Consensus report



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    Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II)



consensus report

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consensus report

Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II)   

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    Austrian consensus on the definition and treatment of portal hypertension and its complications (Billroth II)



consensus report

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Document Outline

  • Austrian consensus on the definition and treatment of portal hypertension and its complications (Bil
  • Zusammenfassung
  • Summary
  • Introduction/background
    • Grade definition
  • Criteria and definition of portal hypertension
  • Approach to the diagnosis of portal hypertension
  • Preprimary prophylaxis of variceal bleeding
    • Background
    • Recommendation
  • Primary prophylaxis
    • Indications for medical treatment and follow-up endoscopy
    • Monitoring of beta-blockade
    • Choice of primary prophylaxis for patients with large varices
    • Combination of treatments for primary prophylaxis
  • Acute variceal bleeding and rebleeding: definition and prognostic value
    • Definition of acute variceal bleeding
    • Failure to control acute bleeding (based on international consensus)
    • Failure of secondary prophylaxis (every variceal bleeding after initiation of secondary prophylaxis)
  • Treatment of acute variceal bleeding (AVB)
    • Prerequisites for therapy (III)
    • Time management of endoscopic treatment
    • Blood volume restitution
    • Antibiotic prophylaxis to prevent bacterial infections/spontaneous bacterial peritonitis
    • Prevention/therapy of hepatic encephalopathy
    • Assessment of prognosis
    • Use of balloon tamponade
    • Pharmacological treatment
    • Recommended drug doses
    • Endoscopic therapy of esophageal variceal bleeding
    • Early TIPS-placement
  • Prevention of variceal rebleeding (secondary prophylaxis)
    • Standard therapy
    • Treatment of patients with contraindications to beta-blockers or combination drug therapy
    • Treatment of low-risk patients (early stage liver disease, sufficient tolerance of bleeding) with failure of secondary prophylaxis
    • Treatment for high-risk patients with failure of medical/endoscopic therapy in the prophylaxis of rebleeding
  • Portal hypertensive gastropathy (PHG), gastric antral vascular ectasia (GAVE)
    • Definitions
    • Treatment of acute PHG bleeding
    • Treatment of chronic PHG bleeding
    • Treatment of GAVE bleeding
  • Gastric varices
    • Definitions
    • For therapy of bleeding gastric varices, the following approaches can be used
    • For long-term therapy of fundal varices, there are no established and prospectively evaluated therapies. Potential candidate therapies include
  • Management of ascites
    • Diagnostic approach in patients with ascites
    • Therapy of uncomplicated ascites
    • Refractory ascites
  • Spontaneous bacterial peritonitis (SBP)
    • Definition and management of SBP
    • Long-term prophylaxis of SBP
  • Transjugular intrahepatic portosystemic shunt (TIPS) for therapy of portal hypertension [3]
    • General suppositions for TIPS placement
    • TIPS for variceal bleeding
      • TIPS in acute variceal bleeding
      • TIPS for prophylaxis of variceal bleeding
    • TIPS for refractory ascites (III)
    • TIPS for other indications
  • Hepatorenal syndrome (HRS)
    • Diagnosis of HRS
    • Management, general measures
    • Specific treatment for HRS
      • TIPS in HRS
      • Role of renal replacement therapy and artificial liver support systems
      • Liver transplantation
      • Prevention of HRS
  • Management of vascular liver disease
    • Epidemiology
    • Pathophysiology
    • Diagnosis
    • Management of noncirrhotic portal hypertension
  • Hepato-pulmonary vascular disorders
    • Portopulmonary hypertension
      • Definition
      • Staging of severity [2]
      • Diagnosis
      • Therapy
    • Hepatopulmonary syndrome
      • Definition
      • Staging of severity
      • Diagnosis
      • Therapy
  • Appendix
  • References

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