Krvarenje iz probavnog sustava u bolesnika s cirozom jetre

master's thesis

• Title (english): Gastrointestinal bleeding in patients with liver cirrhosis
• Author: Josipa Dropuljić
• Mentor: Lucija Virović Jukić (mentor)
• Committee member: Neven Baršić (predsjednik povjerenstva)
• Committee member: Marija Bakula (član povjerenstva)
• Committee member: Lucija Virović Jukić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Ciroza je posljednji stadij kroničnih bolesti jetre u kojem dolazi do zamjene normalnog jetrenog parenhima regeneratornim nodulima. Oštećenje jetre utječe na njezinu sintetsku funkciju dovodeći do snižene koncentracije svih čimbenika zgrušavanja osim faktora VIII. Kao posljedica toga narušena je ravnoteža između hemostaze i fibrinolize. Napredovanjem bolesti također dolazi do porasta portalnog tlaka i pojave portalne hipertenzije koja je povezana s nastankom varikoziteta.

Krvarenje iz varikoziteta jednjaka najčešći je uzrok krvarenja iz gornjeg dijela probavnog sustava kod bolesnika s cirozom. Zlatni standard u dijagnostici je ezofagogastroduodenoskopija. Od neinvazivnih metoda koriste se laboratorijske pretrage, elastografija i slikovne metode. Osim krvarenja iz varikoziteta jednjaka, kod bolesnika s cirozom također se pojavljuje krvarenje iz varikoziteta želuca, rektalnih i ektopičnih varikoziteta te krvarenje iz portalne hipertenzivne gastropatije i kolopatije.

U liječenju akutnog krvarenja primjenjuju se opće mjere koje obuhvaćaju nadoknadu volumena, antibiotsku profilaksu i korekciju pridružene koagulopatije, te specifične mjere koje uključuju primjenu vazoaktivnih lijekova, endoskopsko liječenje krvarenja i transjugularni intrahepatalni portosistemski shunt (TIPS).

Abstract (english)

Liver cirrhosis represents an end stage of chronic liver diseases in which the normal liver parenchyma is transformed into regenerative nodules. Liver damage affects its synthetic function, leading to reduced levels of all procoagulant factors except factor VIII. As a result, the balance between hemostasis and fibrinolysis is disturbed. As the disease progresses, there is also an increase in portal pressure and the appearance of portal hypertension, which is associated with the development of varicose veins.

Bleeding from esophageal varices is the most common cause of bleeding from the upper part of the gastrointestinal tract in patients with liver cirrhosis. The gold standard for diagnosis is esophagogastroduodenoscopy. Laboratory tests, elastography, and imaging methods are used as non-invasive methods. In addition to bleeding from esophageal varices, patients with cirrhosis also experience bleeding from gastric varices, rectal and ectopic varices, and bleeding from portal hypertensive gastropathy and colopathy.

In the treatment of acute bleeding, general measures are applied that include volume replacement, antibiotic prophylaxis and correction of associated coagulopathy, together with specific measures that include the use of vasoactive drugs, endoscopic treatment of bleeding, and transjugular intrahepatic portosystemic shunt (TIPS).

• Keywords: ciroza jetre; poremećaji zgrušavanja; portalna hipertenzija; krvarenje; varikoziteti jednjaka
• Keywords (english): liver cirrhosis; coagulation disorders; portal hypertension; esophageal varices; bleeding
• Language: croatian
• URN:NBN: urn:nbn:hr:105:175130
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-24 09:26:42