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Sample records for extrahepatic portal hypertension

  1. Extrahepatic complications to cirrhosis and portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Henriksen, Jens H; Bendtsen, Flemming

    2014-01-01

    In addition to complications relating to the liver, patients with cirrhosis and portal hypertension develop extrahepatic functional disturbances of multiple organ systems. This can be considered a multiple organ failure that involves the heart, lungs, kidneys, the immune systems, and other organ...

  2. Asymptomatic extrahepatic portal obstruction without portal hypertensive findings detected in ultrasonic mass screening.

    Science.gov (United States)

    Koda, M; Ikawa, S; Kobayashi, J; Murawaki, Y; Horie, Y; Suou, T; Kawasaki, H; Miyoshi, Y

    1995-01-01

    We report three adult cases of extrahepatic portal obstruction (EHPO) detected by ultrasonic (US) mass screening. All these cases were asymptomatic with no abnormalities on hematological or biochemical tests. Only indocynanine green clearance test revealed a slight abnormality. By imaging modalities, the portal trunk could not be visualized and cavernous transformation could be visualized. There were no findings of portal hypertension, such as splenomegaly, esophageal varices and hepatofugal collaterals, in any of these cases. As many EHPOs without symptoms can be detected on US mass survey, US is considered to be the best modality for screening for this disease.

  3. Extrahepatic Portal Hypertension following Liver Transplantation: a Rare but Challenging Problem

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    B. Malassagne

    1998-01-01

    Full Text Available This study reports our experience of 8 cases of extrahepatic portal hypertension after 273 orthotopic liver transplantations in 244 adult patients over a 10- year period. The main clinical feature was ascites, and the life-threatening complication was variceal bleeding. Extrahepatic portal hypertension was caused by portal vein stenosis in 6 patients, and left-sided portal hypertension in 2 patients after inadventent ligation of portal venous tributaries or portasystemic shunts. All patients with portal vein stenosis had complete relief of portal hypertension after percutaneous transhepatic venoplasty (n=4 or surgical reconstruction (n=2, after a median follow-up of 33 (range: 6–62 months. Of the 2 patients with left-sided portal hypertension, one died after splenectomy and one rebled 6 months after left colectomy. This study suggests that extrahepatic portal hypertension is a series complication after liver transplantation that could be prevented by meticulous portal anastomosis and closure of portal tributaries or portasystemic shunts to improve the portal venous flow. However, any ligation has to be performed under ultrasound guidance to avoid inadventent venous ligations.

  4. [Surgical treatment of extrahepatic portal hypertension in children].

    Science.gov (United States)

    Sevriugov, B L; Ulŕikh, E V; Korolev, M P; Kupatadze, D D; Ivanov, A P; Nabokov, V V

    1994-08-01

    In the period from 1985 to 1992 sixty-three patients aged from 7 months to 15 years were treated for the portal hypertension syndrome, 60 had the extrahepatie form. Forty-five various operations for portosystemic shunting were carried out: formation of proximal splenorenal anastomosis in 31, distal splenorenal anastomosis in 4, mesentericocaval anastomosis in 6, gastrocaval anastomisis in 2, and an atypical vascular shunt in 2 cases. Nonshunting operations were performed on 8 patients. Since 1986 39 sessions of endoscopic sclerotherapy were conducted, 16 of them were carried out in cases with esophagogastric bleeding.

  5. Very Early Presentation of Extrahepatic Portal Vein Obstruction Causing Portal Hypertension in an Infant: Uncertainties in the Management and Therapeutic Limitations

    OpenAIRE

    Parisá Khodayar-Pardo; Andrés Peña Aldea; Ana Ramírez González; Adela Meseguer Carrascosa; Cristina Calabuig Bayo

    2016-01-01

    Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous ...

  6. Portal Hypertension

    Science.gov (United States)

    ... Obesity to Liver Cancer Additional Content Medical News Portal Hypertension By Steven K. Herrine, MD, Thomas Jefferson ... Liver Hepatic Encephalopathy Jaundice in Adults Liver Failure Portal Hypertension (See also Overview of Liver Disease .) Portal ...

  7. Very Early Presentation of Extrahepatic Portal Vein Obstruction Causing Portal Hypertension in an Infant: Uncertainties in the Management and Therapeutic Limitations.

