Hepatic Circulation Flashcards
(17 cards)
Don’t recommend FFP to improve thrombin generation w/ cirrhosis - volume expansion increases portal pressure and may trigger vatical hemorrhage; thus in most situations, infusion of plasma prophylactically is futile and potentially risky
conditional, low evidence
Don’t recommend prophylactic platelet transfusion outside of Cr > 2.5 or sepsis
conditional, very low evidence
Recommend doppler US as initial noninvasive method for diagnosis of portal vein thrombosis - CT w/ contrast or MRI is recommended to asses extension of thrombus and to exclude tumor thrombus
strong, very low evidence
Recommend anticoagulation for all non cirrhotic patients w/ acute symptomatic portal or mesenteric vein thrombosis in the absence or any contraindication
strong, low evidence
Suggest anticoagulation for patients w/ chronic PVT if there is evidence of inherited thrombophilia, progression of thrombus into mesenteric veins, or current or previous evidence of bowel ischemia
conditional, very low evidence
Suggest at least 6 months of anticoagulation in patients w/ portal or mesenteric vein thrombosis w/o a demonstrable thrombophilia and when the etiology of thrombosis is reversible - indefinite AC is recommended w/ portal or mesenteric vein thrombosis and thrombophilia
conditional, very low evidence
Recommend nonselective beta blockers for prevention of variceal bleeding in patients w/ high-risk varices and portal and/or mesenteric vein thrombosis requiring anticoagulation
strong, low evidence
Suggest either unfractionated heparin or LMWH be used once a decision is made to initiate anticoagulation for treatment of PVT and/or MVT
conditional, very low evidence
Recommend anticoagulation for patients w/ acute complete main PVT, MVT, or extension of PVT into mesenteric veins - risk of bleeding must be weighed against benefits (ie: platelets < 50,000 or hepatic encephalopathy at risk of falls)
strong, low evidence
Suggest anticoagulation in patients w/ chronic PVT only if there is (i) evidence of inherited thrombophilia, (ii) progression of thrombus, or (iii) hx of bowel ischemia due to thrombus extension into mesenteric veins
conditional, very low evidence
Suggest 6 months of anticoagulation in patients w/ cirrhosis and acute portal of MVT. Anticoagulation is continued beyond this period in patients w/ portal or mesenteric vein thrombosis who are on the waiting list for liver transplant.
conditional, very low evidence
Suggest surveillance for HCC w/ abdominal US and serum AFP levels every 6 months in patients w/ chronic Budd-Chiari
conditional, low evidence
Suggest treatment in asymptomatic patients only w/ aneurysms of the pancreaticoduodenal and gastroduodenal arcade, intraparenchymal hepatic artery branches, women of childbearing age, and recipients of a liver transplant, irrespective of aneurysm diameter.
Asymptomatic patients w/ mesenteric aneurysms < 2cm - follow-up imaging is recommended initially in 6 months, then at 1 year and subsequently every 1-2 years.
Recommend mesenteric artery aneurysms associated w/ symptoms be treated.
conditional, low evidence
Recommend intervention for all aneurysms > 2cm in diameter even when asymptomatic
strong, low evidence
Do not recommend routing screening for LVMs in patients w/ hereditary hemorrhagic telangiectasia. However, those w/ a liver bruit, hyper dynamic circulation, or liver test abnormalities should be further evaluated for LVMs. Of note, women w/ HHT and LVMs who become pregnant warrant special attention due to anticipated hemodynamic stress.
strong, low evidence
Suggest contrast CT or MRI/MRCP in patients w/ HHT who develop symptoms/signs of heart failure, biliary ischemia, hepatic encephalopathy, mesenteric ischemia, or PH. Doppler US may establish a diagnosis of LVMs in patients w/ HHT and a compatible clinical picture, but is less accurate than CT scan or MRI/MRCP. Angiography and/or liver biopsy are not recommended in the diagnosis of LVMs.
strong, low evidence
In patients w/ HHT, Bevacizumab should be considered in patients w/ high-output heart failure and possibly for other complications or LVM before using invasive therapies, although not all patients respond. Transarterial hepatic artery embolization or surgical ligation is proscribed in patients w/ biliary involvement or PH.
conditional, low evidence
