Revision and update on clinical practice guideline for liver cirrhosis

Forns index as a useful noninvasive predictor of esophageal varices in liver cirrhosis

“…This is in line with a previous study reporting that low platelet count was an independent risk factor or predictor for the presence of esophageal varices and their size. (22) The study conducted by Stefanescu et al (7) evaluated four non-invasive methods that had previously been known as predictors of liver fibrosis grade, for identifying esophageal varices and their size, in comparison with endoscopic checkup as a standard procedure. One of the evaluated methods was Forns index.…”

Manejo de la ascitis secundaria a cirrosis en el paciente pediátrico. Revisión y recomendaciones. Parte 1: Fisiopatología, evaluación diagnóstica, criterios de hospitalización, tratamiento, manejo nutricional

“…2,3,5,6,[8][9][10][11][12][13] Además, consideraciones propias de esta edad dificultan a los pediatras basarse en recomendaciones extrapoladas de la población adulta.…”

“…8 Existen numerosos artículos y guías de práctica clínica basadas en evidencias para pacientes adultos, pero poco ha sido publicado en la población pediátrica. 2,3,5,6,[8][9][10][11][12][13] Además, consideraciones propias de esta edad dificultan a los pediatras basarse en recomendaciones extrapoladas de la población adulta. 2,14 Entre las diferencias, se encuentran las etiologías de la cirrosis, la función renal en relación con la superficie corporal, la distribución corporal del agua, los requerimientos hídricos y nutricionales que deben contemplar el crecimiento, los niveles séricos de creatinina que definen la insuficiencia renal y el tipo de dieta con mayor contenido de sodio y agua libre de solutos.…”

Management of cirrhotic ascites in children. Review and recommendations. Part 2: Electrolyte disturbances, nonelectrolyte disturbances, therapeutic options

“…64,65 In general, it is accompanied with an increase of intravascular volume. 8,66 Although it has been described a s h y p e r v o l e m i c o r d i l u t i o n a l hyponatremia (HH) in the literature regarding the adult population, 6,10,12,13,67 the first term is preferred in pediatrics because excess water relative to sodium also occurs in euvolemic or hypovolemic hyponatremia. 16 As cirrhosis progresses, circulatory dysfunction induces non-osmotic ADH secretion with greater water retention relative to sodium and HH develops.…”

“…65,67 A l t h o u g h t h e r e i s consensus not to treat patients when serum values are > 130 mEq/L, values for the discontinuation of diuretics range between ≤ 125 mEq/L and < 120 mEq/L. 6,[8][9][10]13,65,71 Our recommendation is to discontinue diuretics when serum levels are ≤ 1 2 5 m E q / L . A l t h o u g h i t i s controversial, water restriction has become a standard treatment for HH.…”