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Symptomatic duodenal metastasis from a small cell lung cancer primary: a rare case 原发性小细胞肺癌的症状性十二指肠转移:一例罕见病例
Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-14 DOI: 10.1136/flgastro-2023-102456
Panagiotis Armonis, Jeffrey Leung, Charles Murray, Alberto Murino
An elderly man presented with chest pain and shortness of breath on a background of left lower lobe small cell lung cancer, previously treated with chemotherapy. Blood test showed iron deficiency anaemia requiring transfusion. An oesophagogastroduodenoscopy was performed, highlighting an external compression to the distal stomach and a 15 mm round lesion, with a central ulcerated depression and rolled edges in D3, which was suspicious of malignancy (figure 1). Target biopsies (figure 2) confirmed the malignant nature of the lesion with features of small cell neuroendocrine carcinoma, in keeping with a lung metastasis. Gastrointestinal metastases from a lung cancer primary are rare, with a clinical prevalence of 0.19%. The small bowel is the most common gastrointestinal metastatic site and tumours are spread via the haematogenous and lymphatic routes. Patients with small bowel involvement usually present with bowel perforation or gastrointestinal bleeding. Diagnosis is made through oesophagogastroduodenoscopy or emergency laparotomy and the average time between discovery of gastrointestinal metastasis to death is 3–4 months. Panagiotis Armonis , Jeffrey Leung, Charles Murray, Alberto Murino General Internal Medicine, Guy’s and St Thomas’ Hospitals NHS Trust, London, UK Division of Surgery and Interventional Science, UCL, London, UK Gastroenterology, Royal Free Hospital, London, UK Royal Free Unit for Endoscopy, Royal Free Hospital Liver Services, London, UK
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引用次数: 0
Stepping into nursing research: an introduction for gastroenterology and hepatology nurses 迈向护理研究:胃肠病学和肝病学护士介绍
Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-14 DOI: 10.1136/flgastro-2023-102493
Stacey Munnelly, Shellie Jean Radford, Pooja Datt, Leigh Donnelly, Aileen Fraser, Elena Gil-Zaragozano, Kathryn Jack, Harriet Watson, Tariq H Iqbal, Shaji Sebastian, Karen Kemp
In this second part of an introduction to research for gastroenterology and hepatology nurses, we aim to build on the first article that introduced the significance and structure of the National Institute for Health and Care Research clinical research landscape in the UK and the importance of nurse engagement. This article introduces possible career pathways available in the profession and specialty. Practical information on how to start research is provided, including an overview of the education, training and support required for a career in research delivery and academic research. Some of the potential barriers to nursing research careers are highlighted, and solutions to navigate a successful career in nursing research are proposed.
在介绍胃肠病学和肝病学护士研究的第二部分,我们的目标是建立在第一篇文章的基础上,介绍了英国国家健康与护理研究所临床研究景观的意义和结构以及护士参与的重要性。这篇文章介绍了职业和专业中可能的职业道路。提供了关于如何开始研究的实用信息,包括研究交付和学术研究职业所需的教育,培训和支持的概述。一些护理研究事业的潜在障碍被突出,并提出了解决方案,以导航一个成功的护理研究事业。
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引用次数: 0
JAK inhibitors for inflammatory bowel disease: recent advances JAK抑制剂治疗炎症性肠病:最新进展
Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-14 DOI: 10.1136/flgastro-2023-102400
Sailish Honap, Alexandra Agorogianni, Michael J Colwill, Sonia Kalyanji Mehta, Fiona Donovan, Richard Pollok, Andrew Poullis, Kamal Patel
Inflammatory bowel disease (IBD) commonly requires immunosuppressive treatments to induce and maintain durable remission. Janus kinase inhibitors (JAKis) are a novel group of orally administered, small molecule drugs that work by attenuating multiple cytokine signalling pathways to mediate dysregulated immune responses involved in the pathogenesis of IBD. Tofacitinib, filgotinib and upadacitinib have demonstrated efficacy against placebo and are licensed for the treatment of moderate to severe ulcerative colitis; upadacitinib is the only JAKi also currently approved for the treatment of Crohn’s disease. Safety concerns stratified by age have led to class-wide regulatory restrictions for JAKi use across all inflammatory diseases. It is important for gastroenterologists managing patients with IBD to be aware of the key pivotal trial outcomes, to identify appropriate patients in whom to commence a JAKi, and to understand the safety considerations and ways to mitigate these risks in the patients they treat. This review provides a contemporaneous overview of this emerging therapeutic class and provides a practical guide for healthcare practitioners for initiating and monitoring JAKi in IBD.
