Podcasts about patients with cirrhosis

Host: Jody Takemoto, PhD Guest: Robert Wong, MD A recent study explored clinician-level gaps and barriers to hepatocellular carcinoma surveillance in patients with cirrhosis and found that there is a lot of work to be done to help improve knowledge about cirrhosis, the recommended cancer screening guidelines, and how to implement those recommendations. Joining Dr. Jody Takemoto to discuss these findings and how we can address the uncovered challenges is Dr. Robert Wong, Clinical Associate Professor of Medicine in the Division of Gastroenterology and Hepatology at Stanford University School of Medicine.

In this episode, the faculty review the evidence base for ammonia measurement in patients with cirrhosis, exploring whether hyperammonaemia is indicative of a poor prognosis and if erroneous measurements correlate with the efficacy of ammonia-lowering therapies. The debate also extends to the use of ammonia as a potential endpoint in randomised controlled trials for hepatic encephalopathy drugs.FacultyDebbie Shawcross (Moderator)Rajiv Jalan (Faculty)Sara Montagnese (Faculty)Elliot Tapper (Faculty)This EASL Studio episode is organised in collaboration with the International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN).Related episodesEASL Studio S5E11: Statins in cirrhosis: The window hypothesis again, or just a closed window?EASL Studio from EASL Congress 2023: Liver cirrhosis in 2023: Unmet needs and how to address themEASL Studio S4E17: Albumin in Cirrhosis: For all, some, or none?EASL Studio S3E12: Meeting the challenge of antimicrobial resistance (AMR) in cirrhosis: the invisible threat that lies withinEASL Studio S2E6: Should anticoagulants be given to patients with cirrhosis to improve outcome?EASL Studio S2E4: Betablockers in cirrhosis: Has Baveno consensus gone too far?All EASL Studio Podcasts are available on EASL Campus.

Jasmohan Bajaj (Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, VA, USA), on behalf of the CLEARED Consortium, discusses a prospective observational cohort study examining global disparities in mortality and liver transplantation in hospitalised patients with cirrhosis.Read the full article:https://www.thelancet.com/journals/langas/article/PIIS2468-1253(23)00098-5/fulltext?dgcid=buzzsprout_icw_podcast_generic_langasContinue this conversation on social!Follow us today at...https://twitter.com/thelancethttps://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

Today's episode is with Dr David Wong from UHN discussing how to manage covid in patients with cirrhosis in the outpatient setting.

On this episode of Liver Talks, Alex and Adam are joined by Dr. Nadim Mahmud of the University of Pennsylvania to discuss his training and career, surgical risk stratification in cirrhosis--notably the creation of his group's VOCAL-Penn score--and tips for getting involved in Big Data. VOCAL-Penn Instrument: https://www.vocalpennscore.com/ Risk Prediction Models for Post-Operative Mortality in Patients With Cirrhosis: https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.31558 External Validation of VOCAL-Penn: https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/lt.26060 Join the LFN Workroom: https://liverfellow.org/post/the-workroom Hosts: Adam Winters @adam_c_winters Alex Vogel @AlexSVogel Guest: Nadim Mahmud @nadimmahmud Music Credits: “Tropkicks”, Broke for Free “Something Elated”, Broke for Free “Take Me Higher”, Jahzzar “RSPN,” Blank & Kytt All music furnished by https://freemusicarchive.org/ under Creative Commons licensing. http://brokeforfree.com/ https://jahzzar.bandcamp.com/ https://blankkytt.bandcamp.com/

Discover this EASL Studio Podcast highlighting the recently published EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. Join the faculty as they discuss:What effects do anticoagulants have on survival and liver related events in cirrhosis?What are the mechanisms of action?What type of anticoagulants should be used in patients with cirrhosis?Read more: https://easlcampus.eu/podcasts/easl-studio-podcast-s2-e6-should-anticoagulants-be-given-patients-cirrhosis-improve-outcome

Audible Article by Achintya D. Singh and Shalimar

In this episode Dr. Rodrigues will discuss this Retrospective Analysis of Practice Patterns at a Tertiary Care Teaching Hospital. For the complete abstract visit JCAG the online Journal of the Canadian Association of Gastroenterology 2019 Volume 2, Issue Supplement_2, 15 March 2019, Pages 447–448 https://academic.oup.com/jcag/issue/2/Supplement_2 This episode was recorded during the 2019 Gastroenterology Residents-in-Training (GRIT) Program in Banff, Alberta. Dr. Rodrigues was rated as one of the Best Oral Presenters during GRIT.