    Science.gov (United States)

    Khodayar-Pardo, Parisá; Peña Aldea, Andrés; Ramírez González, Ana; Meseguer Carrascosa, Adela; Calabuig Bayo, Cristina

    2016-01-01

    Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound. Neither signs of thrombosis in arteriovenous system, nor affectation of biliary tract were identified in the magnetic resonance imaging study. A significant enlargement of the caudate lobe of the liver was reported. No risk factors were detected. The differential diagnosis performed was extensive. Inherited thrombophilia and storage disorders were especially considered. Liver biopsy was normal. Upper gastrointestinal esophagogastroduodenoscopy detected two small varicose cords on the distal third of the esophagus. Finding a cavernous transformation of the portal vein with evidence of collateral circulation in such an early age is a challenging condition for professionals, since PHT may lead to severe complications during childhood and can compromise growth and development. Evidence-based guidelines for the management of PHT in adults have been published. However, follow-up and treatment of pediatric patients have not yet been standardized. Moreover, management of PHT in infants faces particular difficulties such as technical restrictions that could hinder their treatment.

  8. Very Early Presentation of Extrahepatic Portal Vein Obstruction Causing Portal Hypertension in an Infant: Uncertainties in the Management and Therapeutic Limitations

    Directory of Open Access Journals (Sweden)

    Parisá Khodayar-Pardo

    2016-07-01

    Full Text Available Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound. Neither signs of thrombosis in arteriovenous system, nor affectation of biliary tract were identified in the magnetic resonance imaging study. A significant enlargement of the caudate lobe of the liver was reported. No risk factors were detected. The differential diagnosis performed was extensive. Inherited thrombophilia and storage disorders were especially considered. Liver biopsy was normal. Upper gastrointestinal esophagogastroduodenoscopy detected two small varicose cords on the distal third of the esophagus. Finding a cavernous transformation of the portal vein with evidence of collateral circulation in such an early age is a challenging condition for professionals, since PHT may lead to severe complications during childhood and can compromise growth and development. Evidence-based guidelines for the management of PHT in adults have been published. However, follow-up and treatment of pediatric patients have not yet been standardized. Moreover, management of PHT in infants faces particular difficulties such as technical restrictions that could hinder their treatment.

  9. Very Early Presentation of Extrahepatic Portal Vein Obstruction Causing Portal Hypertension in an Infant: Uncertainties in the Management and Therapeutic Limitations

    Science.gov (United States)

    Khodayar-Pardo, Parisá; Peña Aldea, Andrés; Ramírez González, Ana; Meseguer Carrascosa, Adela; Calabuig Bayo, Cristina

    2016-01-01

    Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound. Neither signs of thrombosis in arteriovenous system, nor affectation of biliary tract were identified in the magnetic resonance imaging study. A significant enlargement of the caudate lobe of the liver was reported. No risk factors were detected. The differential diagnosis performed was extensive. Inherited thrombophilia and storage disorders were especially considered. Liver biopsy was normal. Upper gastrointestinal esophagogastroduodenoscopy detected two small varicose cords on the distal third of the esophagus. Finding a cavernous transformation of the portal vein with evidence of collateral circulation in such an early age is a challenging condition for professionals, since PHT may lead to severe complications during childhood and can compromise growth and development. Evidence-based guidelines for the management of PHT in adults have been published. However, follow-up and treatment of pediatric patients have not yet been standardized. Moreover, management of PHT in infants faces particular difficulties such as technical restrictions that could hinder their treatment. PMID:27504083

  10. Warren shunt combined with partial splenectomy in children with extra-hepatic portal hypertension, massive splenomegaly and severe hypersplenism