炎症性肠病(IBD)通常需要免疫抑制治疗来诱导和维持持久的缓解。Janus激酶抑制剂(JAKis)是一种新型口服小分子药物,通过减弱多种细胞因子信号通路来介导与IBD发病机制相关的失调免疫反应。Tofacitinib、filgotinib和upadacitinib已证明对安慰剂有效,并获准用于治疗中度至重度溃疡性结肠炎;upadacitinib是目前唯一被批准用于治疗克罗恩病的JAKi。按年龄分层的安全性问题导致了JAKi在所有炎症性疾病中使用的全类别监管限制。对于管理IBD患者的胃肠病学家来说,重要的是要了解关键的关键试验结果,确定开始JAKi的合适患者,并了解他们治疗的患者的安全性考虑和减轻这些风险的方法。这篇综述提供了这一新兴治疗类别的同期概述,并为IBD中启动和监测JAKi的医疗从业人员提供了实用指南。
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引用次数: 0
Update on the optimisation of endoscopic retrograde cholangiography (ERC) in patients with primary sclerosing cholangitis 原发性硬化性胆管炎患者内镜逆行胆管造影(ERC)优化的最新进展
Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-12 DOI: 10.1136/flgastro-2023-102491
Wafaa Ahmed, Deepak Joshi, Matthew T Huggett, Simon M Everett, Martin James, Shyam Menon, Kofi W Oppong, Wei On, Bharat Paranandi, Palak Trivedi, George Webster, Vinod S Hegade
© Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Primary sclerosing cholangitis (PSC) is a rare cholestatic disorder with a prevalence of 16.2 per 100 000 population. It is characterised by progressive inflammation and destruction of the intrahepatic and extraheptic bile ducts culminating in progressive fibrosis and cirrhosis. The course of PSC is complicated by biliary strictures, recurrent cholangitis and a 4001500 times higher risk of cholangiocarcinoma (CC) and other hepatopancreatobiliary malignancy than the general population. 4–9 Treatment of PSC revolves around managing symptoms and complications as they arise. Endoscopic retrograde cholangiography (ERC) is a valuable tool that allows therapeutic interventions to optimise biliary drainage and facilitate biliary sampling. Despite the utility, controversies remain as to when ERC should be performed. 12 This article aims to clarify some of the issues surrounding this and to provide practical guidance on the ERCbased assessment and management of biliary strictures in PSC. bile ducts culminating in progressive fibrosis and cirrhosis. The course of PSC is complicated by biliary strictures, recurrent cholangitis and a 4001500 times higher risk of cholangiocarcinoma (CC) and other hepatopancreatobiliary malignancy than the general population. 4–9 Treatment of PSC revolves around managing symptoms and complications as they arise. Endoscopic retrograde cholangiography (ERC) is a valuable tool that allows therapeutic interventions to optimise biliary drainage and facilitate biliary sampling. Despite the utility, controversies remain as to when ERC should be performed. 12 This article aims to clarify some of the issues surrounding this and to provide practical guidance on the ERCbased assessment and management of biliary strictures in PSC.
