What are some clinical signs and symptoms associated with portal hypertension? Esophageal, gastric, mesenteric, and rectal varices may bleed in response to elevated portal pressures; mortality related to the initial bleeding episode may be 20% or more. Increased sinusoidal pressure may result in ascites and hepatic hydrothorax. Hepatic encephalopathy, hepatorenal syndrome with renal dysfunction, and …
How is transjugular liver biopsy performed? A hepatic vein (most commonly the right hepatic vein) is accessed using a transjugular approach (via the jugular vein to the superior vena cava, through the right atrium to the inferior vena cava, and into the right hepatic vein), and a stiff wire is placed. A stiff metal cannula …
When is transjugular liver biopsy indicated and preferred over percutaneous liver biopsy? Because a transjugular liver biopsy specimen is obtained from within a hepatic vein, bleeding complications resulting from transgression of the liver capsule may be avoided. The transjugular procedure is indicated for patients with coagulopathy or platelet deficiency. Platelet dysfunction because of renal failure …
Should a cholecystostomy catheter be placed to external drainage indefinitely? In the acute phase, although there is evidence of active inflammation, the catheter is maintained on external drainage. In the setting of cholecystitis secondary to obstructing biliary calculi, the catheter is maintained on external drainage. In the setting of acalculous cholecystitis, the catheter may be …
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How long must a percutaneous cholecystostomy catheter remain within the gallbladder before it can be removed? Although some investigators have shown that such catheters can often be safely removed in less time, the majority suggest that the cholecystostomy catheter should stay within the gallbladder for at least 4 to 6 weeks. This allows time for …
Potential complications of percutaneous cholecystostomy What are the potential complications associated with percutaneous cholecystostomy? Complications include hemorrhage, infection (sepsis), bile peritonitis, and respiratory failure or aspiration related to intraprocedural sedation. Pneumothorax is possible but is relatively rare if a subcostal approach is used.
Basic steps involved in performing percutaneous cholecystostomy With US guidance, the gallbladder is accessed with a needle. A wire is placed, and after tract dilation over the wire, a drainage catheter is placed into the gallbladder and allowed to drain externally. A subcostal, transhepatic path to the gallbladder is generally preferred because it may guard …