{"title":"Conduite à tenir devant une ascite","authors":"J.-D. Grangé","doi":"10.1016/j.emchg.2005.07.005","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.07.005","url":null,"abstract":"<div><p>Ascites is the most common complication of cirrhosis. Approximately 50% of patients with compensated cirrhosis will develop ascites over a 10-year period. Ascites is associated with increased risks of infections, renal failure and poor long-term outcome. Abstinence from alcohol, salt restriction and diuretics are the mainstays of the therapy, and these measures are effective in approximately 90% of the patients. Treatment options for diuretic-resistant patients include serial therapeutic paracentesis and transjugular intrahepatic portosystemic stent-shunts. Patients eligible for liver transplantation should undergo evaluation for this procedure after development of ascites. A diagnostic paracentesis should be performed on hospital admission in any cirrhotic patient with ascites to investigate the presence of spontaneous bacterial peritonitis. In patients with an ascetic fluid PMN cell count<!--> <!-->><!--> <!-->250/mm<sup>3</sup>, antibiotic therapy (cefotaxime or amoxicillin-clavulanic acid) and albumin infusion need to be started before obtaining the results of ascites or blood cultures. Prophylactic antibiotic administration is recommended in cirrhotic patients hospitalized with upper gastrointestinal haemorrhage or low ascites protein (i.e.<!--> <!--><<!--> <!-->10 g/l) and in patients recovering from an episode of spontaneous bacterial peritonitis.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 297-306"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91718616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Bulois, G. Sergent-Baudson, C. L'hermine, J. Paris
{"title":"Hémorragies digestives et radiologie interventionnelle","authors":"P. Bulois, G. Sergent-Baudson, C. L'hermine, J. Paris","doi":"10.1016/J.EMCHG.2005.09.002","DOIUrl":"https://doi.org/10.1016/J.EMCHG.2005.09.002","url":null,"abstract":"","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"9 1","pages":"388-399"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88475855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Assistance nutritionnelle au cours des insuffisances hépatocellulaires","authors":"X. Hébuterne","doi":"10.1016/j.emchg.2005.08.001","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.08.001","url":null,"abstract":"<div><p>Protein energy malnutrition is particularly frequent and severe in cirrhotic patients and may be determined by the routine measure of the mid-arm muscle circumference. The reasons for malnutrition include various factors such as anorexia, poor diet, and altered metabolic state. When the patient is hospitalized, malnutrition is frequently worsened due to the test-related necessity of fasting, continued anorexia, and complications such as gastrointestinal bleeding. Dietetic recommendations must be done to all patients. In cirrhotic patients energy needs are about 30 to 35 kcal/d with 1.2 to 1.5 g/d of protein. Oral supplementation with vitamins is often mandatory. Many studies have now clearly demonstrated that in malnourished patients nutrition support may improve outcome. In case of moderate malnutrition oral supplement enriched with branched chain amino acids may be useful. In case of severe malnutrition in hospitalized patients, enteral nutrition may be considered. Peri-operative nutrition support should be considered before surgery for hepatocellular carcinoma or liver transplantation.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 319-329"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91718618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Récidive de la maladie initiale","authors":"D. Samuel (Professeur d'hépatologie), E. Kimmoun","doi":"10.1016/j.emchg.2005.04.003","DOIUrl":"10.1016/j.emchg.2005.04.003","url":null,"abstract":"<div><p>Since rejection has become better controlled, recurrence of the initial disease on the graft is the most important problem after liver transplantation. Recurrence of the initial disease has been established for the B and C hepatitis and the hepatocellular carcinoma. The diagnosis of recurrence of biliary and auto-immune diseases is difficult and depends on a series of arguments. Hepatitis B recurrence is prevented by injection of anti-HBs immunoglobulin and anti viral therapy whereas hepatitis C is more hardly controlled. The period preceding liver transplantation is the moment of choice to limit the risk of recurrence, by treating the hepatitis C and confirming alcohol abstinence. Optimised management of the alcoholic disease allows decreasing its recurrence. The treatment of hepatitis C recurrence after liver transplantation is under evaluation. The ideal immunosuppression to limit recurrences of hepatitis C and biliary and auto-immune diseases is not currently known. In some cases, the only treatment is re-transplantation.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 348-361"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75099332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Dao , K. Bouhier , R. Gloro , V. Rouleau , P. Rousselot
{"title":"Amylose hépatique","authors":"T. Dao , K. Bouhier , R. Gloro , V. Rouleau , P. Rousselot","doi":"10.1016/j.emchg.2005.07.004","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.07.004","url":null,"abstract":"<div><p>Amyloidosis is a disease characterized by the extracellular deposition of insoluble fibrillar protein amyloid in organs or tissues. The liver is a common site of amyloidal deposition in amyloidosis AL and AA. There is a poor correlation between the amount of amyloid and the degree of hepatic impairment. Hepatomegaly is the most typical clinical feature, contrasting with mild liver tests abnormalities, the most common being an isolated elevation of alkaline phosphatase. Histological analysis of biopsy specimens is the only method to establish the diagnosis of amyloidosis but liver biopsy carries a risk of bleeding. Less invasive alternatives are rectal biopsy and subcutaneous fat aspiration or biopsy. Scintigraphy with radiolabeled serum amyloid (SAP) component is emerging as a non invasive technique for detecting, localizing, quantifying amyloid deposits and for monitoring treatment. The prognosis of amyloidosis AL is poor (median survival 9 months) despite systemic chemotherapy. Results of high dose chemotherapy associated with peripheral blood stem cell transplantation remain to assess. Prognosis of amyloidosis AA depends on treatment of the causal disease.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 330-338"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.07.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91718052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Ducrotté (Professeur des Universités, médecin des Hôpitaux), U. Chaput (Interne des Hôpitaux de Rouen)
