, 65 mg per dl for triglycerides and 2.5 gm per dl for protein. Application of these cutoff points to 38 subsequent patients (17 cirrhotic, 1 with cardiac failure and 20 with malignancy) revealed an efficiency of 86.8% for cholesterol, 86.8% for phospholipids, 68.4% for triglycerides and 79.0% for protein. From the data of all 92 patients, an efficiency of 92.3% forcholesterol, 79.4% for phospholipids, 72.8% for triglycerides and 79.4% for protein was calculated. We conclude that ascitic fluid cholesterol determination offers an excellent, cost-effective discrimination of ascites due to cirrhosis vs. ascites caused by malignancies.

High concentrations of lipids in ascites fluid caused by peritoneal carcinomatosis have been described recently. Since their nature has not yet been clarified, we isolated ascitic lipids from 25 patients with various neoplasms for further characterization. After chromatography on Sephadex G-100 gels, the ascitic lipids were fractionated on a Biogel A-5m column in three peaks. The second and third peaks were identified as low and high density lipoproteins, which were most likely of plasmatic origin, and represented the major amounts of ascitic lipids. The first peak was eluted in the void volume, indicating a molecular weight over 5 million. It consisted, on the average, of 65.3% protein, 16.2% triglycerides, 7.4% phospholipids, and 7.0% cholesterol. In a CsCl gradient, this protein-lipid complex floated in the density range from 1.128 to 1.181 g/ml. Sodium dodecyl sulfate: polyacrylamide gel electrophoresis separated up to 11 protein subunits (Mr 29,000 to 97,000), and electron microscopy revealed globular particles of 36 to 64 nm in diameter. The macromolecular complex showed no immunological reaction against anti-{alpha}- and anti-ß-lipoproteins, but a single precipitation line against anti-liver-specific lipoprotein was seen. The biochemical characteristics of this protein-lipid complex proved to have a close relationship to liver-specific lipoprotein. It is most likely derived from cell membranes of the peritoneum detached by carcinomatosis.

Listen to 3 cardiorenal cases that highlight that “without flow it really doesn't matter what you're doing with the diuretic!”Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with FreedTimestamps:(01:53) | Case 1: Diuretic Resistance from Ascites and Intra-abdominal Hypertension(09:57) | Case 2: Diuretic Resistance from Low Cardiac Output(26:34) | Case 3: Diuretic Resistance from Inadequate Renal Perfusion PressureTranscript and Show notesCardiorenal Considerations: 5 Pearls SegmentTags:IMCore, CoreIM, Diuretics, Cardiorenal, Medical Education, nephrology, cardiology, CCU, ICU, critical careFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Fri, 1 Jan 1960 12:00:00 +0100 https://epub.ub.uni-muenchen.de/7678/1/7678.pdf Holzer, H.; Schneider, S.; Scriba, Peter Christian

Thu, 1 Jan 1959 12:00:00 +0100 https://epub.ub.uni-muenchen.de/8774/1/8774.pdf Scriba, Peter Christian