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引用次数: 0
Case of diarrhoea 腹泻个案
Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-11 DOI: 10.1136/flgastro-2023-102516
Giorgio Bartalucci, David Parham, Richard Felwick
A 66year woman presented to our hospital with a 6week history of watery diarrhoea and central abdominal pain. She was taking naproxen occasionally with omeprazole for osteoarthritis but was not on any other regular medications. She had no significant medical history. On admission, physical examination was unremarkable. Laboratory evaluation showed an elevated C reactive protein of 95 mg/L and white cell count of 11.8×10/L. The remainder of her routine biochemistry was within normal ranges. On admission, faecal pathogen PCR panel for bacterial infection including Clostridioides difficile (C. difficile) was negative. Abdominal Xray showed mild thickening of the left colon. A recent faecal calprotectin that was elevated at 3620 μg/L (normal <50) was noted. A flexible sigmoidoscopy was performed and the appearance was as shown in (figure 1). Biopsies were taken (figure 2). Flexible sigmoidoscopy showed features of colitis with widespread pseudomembranes (a layer resembling a membrane over a mucosal surface) giving the endoscopic impression of C. difficile infection. However, repeated stool cultures were negative. Histology revealed a normal crypt architecture with pseudomembranes erupting from the surface of the mucosa. There was an excess of inflammatory cells in the lamina propria and a thickened subepithelial collagen band in keeping with a diagnosis of pseudomembranous collagenous colitis, a rare subtype of microscopic colitis (MC)/collagenous colitis (figure 2). Colonic pseudomembranes form from fibrinous exudate and acute inflammatory cells on the surface of the mucosa, most commonly driven by infection with C. difficile or ischaemia. However, rarer noninfectious causes have also been described including this variant of MC. Pseudomembranous collagenous colitis is uncommon. To date, there are only 15 case series/reports in the literature, with the largest case series having 10 patients. Typically, MC has a normal mucosal appearance, however, in 20% of patients inflammatory changes have been described. 4 A single case series of 10 patients reports inflammatory changes in all patients in addition to pseudomembranous collagenous colitis. Similar to classic MC, the use of nonsteroidal antiinflammatory drugs (NSAIDs) was also associated with statins, proton pump inhibitors and some antidepressants. This entity responds well to treatment with steroids as well as withdrawal of contributing medications. In our case, the patient was discharged with a 8week course of budesonide MMX 9 mg/day and advised to avoid NSAIDs. At followup 3 months later, her symptoms had resolved and a faecal calprotectin was undetectable (<3.8 μg/L). Giorgio Bartalucci, David Parham, Richard Felwick 1 Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK Histopathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
{"title":"Case of diarrhoea","authors":"Giorgio Bartalucci, David Parham, Richard Felwick","doi":"10.1136/flgastro-2023-102516","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102516","url":null,"abstract":"A 66year woman presented to our hospital with a 6week history of watery diarrhoea and central abdominal pain. She was taking naproxen occasionally with omeprazole for osteoarthritis but was not on any other regular medications. She had no significant medical history. On admission, physical examination was unremarkable. Laboratory evaluation showed an elevated C reactive protein of 95 mg/L and white cell count of 11.8×10/L. The remainder of her routine biochemistry was within normal ranges. On admission, faecal pathogen PCR panel for bacterial infection including Clostridioides difficile (C. difficile) was negative. Abdominal Xray showed mild thickening of the left colon. A recent faecal calprotectin that was elevated at 3620 μg/L (normal <50) was noted. A flexible sigmoidoscopy was performed and the appearance was as shown in (figure 1). Biopsies were taken (figure 2). Flexible sigmoidoscopy showed features of colitis with widespread pseudomembranes (a layer resembling a membrane over a mucosal surface) giving the endoscopic impression of C. difficile infection. However, repeated stool cultures were negative. Histology revealed a normal crypt architecture with pseudomembranes erupting from the surface of the mucosa. There was an excess of inflammatory cells in the lamina propria and a thickened subepithelial collagen band in keeping with a diagnosis of pseudomembranous collagenous colitis, a rare subtype of microscopic colitis (MC)/collagenous colitis (figure 2). Colonic pseudomembranes form from fibrinous exudate and acute inflammatory cells on the surface of the mucosa, most commonly driven by infection with C. difficile or ischaemia. However, rarer noninfectious causes have also been described including this variant of MC. Pseudomembranous collagenous colitis is uncommon. To date, there are only 15 case series/reports in the literature, with the largest case series having 10 patients. Typically, MC has a normal mucosal appearance, however, in 20% of patients inflammatory changes have been described. 4 A single case series of 10 patients reports inflammatory changes in all patients in addition to pseudomembranous collagenous colitis. Similar to classic MC, the use of nonsteroidal antiinflammatory drugs (NSAIDs) was also associated with statins, proton pump inhibitors and some antidepressants. This entity responds well to treatment with steroids as well as withdrawal of contributing medications. In our case, the patient was discharged with a 8week course of budesonide MMX 9 mg/day and advised to avoid NSAIDs. At followup 3 months later, her symptoms had resolved and a faecal calprotectin was undetectable (<3.8 μg/L). Giorgio Bartalucci, David Parham, Richard Felwick 1 Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK Histopathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135981857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient experiences of Cytosponge: a qualitative study 细胞海绵的患者经验:一项定性研究
Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-09-11 DOI: 10.1136/flgastro-2023-102484
Laura Jane Neilson, Rebecca C Fitzgerald, Jennifer Deane, Irene Debiram-Beecham, Halime Gulle, Colin Rees, Linda Sharp
Objective Cytosponge is a novel technology for oesophageal pathology diagnosis. Uses include diagnosis of Barrett’s oesophagus and as a triage tool to prioritise upper gastrointestinal endoscopy. Patient experience is a key component of quality care. Previous work has developed endoscopy patient-reported experience measures. An appropriate tool to measure patient experience of Cytosponge is required. The aim of this work was to describe the patient experience of Cytosponge. Design/Method Individuals aged 18 years or over, who had undergone Cytosponge from September 2020 to March 2021, were invited to participate in a semi-structured interview. Interviews were audio-recorded, transcribed verbatim and anonymised. Thematic analysis was undertaken. Themes were organised into two overarching areas relating to patient experiences and patient perceptions of the test. Results 19 patients underwent interview (aged 37–80 years, 13 male). In terms of patient experiences of Cytosponge, five themes were identified: emotional reaction; expectations; environment and physical process; sensory experience; communication and information. All themes were present across all procedural phases, aside from sensory experience which was only present during the test. With regard to perception of the test, two major themes were identified: test novelty (encompassing patient awareness of the test and reaction to the new test) and trusting the test results. Conclusion Patients must remain central to novel technologies such as Cytosponge. Measuring patient experience is essential to achieve that. This study demonstrates five major themes which describe the patient experience of this procedure. These have been used to adapt the Newcastle ENDOPREM for use in Cytosponge.