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    Sretenović Aleksandar

    2014-01-01

    Full Text Available Introduction. Extra-hepatic portal vein obstruction (EHPVO is one of the most often causes of portal hypertension in children. Objective. Establishing the importance of shunt surgery in combination with partial spleen resection in selected pediatric patients with EHPVO, enormous splenomegaly and severe hypersplenism. Methods. Distal splenorenal shunt (DSRS with partial spleen resection was performed in 22 children age from 2 to 17 years with EHPVO. Indications for surgery were pain and abdominal discomfort caused by spleen enlargement, as well as symptomatic hypersplenism with leucopenia, thrombocytopenia and anemia. The partial spleen resection was performed by ligation of blood vessels to caudal two thirds of the spleen. After ischemic parenchymal demarcation transection with electrocautery LigaSure was performed with preservation of 20-30% of spleen tissue, and then Warren DSRS was created. Platelet and leucocytes counts and liver function tests were obtained before, one month and one year after surgery. Growth was assessed with SD scores (Z scores for height, weight and body mass index at the time of surgery and one year later. Results. In all patients postoperative period was without significant complications. Platelets and leucocytes counts were normalized. Patency rate of shunts was 100%. Two significant shunts stenosis were observed and successfully treated with percutaneous angioplasty. During the follow-up period (1 to 9 years all patients were asymptomatic, with improved quality of life and growth. Conclusion. Results of our study indicate that shunt surgery with a partial spleen resection is an effective and safe procedure for patients with enormous splenomegaly and severe hypersplenism caused by EHPVO.

  11. Research progress of vasculopathy in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Tao Li; Zhen Yang

    2005-01-01

    Portal hypertension, one of the vascular diseases, not only has lesions in liver, but also changes in vascular structures and functions of extrahepatic portal system, systemic system and pulmonary circulation. The pathological changes of vasculopathy in portal hypertension include remodeling of arterialized visceral veins, intimal injury of visceral veins and destruction of contractile structure in visceral arterial wall. The mechanisms of vasculopathy in portal hypertension may be attributed to the changes of hemodynamics in portal system, immune response, gene modulation, vasoactive substances, and intrahepatic blood flow resistance. Portal hypertension can cause visceral hyperdynamic circulation, and the development and progression of visceral vasculopathy,while visceral vasculopathy can promote the development and progression of portal hypertension and visceral hyperdynamic circulation in turn. The aforementioned three factors interact in the pathogenesis of hepatic cirrhosisinduced portal hypertension and are involved in hemorrhage due to varicose vein rupture.

  12. Noncirrotisk intrahepatisk portal hypertension

    DEFF Research Database (Denmark)

    Dam Fialla, Annette; Havelund, Troels

    2007-01-01

    Non-cirrhotic intrahepatic portal hypertension is characterized by portal hypertension in the absence of liver cirrhosis or portal vein thrombosis. The disease is common in the East and rarely seen in the West. Two cases with oesophageal varices are described. The histopathology is heterogeneous...... but includes vascular lesions and portal fibrosis. Patient management follows the current recommendations for variceal bleeding....

  13. Extrahepatic Portal Vein Obstruction and Portal Vein Thrombosis in Special Situations: Need for a New Classification

    Science.gov (United States)

    Wani, Zeeshan A.; Bhat, Riyaz A.; Bhadoria, Ajeet S.; Maiwall, Rakhi

    2015-01-01

    Extrahepatic portal vein obstruction is a vascular disorder of liver, which results in obstruction and cavernomatous transformation of portal vein with or without the involvement of intrahepatic portal vein, splenic vein, or superior mesenteric vein. Portal vein obstruction due to chronic liver disease, neoplasm, or postsurgery is a separate entity and is not the same as extrahepatic portal vein obstruction. Patients with extrahepatic portal vein obstruction are generally young and belong mostly to Asian countries. It is therefore very important to define portal vein thrombosis as acute or chronic from management point of view. Portal vein thrombosis in certain situations such as liver transplant and postsurgical/liver transplant period is an evolving area and needs extensive research. There is a need for a new classification, which includes all areas of the entity. In the current review, the most recent literature of extrahepatic portal vein obstruction is reviewed and summarized. PMID:26021771

  14. Extrahepatic portal vein obstruction and portal vein thrombosis in special situations: Need for a new classification

    Directory of Open Access Journals (Sweden)

    Zeeshan A Wani

    2015-01-01

    Full Text Available Extrahepatic portal vein obstruction is a vascular disorder of liver, which results in obstruction and cavernomatous transformation of portal vein with or without the involvement of intrahepatic portal vein, splenic vein, or superior mesenteric vein. Portal vein obstruction due to chronic liver disease, neoplasm, or postsurgery is a separate entity and is not the same as extrahepatic portal vein obstruction. Patients with extrahepatic portal vein obstruction are generally young and belong mostly to Asian countries. It is therefore very important to define portal vein thrombosis as acute or chronic from management point of view. Portal vein thrombosis in certain situations such as liver transplant and postsurgical/liver transplant period is an evolving area and needs extensive research. There is a need for a new classification, which includes all areas of the entity. In the current review, the most recent literature of extrahepatic portal vein obstruction is reviewed and summarized.