In this episode of Critical Matters, we discuss the management of critically ill patients with cirrhosis. Our guest is Dr. Ram Subramanian, Medical Director of Liver Transplantation at the Emory School of Medicine in Atlanta. In his dual role as a transplant hepatologist and an intensivist, Dr. Subramanian is involved in the inpatient care of patients before and after liver transplantation and provides a unique perspective on caring for this complex patient population. ADDITIONAL RESOURCES: Management of critically ill cirrhotic patients: a multidisciplinary perspective: https://bit.ly/2Et9hN5 A detailed review on ACLF and the impact of scoring systems on prognosis: https://bit.ly/2AcTtev A recent study evaluating the incidence and outcomes for patients with cirrhosis admitted to the ICU with an associated editorial by our guest: https://bit.ly/2BnQaAJ hhttps://bit.ly/2QzuPPc BOOKS MENTIONED IN THIS EPISODE: The McKinsey Edge: Success Principles from the World’s Most Powerful Consulting Firm by Shu Hattori: https://amzn.to/2QVVvZW The McKinsey Mind: Understanding and Implementing the Problem-Solving Tools and Management Techniques of the World’s Top Strategic Consulting Firm by Ethan M. Rasiel and Paul N. Friga: https://amzn.to/2Glph6c

Article Summary by Andrew Allegretti, MD and Nwamaka Eneanya, MD on behalf of their colleagues on their recent study, "Prognosis of Patients With Cirrhosis and Acute Kidney Injury Who Initiate Renal Replacement Therapy".

Article Summary by Andrew Allegretti, MD and Nwamaka Eneanya, MD on behalf of their colleagues on their recent study, "Prognosis of Patients With Cirrhosis and Acute Kidney Injury Who Initiate Renal Replacement Therapy".

Acute renal failure (ARF) is a common complication in patients with decompensated cirrhosis. The traditional diagnostic criteria of renal failure in these patients were proposed in 1996 and have been refined in subsequent years. More recently the International Club of Ascites (ICA)redefined the criteria to reach a new definition of acute kidney injury (AKI) in patients with cirrhosis. Dr Mairi McLean speaks to lead author Professor Paolo Angeli from the University of Padova about the scientific evidence supporting the new approach to the diagnosis and treatment of acute kidney injury.Read the full article >> http://gut.bmj.com/content/64/4/531.full

Acute kidney injury (AKI) is common in patients with cirrhosis and associated with significant mortality. The most common etiologies of AKI in this setting are prerenal azotemia (PRA), acute tubular necrosis (ATN), and hepatorenal syndrome (HRS). Accurately distinguishing the etiology of AKI is critical, as treatments differ markedly. However, establishing an accurate differential diagnosis is extremely challenging. Urinary biomarkers of kidney injury distinguish structural from functional causes of AKI and may facilitate more accurate and rapid diagnoses. We conducted a multicenter, prospective cohort study of patients with cirrhosis and AKI assessing multiple biomarkers for differential diagnosis of clinically adjudicated AKI. Patients (n = 36) whose creatinine returned to within 25% of their baseline within 48 hours were diagnosed with PRA. In addition, 76 patients with progressive AKI were diagnosed by way of blinded retrospective adjudication. Of these progressors, 39 (53%) patients were diagnosed with ATN, 19 (26%) with PRA, and 16 (22%) with HRS. Median values for neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), liver-type fatty acid binding protein (L-FABP), and albumin differed between etiologies and were significantly higher in patients adjudicated with ATN. The fractional excretion of sodium (FENa) was lowest in patients with HRS, 0.10%, but did not differ between those with PRA, 0.27%, or ATN, 0.31%, P = 0.54. The likelihood of being diagnosed with ATN increased step-wise with the number of biomarkers above optimal diagnostic cutoffs. Conclusion: Urinary biomarkers of kidney injury are elevated in patients with cirrhosis and AKI due to ATN. Incorporating biomarkers into clinical decision making has the potential to more accurately guide treatment by establishing which patients have structural injury underlying their AKI. Further research is required to document biomarkers specific to HRS.

Audible Article by Thomas D. Boyer, M.D., and Shahid Habib, M.D.

Audible Article by Thomas D. Boyer, M.D., and Shahid Habib, M.D.