目的细胞海绵是一种新的食管病理诊断技术。用途包括巴雷特食管的诊断,以及作为优先进行上消化道内窥镜检查的分类工具。患者体验是优质护理的关键组成部分。以前的工作已经开发了内窥镜检查患者报告的经验措施。需要一种合适的工具来测量患者对Cytosponge的体验。这项工作的目的是描述患者体验的细胞海绵。设计/方法在2020年9月至2021年3月期间接受过Cytosponge治疗的18岁或以上的个人被邀请参加半结构化访谈。采访录音,逐字抄写和匿名。进行了专题分析。主题被组织成与患者体验和患者对测试的看法有关的两个总体领域。结果随访19例患者,年龄37 ~ 80岁,男性13例。在使用Cytosponge的患者体验方面,确定了五个主题:情绪反应;预期;环境与物理过程;感官体验;通信和信息。所有的主题都出现在所有的程序阶段,除了只在测试期间出现的感官体验。关于测试的感知,确定了两个主要主题:测试新颖性(包括患者对测试的认识和对新测试的反应)和信任测试结果。结论必须以患者为中心,使用Cytosponge等新技术。衡量病人的经验对实现这一目标至关重要。本研究展示了五个主要主题,描述了该手术的患者体验。这些已被用于适应纽卡斯尔ENDOPREM用于细胞海绵。
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引用次数: 0
Outpatient management of cirrhosis: moving forward 肝硬化的门诊管理:向前发展
IF 2.6 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-17 DOI: 10.1136/flgastro-2023-102450
Rebecca L. Jones
{"title":"Outpatient management of cirrhosis: moving forward","authors":"Rebecca L. Jones","doi":"10.1136/flgastro-2023-102450","DOIUrl":"https://doi.org/10.1136/flgastro-2023-102450","url":null,"abstract":"","PeriodicalId":46937,"journal":{"name":"Frontline Gastroenterology","volume":"14 1","pages":"447 - 448"},"PeriodicalIF":2.6,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44689205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
UpFront. UpFront.
IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-08-07 eCollection Date: 2023-01-01 DOI: 10.1136/flgastro-2023-102519
R Mark Beattie
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引用次数: 0
British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 3: special circumstances. 英国胃肠病学会最佳实践指南:肝硬化的门诊管理-第3部分:特殊情况
IF 2.6 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-07-28 eCollection Date: 2023-01-01 DOI: 10.1136/flgastro-2023-102432
Dina Mansour, Steven Masson, John Hammond, Joanna A Leithead, Jill Johnson, Mussarat Nazia Rahim, Andrew C Douds, Lynsey Corless, Debbie L Shawcross, Michael A Heneghan, Dhiraj Tripathi, Stuart McPherson, Emily Bonner, Gemma Botterill, Rebecca West, Mhairi Donnelly, Allison Grapes, Coral Hollywood, Valerie Ross

The prevalence of cirrhosis has risen significantly over recent decades and is predicted to rise further. Widespread use of non-invasive testing means cirrhosis is increasingly diagnosed at an earlier stage. Despite this, there are significant variations in outcomes in patients with cirrhosis across the UK, and patients in areas with higher levels of deprivation are more likely to die from their liver disease. This three-part best practice guidance aims to address outpatient management of cirrhosis, in order to standardise care and to reduce the risk of progression, decompensation and mortality from liver disease. Part 1 addresses outpatient management of compensated cirrhosis: screening for hepatocellular cancer, varices and osteoporosis, vaccination and lifestyle measures. Part 2 concentrates on outpatient management of decompensated disease including management of ascites, encephalopathy, varices, nutrition as well as liver transplantation and palliative care. In this, the third part of the guidance, we focus on special circumstances encountered in managing people with cirrhosis, namely surgery, pregnancy, travel, managing bleeding risk for invasive procedures and portal vein thrombosis.