  15. Noncirrotisk intrahepatisk portal hypertension

    DEFF Research Database (Denmark)

    Dam Fialla, Annette; Havelund, Troels

    2007-01-01

    Non-cirrhotic intrahepatic portal hypertension is characterized by portal hypertension in the absence of liver cirrhosis or portal vein thrombosis. The disease is common in the East and rarely seen in the West. Two cases with oesophageal varices are described. The histopathology is heterogeneous...

  16. Sinistral Portal Hypertension. A Case Report

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    Dinesh Singhal

    2006-11-01

    Full Text Available Sinistral portal hypertension is a clinical syndrome of gastric variceal hemorrhage in the setting of splenic vein thrombosis due to a primary pancreatic pathology. The distinguishing features from other forms of portal hypertension are preserved liver function and a patent extrahepatic portal vein. The important causes include acute and chronic pancreatitis, pancreatic pseudocysts and pancreatic carcinomas. Benign pancreatic neoplasms only rarely cause sinistral portal hypertension. Splenic vein thrombosis complicates 7-20% of patients having pancreatitis or a pancreatic pseudocyst; however, bleeding occurs in only approximately 5% of patients. The diagnosis of sinistral portal hypertension is achieved by a combination of gastroscopy, liver function tests, ultrasound examination (with Doppler and/or contrast-enhanced CT scan of the abdomen.A mere demonstration of sinistral portal hypertension does not warrant intervention. An expectant management is justifiable in asymptomatic patients with pancreatitis. However, concomitant splenectomy may be considered in patients undergoing operative treatment of symptomatic chronic pancreatitis if sinistral portal hypertension and gastroesophageal varices are present. In patients presenting with gastric variceal hemorrhage, splenectomy (with treatment for the primary pancreatic pathology, e.g. distal pancreatectomy is curative with excellent long term results.

  17. Bleeding Ectopic Varices as the First Manifestation of Portal Hypertension

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    Brij Sharma

    2014-01-01

    Full Text Available Ectopic varices are defined as dilated portosystemic collateral veins in locations other than the gastroesophageal region. We present a case of recurrent upper gastrointestinal bleeding as the first manifestation of portal hypertension. We diagnosed ectopic duodenal varices without gastroesophageal varices on upper GI endoscopy and extrahepatic portal venous obstruction (EHPVO on CT angiography and managed this case.

  18. Extrahepatic portal vein aneurysm: Two case reports of surgical intervention

    Institute of Scientific and Technical Information of China (English)

    Bi Jin; Yuan Sun; Yi-Qing Li; Yu-Guo Zhao; Chuan-Shan Lai; Xian-Song Feng; Chi-Dan Wan

    2005-01-01

    We report two cases of extrahepatic portal vein aneurysm,and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Physical examination revealed nothing abnormal. Both of them were diagnosed by magnetic resonance imaging angiography (MRA). One of the aneurysms was located at the main portal vein, the other, at the confluence of the superior mesenteric vein and the splenic vein, and these two places are exactly the most common locations of the extrahepatic portal vein aneurysm reported in the literature (30.7% each site). The first case underwent aneurysmorrhaphy and the second case, aneurysm resection with splenectomy. Both of them recovered soon after the operation, and the symptom of the first case was greatly alleviated. During the follow-up of half a year, no complication and adverse effect of surgical intervention was found and the color Doppler ultrasonography revealed no recurrence of the aneurysmal dilation. We suggest that surgical intervention can alleviate the symptom of the extrahepatic portal vein aneurysm and prevent its complications effectively and safely for low risk patients.

