How to beat cirrhosis complications?What does the expert say


Cirrhosis is a common chronic progressive liver disease, which cannot be cured by existing medical treatment.Chronic hepatitis virus infection (hepatitis B, hepatitis C, etc.), long-term heavy drinking, obesity, chronic liver dysfunction of unknown cause are the risk factors of cirrhosis.In the early stage of cirrhosis, there are usually no symptoms or only mild symptoms, such as liver pain, loss of appetite, fatigue, etc., but the occurrence of cirrhosis complications often endangers the life of patients, such as esophageal and gastric varices rupture and bleeding, ascites, renal dysfunction, etc.Once gastrointestinal bleeding, ascites and other conditions occur, treatment at this time will be difficult, high mortality, will bring significant mental and economic burden for patients and their families.”Shanghai Putuo” and Tongji Hospital affiliated to Tongji University open a column of “Health Language”, this issue invites Yang Changqing, director of department of internal medicine and director of gastroenterology department of Tongji Hospital affiliated to Tongji University, to talk with you about the complications of cirrhosis.Changqing Yang, Director of Department of Gastroenterology and Department of Gastroenterology, Tongji Hospital affiliated to Tongji University, second-class professor, doctoral supervisor, Shanghai Leading Talent and Outstanding academic leader.He studied in Harvard Medical School in the United States.Liver disease branch incoming chairman, who is now the Shanghai medical association digestion branch of Shanghai combine traditional Chinese and western medicine institute chair, rehabilitation medical association digestion branch chairman of Shanghai, Shanghai medical association digestion branch of the standing committee and the liver group leader, director of Chinese elderly medical association digestion branch, vice chairman, standing committee of the Chinese medicine will promote digestion branch and the endoscopic group members,Member of Gastroenterologist Branch of Chinese Medical Association, member of Hepatobiliary Group and Difficult And severe Disease Cooperation Group of Digestive Society of Chinese Medical Association, deputy leader of Portal hypertension Group of Chinese Research Hospital;Editorial board member of national unified textbook internal Medicine (9th edition) and deputy editor of Introduction to Medicine (2nd edition).She studied at Beth Israel Deaconess Hospital affiliated to Harvard Medical School.Specialist clinic: Every Thursday morning;Special clinic: Every Monday morning;Endoscopic diagnosis and treatment: Tuesday and Wednesday mornings.With the improvement of people’s health awareness, a large number of patients with cirrhosis are found in the early stage.Then, after being diagnosed with cirrhosis, can we only choose to lie down quietly and worry about various complications every day?If we take the initiative in the early stage of the disease, predict the occurrence of complications and monitor the rate of disease progress, and take preventive measures, and take targeted diagnosis and treatment measures, then the complications of cirrhosis will not be terrible.For patients with cirrhosis, how to use the loyal “sentry” to spot danger in order to get ahead at the starting line?From the root, portal hypertension caused by cirrhosis is the main cause of various complications in patients. Meanwhile, standardized treatment to reduce portal hypertension has been proved by domestic and foreign studies to improve the prognosis of patients with cirrhosis.So how to measure the portal vein pressure before “depressurizing” the portal vein?Direct surgical measurement of portal vein pressure is highly traumatic and risky. Hepatic vein pressure gradient detection (HVPG) is an effective method to evaluate portal vein pressure at present, which is recognized as the gold standard for portal vein pressure at home and abroad.What is hepatic vein pressure gradient detection?Hepatic vein pressure gradient detection (HVPG) is a safe and minimally invasive and effective method to assess portal vein pressure with fewer monitoring related complications.The specific operation method of HVPG is as follows: the catheter enters the hepatic vein through the right femoral vein or jugular vein approach, measures the hepatic vein free pressure, and then infuses air to make the balloon dilate and fully block the hepatic vein blood flow, and measures the hepatic vein wedge pressure. The difference between the hepatic vein wedge pressure and the hepatic vein free pressure is the hepatic vein pressure gradient detection (HVPG).The gold standard for the diagnosis and risk stratification of portal hypertension in liver cirrhosis Evaluation of therapeutic objectives for liver cirrhosis Common venous access sites for hepatic vein catheterization When is hepatic vein pressure gradient testing appropriate for patients with liver cirrhosis?Compensatory cirrhosis patients requiring risk stratification and precision therapy;Patients with decompensated cirrhosis were reevaluated before and after treatment.Evaluation of compensatory cirrhosis with hepatocellular carcinoma before surgical treatment;Extrahepatic preoperative evaluation of patients with cirrhosis;When patients need hemodynamic response evaluation after drug treatment for portal hypertension;In addition, HVPG in patients with nonsclerosing portal hypertension or ascites of unknown origin may assist in the differential diagnosis of etiology.I have received the HVPG test, what is the help to the disease treatment?The normal range of HVPG is 3-5 mmHg, HVPG>5 mmHg can be defined as portal hypertension, ≥10 mmH is clinically significant portal hypertension, which is also the gold standard for the diagnosis of clinically significant portal hypertension, ≥12 mmHg is the threshold of varicose venous bleeding.≥16 mm Hg suggests complications that are difficult to control, and ≥20 mm Hg suggests poor hemostasis after varicose vein hemorrhage.After HVPG measurement, the physician will choose the appropriate treatment according to the patient’s compensatory/decompensated liver function status and complications.Data: Yang Changqing tongji Hospital affiliated to Tongji University Original title: “Health benefits language! How to beat cirrhosis complications? Listen to what experts say →”

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