Peritoneal bleeding

Choi D, Lim HK, Rhim H et al (2007) Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy long-term results and prognostic factors. Ann Surg Oncol 14(8) 2319-2329 Chuang CH, Chen CY, Tsai HM (2005) Hepatic infarction and hepatic artery pseudoaneurysm with peritoneal bleeding after radiofrequency ablation for hepatoma. Clin Gastroenterol Hepatol 3(11) A23... 

In contrast to subcapsular hematomas, intra-peritoneal bleeding can rapidly evolve into an emergency situation therefore, close hemodynamic monitoring by the anesthetist or the interventional nurse is essential to detect for signs of intraperito-neal hemorrhage. Clinically suspected acute hemorrhage can be confirmed by the detection of new high... 

O Portal hypertension is the precipitating factor for the complications of cirrhotic liver disease—ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy. Lowering portal pressure can reduce the complications of cirrhosis and decrease morbidity and mortality. 

Cirrhosis is the progressive replacement of normal hepatic cells by fibrous scar tissue. This scarring is accompanied by the loss of viable hepatocytes, which are the functional cells of the liver. Progressive cirrhosis is irreversible and leads to portal hypertension that is in turn responsible for many of the complications of advanced liver disease. These consequences include (but are not limited to) spontaneous bacterial peritonitis (SBP), hepatic encephalopathy, and variceal bleeding.1... 

Patients who have previously experienced spontaneous bacterial peritonitis and have low-protein ascites (ascitic fluid albumin less than 1 g/dL [less than 10 g/L]) are candidates for long-term prophylactic therapy. Recommended regimens include either a single trimethoprim-sulfamethoxazole doublestrength tablet 5 days per week (Monday through Friday) or ciprofloxacin 750 mg once weekly.19,46 Any patient who has experienced an episode of variceal bleeding should also receive prophylactic antibiotics. 

Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhotic ascites, arising most frequently in those with advanced liver disease. Its development leads to a further reduction in the effective arterial blood volume, and it has a mortality rate equivalent to that of a variceal bleed [202], Since hepatic blood flow and func-... 

Besides causing loss of appetite and quality of life, longstanding and severe constipation can lead to diverticulosis, diverticulitis and in worst cases perforation of the large intestine with life threatening peritonitis (McConnell et al. 2003). Diverticulosis, irritable bowel syndrome and haemorrhoids are caused by chronic constipation and can lead to bleeding and anaemia. 

Decompensated liver disease is complicated by jaundice, refractory ascites, bacterial peritonitis, coagulopathy, and variceal bleeding and may require liver transplantation. The number of liver transplants for decompensated cirrhosis doubled from 1990 to 2004, when 5845 cadaveric (orthotopic) liver transplants were performed (65). 

Q12 Irritation and damage to other structures in the abdomen may occur if the diverticulitis is not treated. Abdominal muscles may go into painful spasm and a minority of patients might have rectal bleeding. A major problem could be development of an intestinal obstruction or an abscess in the wall of the intestine. The abscess may eventually cause perforation of the intestinal wall leakage of infected material into the peritoneal cavity and then infection of the peritoneal membranes (peritonitis) may occur. Peritonitis is a very serious condition. 

Patient 4 is a 58-year-old with a history of excess alcohol intake approximately 60 units per week for the past four years. Recent admissions have been for ascites requiring paracentesis, spontaneous bacterial peritonitis, and large variceal bleeds. Over the last six months the patient has had a reduced appetite, poor nutrition and a significant loss of muscle mass. 

Complications such as variceal bleeding, hepatic encephalopathy, ascites and infections as well as reduced renal function also influence the mortality rate of liver cirrhosis (in Germany some 25,000/year). The main causes of death are hepatic coma or liver failure (25-40%), bleeding (20-30%), infections (about 10%) and HCC (about 5%). Spontaneous bacterial peritonitis is fatal in 50-70%, and with liver dysfunction even in 90% of cases. Occurrence of the hepatorenal syndrome is almost invariably fatal. 

Ascites unresponsive to treatment Hepatopulmonary syndrome Hepatorenal syndrome Recurrent varix bleeding Severe hypoalimentation Spontaneous bacterial peritonitis... 

Dilute solutions of 1-10% formalin have been instilled into the bladder to treat inoperable profusely bleeding tumors or intractable hemorrhagic cystitis. Anuria was a severe complication. This was due either to edematous obstruction of the ureter or to tubular or papillary necrosis, probably caused by systemic absorption. Bladder perforation with intraperitoneal spillage, peritonitis, and finally death was described in an elderly patient with a carcinoma of the uterine cervix (SEDA-11, 476). 

Anorexia, hiccups, and a metallic taste in the mouth are common as kidney disease becomes more severe. Nausea, vomiting, diarrhea, or abdominal distention may also occur. Gastric and colonic mucosal ulcerations and telangiectasias with resultant gastrointestinal bleeding are common. Ascites may develop secondary to fluid overload or peritoneal serositis. 

Hepatic cirrhosis may be associated with portal hypertension, ascites, encephalopathy, spontaneous bacterial peritonitis, and hepatocellular carcinoma. Portal hypertension is directly responsible for the formation of esophageal varices, which may give rise to massive upper gastrointestinal bleeding. Therapy is aimed at correcting hypovolemic shock and at achieving hemostasis at the bleeding site. 

The most common manifestations of hemophilia A are those caused by bleeding into soft tissues (hematomas) such as muscle or into body spaces such as the peritoneal cavity or the lumen of the gastrointestinal tract. When bleeding occurs repeatedly into joints (hemarthrosis), the joint may eventually become deformed and immobile. 

Most HE episodes in patients with chronic liver disease are precipitated by events such as oral protein load, gastrointestinal bleeding, obstipation, infection, especially peritonitis, hypokalemia and alkalosis complicating the use of diuretic drugs, administration of sedative drugs, for example for diagnostic procedures or induction of portal-systemic shunt via shunt operation or the TIPSS implantation. 

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