Saturday, July 5, 2014

A New Way To Monitor Patients With End Stage Liver Disease

This is not a subject I like to talk about.  End stage liver disease.  These patients are very ill, and not happy.  Sonographers deal with many issues but a large part of our job is the hepato-biliary system.  How many times have I been called in for a RUQ sonogram?  In many cases, the cause of discomfort is gallstones, or choleycystitis. In many cases it is liver failure.
Cholecystitis (Greek, -cholecyst, "gallbladder", combined with the suffix -itis, "inflammation") is inflammation of thegallbladder, which occurs most commonly due to obstruction of the cystic duct with gallstones (cholelithiasis). Blockage of the cystic duct with gallstones causes accumulation of bile in the gallbladder and increased pressure within the gallbladder. Concentrated bile, pressure, and sometimes bacterial infection irritate and damage the gallbladder wall, causing inflammation and swelling of the gallbladder. Inflammation and swelling of the gallbladder can reduce normal blood flow to areas of the gallbladder, which can lead to cell death due to insufficient oxygen. Not everyone who has gallstones will go on to develop cholecystitis.

http://en.wikipedia.org/wiki/Cholecystitis

Many sonographers have night mares about being called in for gall bladder attacks.  The surgeon does nothing  till 4 PM the next day. He asks the ED doctor to admit the patient. I must come out at 3 AM to evaluate a sick person with abdominal pain. Gosh I hate those late night calls when nothing is done!
  Here is something we sonographers want to look at.  Though many of us are beyond endoscopic ultrasound, it is a great read.  The link is pretty much technical, but interesting if you are into ways to look at the nasty way liver failure can take you down.  Portal hypertension is what most educated sonographers are aware of.  We can measure the diameter of the main portal vein on a sonogram.  A diameter of over 1.7 cm indicates portal pressure is elevated.  Most liver disease is caused by fatty liver disease, a subject for another post.  Here is a link to portal measurements by ultrasound.

http://www.ajronline.org/doi/pdf/10.2214/ajr.139.3.497


Now to the post. Looks like doctors can measure the restive index in esophageal varacies using ultrasound. Great.  Read the link.  TW

In patients with cirrhosis, esophageal varices are commonly observed, with an estimated prevalence of 50%[1]. After esophageal varices have formed, the annual risk for bleeding can range from 10% to 30%[2,3]. In patients with decompensated cirrhosis, acute esophageal variceal bleeding (EVB) represents a predominant cause for morbidity and mortality. Due to the increased risk of fatality in cirrhotic patients with EVB, the risk status in patients must be routinely evaluated such that the appropriate prophylactic therapy is administered to prevent variceal bleeding events.

http://www.wjgnet.com/1007-9327/full/v20/i22/6989.htm

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