{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T17:00:54Z","timestamp":1769533254858,"version":"3.49.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Was ist neu?<\/jats:title><jats:p>\n            Hepatorenales Syndrom Nicht nur h\u00e4modynamische Ver\u00e4nderungen k\u00f6nnen zur Entstehung des hepatorenalen Syndroms f\u00fchren, sondern auch die bestehende Inflammation. Nach der aktuellen Leitlinie der EASL wird zwischen einer akuten Form (HRS-AKI) und einer chronischen Form (HRS-NAKI) unterschieden. Bei der Diagnose muss ein Volumenmangel ausgeschlossen werden. In der Therapie des HRS-AKI werden die splanchnische Vasodilatation mit konsekutiver renaler Minderperfusion und auch die Inflammation direkt adressiert.<\/jats:p><jats:p>\n            Zirrhotische Kardiomyopathie Tumor-Nekrose-Faktor alpha (TNF-\u03b1) und Interleukin 1\u03b2 haben einen negativen Einfluss auf die Inotropie des Myokards. Die komplexen Vorg\u00e4nge, die bei einer CCM ablaufen, lassen sich diagnostisch nur eingeschr\u00e4nkt mit konventionellen Parametern abbilden. Daher wird in den aktuellen Diagnosekriterien die Messung der myokardialen Deformation mittels Speckle-Tracking-Echokardiografie empfohlen. Eine spezifische Therapie der CCM existiert aktuell nicht.<\/jats:p><jats:p>\n            Portopulmonale Hypertonie und hepatopulmonales Syndrom Es konnte gezeigt werden, dass die bestehende Inflammation eine entscheidende Rolle spielt. Proinflammatorische Zytokine f\u00fchren zu einer Akkumulation von Makrophagen und einer vermehrten Adh\u00e4renz von Monozyten in der Lunge. Bei Patienten mit einer Leberzirrhose sollte das Screening auf eine Hypoxie mittels Pulsoxymetrie erfolgen. Als erster Schritt wird die Durchf\u00fchrung einer arteriellen Blutgasanalyse empfohlen. Therapeutisch erfolgt in erster Linie eine symptomatische Gabe von Sauerstoff.<\/jats:p><jats:p>\n            Hepatische Enzephalopathie Ansammlungen von toxischen Substanzen im Gehirn sind Ursache einer HE und es k\u00f6nnen sich vermehrt entz\u00fcndliche Mediatoren, wie TNF-\u03b1 oder IL-6, messen lassen. Die Diagnose wird mittels West-Haven-Kriterien und z.B. Zahlenverbindungstest oder dem \u201eAnimal Naming Test\u201c gestellt. In der Akutphase einer HE k\u00f6nnen auch verzweigtkettige Aminos\u00e4uren eingesetzt werden.<\/jats:p><jats:p>\n            Relative Nebenniereninsuffizienz Pathophysiologisch spielt auch hier eine Inflammation eine wichtige Rolle, wodurch die adrenale Steroidsynthese gehemmt wird. F\u00fcr die Diagnostik der NNRI bietet sich die Bestimmung des freien Serumkortisols an. Bei Patienten mit einer Leberzirrhose und einem septischen Schock kann eine Hydrokortisonsubstitution sinnvoll sein.<\/jats:p>","DOI":"10.1055\/a-2146-7514","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T22:43:13Z","timestamp":1716504193000},"page":"690-695","source":"Crossref","is-referenced-by-count":2,"title":["Die Leberzirrhose als Multisystemerkrankung"],"prefix":"10.1055","volume":"149","author":[{"given":"Dominik","family":"Bettinger","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin II des Universit\u00e4tsklinikums Freiburg im Breisgau, Freibrug"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Thimme","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin II des Universit\u00e4tsklinikums Freiburg im Breisgau, Freibrug"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Schulthei\u00df","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin II des Universit\u00e4tsklinikums Freiburg im Breisgau, Freibrug"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1111\/j.1478-3231.2011.02579.x","article-title":"Endothelial dysfunction in the regulation of cirrhosis and portal hypertension","volume":"32","author":"Y Iwakiri","year":"2012","journal-title":"Liver Int"},{"issue":"11","key":"ref2","doi-asserted-by":"publisher","first-page":"3209","DOI":"10.1007\/s10620-015-3752-3","article-title":"Cirrhotic Multiorgan Syndrome","volume":"60","author":"S M\u00f8ller","year":"2015","journal-title":"Dig Dis Sci"},{"issue":"01","key":"ref3","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.jhep.2013.07.044","article-title":"Pathological bacterial translocation in liver cirrhosis","volume":"60","author":"R Wiest","year":"2014","journal-title":"J Hepatol"},{"issue":"03","key":"ref4","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1016\/j.jhep.2020.11.048","article-title":"The systemic inflammation hypothesis: Towards a new paradigm of acute decompensation and multiorgan failure in cirrhosis","volume":"74","author":"V Arroyo","year":"2021","journal-title":"J Hepatol"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.jhep.2018.03.024","article-title":"EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis","volume":"69","author":"P Angeli","year":"2018","journal-title":"J Hepatol"},{"issue":"09","key":"ref6","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s11894-020-00783-1","article-title":"Cirrhotic Cardiomyopathy","volume":"22","author":"KT Yoon","year":"2020","journal-title":"Curr Gastroenterol Rep"},{"issue":"02","key":"ref7","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.jjcc.2015.04.016","article-title":"Cirrhotic cardiomyopathy in the pre- and post-liver transplantation phase","volume":"67","author":"EM Zardi","year":"2016","journal-title":"J Cardiol"},{"issue":"05","key":"ref8","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1080\/17474124.2019.1587293","article-title":"An update on cirrhotic cardiomyopathy","volume":"13","author":"S M\u00f8ller","year":"2019","journal-title":"Expert Rev Gastroenterol Hepatol"},{"issue":"01","key":"ref9","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1002\/hep.30875","article-title":"Redefining Cirrhotic Cardiomyopathy for the Modern Era","volume":"71","author":"M Izzy","year":"2020","journal-title":"Hepatology"},{"issue":"08","key":"ref10","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1164\/rccm.201008-1303OC","article-title":"A central role for CD68(+) macrophages in hepatopulmonary syndrome. 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