Dr. Florence Wong discusses her manuscript "New Consensus Definition of Acute Kidney Injury Accurately Predicts 30-Day Mortality in Patients With Cirrhosis and Infection." Click http://bit.ly/1bzQ8Cq to access the abstract.

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

Dr. Susana Seijo discusses her manuscript, "Efficacy and Safety of Anticoagulation on Patients With Cirrhosis and Portal Vein Thrombosis."

Dr. Susana Seijo discusses her manuscript, "Efficacy and Safety of Anticoagulation on Patients With Cirrhosis and Portal Vein Thrombosis."

A review article in the September issue of CGH looks at the pathogenesis of infections and immune dysfunction in patients with cirrhosis. Dr. Kuemmerle speaks to author K. Rajender Reddy of the University of Pennsylvania Health System

To propose an improvement on the current classification of renal dysfunction in cirrhosis. Clinicians caring for patients with cirrhosis recognize that the development of renal dysfunction is associated with significant morbidity and mortality. While most cases of renal dysfunction in cirrhosis are functional in nature, developed as a result of changes in haemodynamics, cardiac function, and renal auto-regulation, there is an increasing number of patients with cirrhosis and structural changes in their kidney as a cause of renal dysfunction. Therefore, there is a need for a newer classification to include both functional and structural renal diseases.

Dr. Kuemmerle speaks with Dr. Bruce Bacon about a new set of quality indicators for treatment of patients with cirrhosis. Also, a new segment highlighting stories from the AGA newspaper, GI & Hepatology News

Fri, 1 Jan 1993 12:00:00 +0100 https://epub.ub.uni-muenchen.de/5971/1/Gerbes_ALexander_5971.pdf Gerbes, Alexander L.; Bendtsen, Flemming; Henriksen, Jens H.

Fri, 1 Jan 1993 12:00:00 +0100 https://epub.ub.uni-muenchen.de/5943/1/5943.pdf Henriksen, Jens H.; Gerbes, Alexander L.; Bendtsen, Flemming ddc:610,

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/5985/1/Juengst_Dieter_5985.pdf Jüngst, Dieter; Wernze, Heinrich; Pilz, A.; Gerbes, Alexander L.

A highly specific and sensitive radioimmunoassay (RIA) has been established for determination of endothelin-3 like immunoreactivity in human plasma to investigate its possible role in hemodynamic alterations due to liver disease. Crossreactivity with other endothelin isoforms was always below 4 %, the lower detection limit following extraction on Sep-Pak C18 cartridges was 0.5 pg/ml. The concentration of endothelin-3 (mean ± SEM) was 4.16 ± 0.56 pg/ml (n = 13) in plasma of patients with cirrhosis of the liver, three fold higher than in age matched controls (1.35 ± 0.27 pg/ml, n = 12, p < 0.01). Plasma immunoreactivity was confirmed to be endothelin-3 related by reverse-phase HPLC. These data could suggest a role of plasma endothelin-3 in circulatory changes, as they occur in cirrhosis of the liver.

N-terminal (atrial natriuretic factor (ANF) 1-98) and C-terminal (ANF 99-126) fragments of proatrial natriuretic factor (NTA and CTA, respectively) were determined in plasma of healthy subjects adopting different postures and in patients with cirrhosis. Seven healthy subjects were investigated while seated and 30 min after assuming a horizontal position. NTA plasma concentrations increased in subjects in the horizontal position (from 734±250 (SE) fmol/ml to 9021227 fmol/ml; p

Sun, 1 Jan 1989 12:00:00 +0100 https://epub.ub.uni-muenchen.de/6096/1/6096.pdf Paumgartner, Gustav; Jüngst, Dieter; Sauerbruch, Tilman; Gülberg, Veit; Stangl, E.; Arendt, Rainer M.; Gerbes, Alexander L. ddc:610, M

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.

The role of the atrial natriuretic factor and of the main counteracting sodium-retaining principle, the renin-aldosterone system, in acute volume regulation of cirrhosis of the liver has been investigated. Central volume stimulation was achieved in 21 patients with cirrhosis, 11 without and 10 with ascites, and 25 healthy controls by 1-hr head-out water immersion. Immersion prompted a highly significant (p

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

Tue, 1 Jan 1985 12:00:00 +0100 https://epub.ub.uni-muenchen.de/6182/1/6182.pdf Paumgartner, Gustav; Zähringer, J.; Jüngst, Dieter; Ritter, D.; Arendt, Rainer M.; Gerbes, Alexander L. ddc:610, Medizin