  19. Cholangiopathy in extrahepatic portal venous obstruction: radiological appearances

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    Nagi, B.; Kochhar, R.; Bhasin, D.; Singh, K. [Postgraduate Inst. of Medical Education and Research, Chandigarh (India). Dept. of Gastroenterology

    2000-11-01

    To evaluate cholangiographic abnormalities resulting from extrahepatic portal venous obstruction (EHPVO) by sonography and endoscopic retrograde cholangiopancreaticography (ERCP). Material and Methods: Forty-three patients with an established diagnosis of EHPVO were subjected to duplex Doppler sonography and ERCP. Of these, 8 patients had obstructive jaundice. Results: Dilated common bile duct with pericholedochal varices showing a continuous type of flow pattern was seen in 5 EHPVO patients with obstructive jaundice. ERCP revealed cholangiographic abnormalities in 40 patients (93%). Extrahepatic bile ducts were involved in 100% of cases compared to intrahepatic bile ducts (57%). Abnormalities noted were contour irregularity with indentations, displacement and angulation, strictures and filling defects in the extrahepatic ductal system. Intrahepatic bile ducts showed dilatation with areas of narrowing and filling defects. Conclusion: Cholangiographic abnormalities are very common in patients with EHPVO, even without clinical manifestations of biliary disease. Extrahepatic bile ducts are far more often involved compared to intrahepatic bile ducts. Extrinsic compression with contour irregularity is the most common cholangiographic finding. Sonographic findings are not diagnostic. Dilated common bile duct with pericholedochal varices was seen in only 5 patients.

  20. Treatment of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Khurram Bari; Guadalupe Garcia-Tsao

    2012-01-01

    Portal hypertension is the main complication of cirrhosis and is defined as an hepatic venous pressure gradient (HVPG) of more than 5 mmHg.Clinically significant portal hypertension is defined as HVPG of 10 mmHg or more.Development of gastroesophageal varices and variceal hemorrhage are the most direct consequence of portal hypertension.Over the last decades significant advancements in the field have led to standard treatment options.These clinical recommendations have evolved mostly as a result of randomized controlled trials and consensus conferences among experts where existing evidence has been reviewed and future goals for research and practice guidelines have been proposed.Management of varices/variceal hemorrhage is based on the clinical stage of portal hypertension.No specific treatment has shown to prevent the formation of varices.Prevention of first variceal hemorrhage depends on the size/characteristics of varices.In patients with small varices and high risk of bleeding,nonselective β-blockers are recommended,while patients with medium/large varices can be treated with either β-blockers or esophageal band ligation.Standard of care for acute variceal hemorrhage consists of vasoactive drugs,endoscopic band ligation and antibiotics prophylaxis.Transjugular intrahepatic portosystemic shunt (TIPS) is reserved for those who fail standard of care or for patients who are likely to fail ("early TIPS").Prevention of recurrent variceal hemorrhage consists of the combination of β-blockers and endoscopic band ligation.

  1. Studies in portal hypertension

    NARCIS (Netherlands)

    H.R. van Buuren (Henk)

    2002-01-01

    textabstractOur work focussed on one of the most frequent and serious complications of portal hypertension i.e. variceal bleeding. In particular, studies were initiated aimed at developing a more effective therapeutic strategy for the primary and secondary prevention of variceal bleeding. Aspects of

  2. Splenic Artery Aneurysm Presenting as Extrahepatic Portal Vein Obstruction: A Case Report

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    T. P. Elamurugan

    2011-01-01

    Full Text Available Splenic artery aneurysms are the most common visceral aneurysm occuring predominantly in females. They are usually asymptomatic, and the symptomatic presentation includes chronic abdominal pain of varied severity or an acute rupture with hypotension. Splenic artery aneurysm causing extrahepatic portal hypertension is very rare and is due to splenic vein thrombosis that develops secondary to compression by the aneurysm. We report one such rare presentation of splenic artery aneurysms in a pregnant female with the features of EHPVO (variceal bleed, hypersplenism treated by splenectomy along with excision of the aneurysm.

