Emerging hepatic syndromes: pathophysiology, diagnosis and treatment.
Liver cirrhosis is a major cause of morbidity and mortality worldwide, mainly due to complications of portal hypertension. In this article, we review the current understanding on the pathophysiology, the diagnostic criteria and the available therapeutic options for patients with emerging hepatic syndromes in cirrhosis, namely the hepatorenal, hepato-adrenal and hepatopulmonary syndrome. The hepatorenal syndrome is a well-recognized complication of advanced cirrhosis and is usually associated with an accelerated course to death unless liver transplantation is performed. The hepatopulmonary syndrome is often missed in the evaluation of patients with cirrhosis; however, early recognition is essential for the efficient management of individual patients. The hepato-adrenal syndrome, although not fully characterized, offers an exciting field for research and potential therapeutic interventions.
Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy.
Gaetano
G
Bertino
Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Ospedale Garibaldi-Nesima, Catania, Italy.
Graziella
G
Privitera
Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Ospedale Garibaldi-Nesima, Catania, Italy.
Francesco
F
Purrello
Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy.
Shirin
S
Demma
Hepatology Unit, Department of Clinical and Experimental Medicine, University of Catania, Policlinico "G. Rodolico", Catania, Italy.
Emanuele
E
Crisafulli
Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, Ospedale Garibaldi-Nesima, Catania, Italy.
Luisa
L
Spadaro
UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and UCL, London, UK.
Nikolaos
N
Koukias
UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit, Royal Free Hospital and UCL, London, UK. e.tsochatzis@ucl.ac.uk.
Emmanuel A
EA
Tsochatzis
D058186:Acute Kidney Injury / Q000209:etiology; D000309:Adrenal Insufficiency / Q000150:complications / Q000209:etiology; D001201:Ascites / Q000150:complications / Q000209:etiology; D003404:Creatinine / Q000652:urine; D019317:Evidence-Based Medicine / Q000379:methods; D006530:Hepatorenal Syndrome / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications / Q000209:etiology / Q000503:physiopathology*; D016031:Liver Transplantation; D008236:Lypressin / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D008879:Midodrine / Q000494:pharmacology / Q000627:therapeutic use; D009638:Norepinephrine / Q000494:pharmacology / Q000627:therapeutic use; D015282:Octreotide / Q000494:pharmacology / Q000627:therapeutic use; D010952:Plasma Substitutes / Q000494:pharmacology / Q000627:therapeutic use; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012709:Serum Albumin / Q000494:pharmacology / Q000627:therapeutic use; D000077585:Terlipressin; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use; D014667:Vasopressins / Q000494:pharmacology / Q000627:therapeutic use
D010952:Plasma Substitutes; D012709:Serum Albumin; D014665:Vasodilator Agents; D014667:Vasopressins; D008236:Lypressin; D008879:Midodrine; D000077585:Terlipressin; D003404:Creatinine; D015282:Octreotide; D009638:Norepinephrine
Cirrhosis; Hepato-adrenal; Hepatopulmonary; Hepatorenal