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The management of chronic liver disease, including transplantation 1
Published on September 30, 2021 29 min
A selection of talks on Gastroenterology & Nephrology
The gastrointestinal (GI) tract
- Dr. Richard L. Drake
- Cleveland Clinic Lerner College of Medicine, USA
Hello, my name is Tim McCashland, I'm Professor of Medicine, and Director of Liver Transplant and Hepatology, at the University of Nebraska Medical Center. Today I would like to talk about the management of other aspects of chronic liver disease, including liver transplantation.
The outline for today's talk includes: management of common complications associated with end-stage liver disease; preparation for evaluation and listing for liver transplantation; listing criteria for liver transplantation; management of common medical conditions after transplantation. First, we'll start with management of common complications associated with end-stage liver disease.
The number one complication of end-stage liver disease is ascites. There is a 50% 10-year probability of accumulation of ascites in somebody with end-stage liver disease. It's a harbinger of poor prognosis, with 50% mortality within two years of diagnosis, for patients who have a large amount of ascites. Ascites can be graded from grade 1 to 3, based upon the volume of the ascites, with ultrasound diagnosis for grade 1, grade 2 with moderate abdominal distention, and grade 3 with tense ascites and significant abdominal discomfort. Typically speaking, you require at least 1,500 ml of ascites to be detected by physical examination. Ascites typically is associated with a clear yellow consistency in color. If the ascites - on tapping - is bloody in appearance, the hematocrit should be greater than 0.5 percent.