近几十年来,肝硬化的患病率显著上升,预计还会进一步上升。非侵入性检测的广泛使用意味着肝硬化越来越多地在早期阶段被诊断出来。尽管如此,英国各地肝硬化患者的预后仍存在显著差异,贫困程度较高地区的患者更有可能死于肝病。这份由三部分组成的最佳实践指南旨在解决肝硬化的门诊管理问题,以规范护理并降低肝病进展、失代偿和死亡率的风险。第1部分介绍补偿性肝硬化的门诊管理:肝细胞癌症、静脉曲张和骨质疏松症的筛查、疫苗接种和生活方式措施。第2部分集中讨论失代偿性疾病的门诊管理,包括腹水、脑病、静脉曲张、营养以及肝移植和姑息治疗的管理。在本指南的第三部分中,我们重点介绍了在管理肝硬化患者时遇到的特殊情况,即手术、怀孕、旅行、管理侵入性手术的出血风险和门静脉血栓形成。
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引用次数: 2
British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis - part 2: decompensated cirrhosis. 英国胃肠病学会最佳实践指南:肝硬化的门诊管理-第2部分:失代偿性肝硬化
IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-07-28 eCollection Date: 2023-01-01 DOI: 10.1136/flgastro-2023-102431
Dina Mansour, Steven Masson, Lynsey Corless, Andrew C Douds, Debbie L Shawcross, Jill Johnson, Joanna A Leithead, Michael A Heneghan, Mussarat Nazia Rahim, Dhiraj Tripathi, Valerie Ross, John Hammond, Allison Grapes, Coral Hollywood, Gemma Botterill, Emily Bonner, Mhairi Donnelly, Stuart McPherson, Rebecca West

There are two distinct phases in the natural history of cirrhosis: compensated disease (corresponding to Child Pugh A and early Child Pugh B disease), where the patient may be largely asymptomatic, progressing with increasing portal hypertension and liver dysfunction to decompensated disease (corresponding to Child Pugh late B-C), characterised by the development of overt clinical signs, including jaundice, hepatic encephalopathy (HE), ascites, renal dysfunction and variceal bleeding. The transition from compensated cirrhosis to decompensated cirrhosis (DC) heralds a watershed in the nature and prognosis of the disease. DC is a systemic disease, characterised by multiorgan/system dysfunction, including haemodynamic and immune dysfunction. In this second part of our three-part series on the outpatient management of cirrhosis, we address outpatient management of DC, including management of varices, ascites, HE, nutrition, liver transplantation and palliative care. We also introduce an outpatient DC care bundle. For recommendations on screening for osteoporosis, hepatocellular carcinoma surveillance and vaccination see part one of the guidance. Part 3 of the guidance focusses on special circumstances encountered in patients with cirrhosis, including surgery, pregnancy, travel, management of bleeding risk for invasive procedures and portal vein thrombosis.

肝硬化的自然史有两个不同的阶段:代偿性疾病(对应Child-Pugh A和早期Child-Pugh B疾病),患者可能基本上没有症状,随着门静脉高压和肝功能障碍的增加发展为失代偿性疾病,其特征是出现明显的临床症状,包括黄疸、肝性脑病(HE)、腹水、肾功能障碍和静脉曲张出血。从代偿性肝硬化向失代偿性肝硬化(DC)的转变预示着该疾病性质和预后的分水岭。DC是一种系统性疾病,其特征是多器官/系统功能障碍,包括血液动力学和免疫功能障碍。在我们关于肝硬化门诊管理的三部分系列的第二部分中,我们讨论了DC的门诊管理,包括静脉曲张、腹水、HE、营养、肝移植和姑息治疗的管理。我们还推出了门诊DC护理捆绑包。有关骨质疏松症筛查、肝细胞癌监测和疫苗接种的建议,请参阅指南的第一部分。指南的第3部分侧重于肝硬化患者遇到的特殊情况,包括手术、怀孕、旅行、侵入性手术出血风险的管理和门静脉血栓形成。
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引用次数: 0
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