{"title":"Physiopathologie du reflux gastro-œsophagien","authors":"P. Ducrotté (Professeur des Universités, médecin des Hôpitaux), U. Chaput (Interne des Hôpitaux de Rouen)","doi":"10.1016/j.emchg.2005.09.001","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.09.001","url":null,"abstract":"<div><p>Gastro-œsophageal reflux (GORD) is a multifactorial disease. The key factor in the pathogenesis of GORD is a disordered function of the lower oesophageal sphincter (LOS). Before the description of the dynamics of LOS function, a chronically decreased LOS pressure was considered to be the most important pathogenic mechanism. Then, transient relaxations of the LOS were found to be the most prevalent mechanism of reflux episodes. Recent investigations have pointed out the role of the crural diaphragm which strengthens the LOS in the absence of a hiatus hernia. All of altered oesophageal motility leading to an impaired oesophageal clearance, delayed gastric emptying, abnormal composition of the refluxate and abnormalities in the defensive capacity of the oesophageal mucosa are also important factors in the onset of symptoms and reflux oesophagitis.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 362-369"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91718055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Bulois , G. Sergent-Baudson , C. L'Herminé , J.-C. Paris
{"title":"Hémorragies digestives et radiologie interventionnelle","authors":"P. Bulois , G. Sergent-Baudson , C. L'Herminé , J.-C. Paris","doi":"10.1016/j.emchg.2005.09.002","DOIUrl":"https://doi.org/10.1016/j.emchg.2005.09.002","url":null,"abstract":"<div><p>Radiological techniques and therapy are an important component of the armentarium in evaluating and treating gastro intestinal bleeding, particularly when the bleeding site is obscure or undetermined after thorough endoscopic evaluation, when the bleeding is massive or refractory to endoscopic therapy. Major breakthroughs in catheter and guidewire design as well as improvements in angiographic x-ray equipment currently allow interventional radiologists to diagnose massive life-threatening upper and lower gastro intestinal haemorrhage and to stop the bleeding safely and effectively using superselective catheterization and microcoil embolization. Gastrointestinal bleeding, especially when severe or refractory, is best managed by a team approach with the team including the radiologist, internist, gastroenterologist, and surgeon.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 4","pages":"Pages 388-399"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.09.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91718054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Lahmek (Praticien hospitalier), Stéphane Nahon (Praticien hospitalier)
{"title":"Stéatopathies hépatiques non alcooliques","authors":"P. Lahmek (Praticien hospitalier), Stéphane Nahon (Praticien hospitalier)","doi":"10.1016/j.emchg.2005.01.011","DOIUrl":"10.1016/j.emchg.2005.01.011","url":null,"abstract":"<div><p>Non alcoholic fatty liver disease (NAFLD) is part of a spectrum of liver damage, ranging from simple steatosis to advanced fibrosis and cirrhosis similar to those of alcoholic liver disease but in the absence of significant alcohol intake. Non alcoholic steatohepatitis (NASH) is characterised by liver fatty infiltration with various degrees of inflammation, necrosis, and fibrosis. NAFLD is one of the most common causes of abnormal liver tests and NASH has been proposed as a possible cause of cryptogenic cirrhosis and hepatocellular carcinoma. The prevalence of NAFLD ranges from 10% to 24% among western general populations, whereas that of NASH is about 3%. Insulin resistance is regarded as a hallmark and a causal factor of NAFLD. Several etiologic mechanisms have been proposed as causal factors of NAFLD, including increased afflux of free fatty acids to the liver, reduced free fatty acid-oxidation, and increased lipid-peroxidation. NAFLD is associated with several underlying medical disorders: most commonly type 2 diabetes, dyslipidemia, and obesity. The diagnosis of NAFLD, rarely proposed by clinicians, is generally made when the liver biopsy reveals unexplained abnormalities. Once alcoholic abuse is ruled out, the diagnosis of NAFLD raises two questions: what is the cause? and what is the prognosis ? Although most patients have a benign disease that does not progress, others may develop fibrosis or even cirrhosis. There is no established treatment for NAFLD. Treatment is usually directed toward optimising body weight. The role of pharmacologic agents remains to be established.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 269-283"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.01.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77926713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Dall'Osto, M. Simard, N. Delmont, G. Mann, M. Hermitte, R. Cabrit, C. Théodore
{"title":"Nutrition parentérale : indications, modalités et complications","authors":"H. Dall'Osto, M. Simard, N. Delmont, G. Mann, M. Hermitte, R. Cabrit, C. Théodore","doi":"10.1016/j.emchg.2005.04.001","DOIUrl":"10.1016/j.emchg.2005.04.001","url":null,"abstract":"<div><p>Parenteral nutrition refers to intravenous nutrient supplementation. Main indications are aggressed patients, surgery, oncologic conditions, chronic intestinal failure, and inflammatory bowel diseases. The procedures must be strictly respected. Serious complications can be observed, related to mechanical aspects of line insertion, infections, hydroelectrolytic abnormalities, inappropriate carbohydrate and lipid administration, micronutrient excesses or deficiencies, hepatobiliary and metabolic bone diseases. This method has to be supervised by caregivers with an expertise in nutrition.</p></div>","PeriodicalId":100426,"journal":{"name":"EMC - Hépato-Gastroenterologie","volume":"2 3","pages":"Pages 223-248"},"PeriodicalIF":0.0,"publicationDate":"2005-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.emchg.2005.04.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73931566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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