  3. Portal hypertensive enteropathy

    Institute of Scientific and Technical Information of China (English)

    Parit Mekaroonkamol; Robert Cohen; Saurabh Chawla

    2015-01-01

    Portal hypertensive enteropathy (PHE) is a conditionthat describes the pathologic changes and mucosalabnormalities observed in the small intestine of patientswith portal hypertension. This entity is being increasinglyrecognized and better understood over the past decadedue to increased accessibility of the small intestine madepossible by the introduction of video capsule endoscopyand deep enteroscopy. Though challenged by its diverseendoscopic appearance, multiple scoring systems havebeen proposed to classify the endoscopic presentationand grade its severity. Endoscopic findings can be broadlycategorized into vascular and non-vascular lesions withmany subtypes of both categories. Clinical manifestationsof PHE can range from asymptomatic incidental findingsto fatal gastrointestinal hemorrhage. Classic endoscopicfindings in the setting of portal hypertension may leadto a prompt diagnosis. Occasionally histopathologyand cross sectional imaging like computed tomographyor magnetic resonance imaging may be helpful inestablishing a diagnosis. Management of overt bleedingrequires multidisciplinary approach involving hepatologists,endoscopists, surgeons, and interventionalradiologists. Adequate resuscitation, reduction of portalpressure, and endoscopic therapeutic intervention remainthe main principles of the initial treatment. This articlereviews the existing evidence on PHE with emphasison its classification, diagnosis, clinical manifestations,endoscopic appearance, pathological findings, and clinicalmanagement. A new schematic management of ectopicvariceal bleed is also proposed.

  4. Imaging and radiological interventions in extra-hepatic portal vein obstruction

    Institute of Scientific and Technical Information of China (English)

    Sudheer S Pargewar; Saloni N Desai; S Rajesh; Vaibhav P Singh; Ankur Arora; Amar Mukund

    2016-01-01

    Extrahepatic portal vein obstruction(EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension(PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt(PSS) and revision of PSS.

  5. Imaging and radiological interventions in extra-hepatic portal vein obstruction.

    Science.gov (United States)

    Pargewar, Sudheer S; Desai, Saloni N; Rajesh, S; Singh, Vaibhav P; Arora, Ankur; Mukund, Amar

    2016-06-28

    Extrahepatic portal vein obstruction (EHPVO) is a primary vascular condition characterized by chronic long standing blockage and cavernous transformation of portal vein with or without additional involvement of intrahepatic branches, splenic or superior mesenteric vein. Patients generally present in childhood with multiple episodes of variceal bleed and EHPVO is the predominant cause of paediatric portal hypertension (PHT) in developing countries. It is a pre-hepatic type of PHT in which liver functions and morphology are preserved till late. Characteristic imaging findings include multiple parabiliary venous collaterals which form to bypass the obstructed portal vein with resultant changes in biliary tree termed portal biliopathy or portal cavernoma cholangiopathy. Ultrasound with Doppler, computed tomography, magnetic resonance cholangiography and magnetic resonance portovenography are non-invasive techniques which can provide a comprehensive analysis of degree and extent of EHPVO, collaterals and bile duct abnormalities. These can also be used to assess in surgical planning as well screening for shunt patency in post-operative patients. The multitude of changes and complications seen in EHPVO can be addressed by various radiological interventional procedures. The myriad of symptoms arising secondary to vascular, biliary, visceral and neurocognitive changes in EHPVO can be managed by various radiological interventions like transjugular intra-hepatic portosystemic shunt, percutaneous transhepatic biliary drainage, partial splenic embolization, balloon occluded retrograde obliteration of portosystemic shunt (PSS) and revision of PSS.

  6. Splenectomy and proximal lieno-renal shunt in a factor five deficient patient with extra-hepatic portal vein obstruction

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    Sahni Peush

    2006-05-01

    Full Text Available Abstract Background The clinico-surgical implication and successful management of a rare case of factor five (V deficiency with portal hypertension and hypersplenism due to idiopathic extra-hepatic portal venous obstruction is presented. Case presentation A 16-year old boy had gastro-esophageal variceal bleeding, splenomegaly and hypersplenism. During preoperative workup prolonged prothrombin time and activated partial thromboplastin time were detected, which on further evaluation turned out to be due to factor V deficiency. Proximal lieno-renal shunt and splenectomy were successfully performed with transfusion of fresh frozen plasma during and after the surgical procedure. At surgery there was no excessive bleeding. The perioperative course was uneventful and the patient is doing well on follow up. Conclusion Surgical portal decompressive procedures can be safely undertaken in clotting factor deficient patients with portal hypertension if meticulous surgical hemostasis is achieved at operation and the deficient factor is adequately replaced in the perioperative period.

  7. Animal models of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Juan G Abraldes; Marcos Pasarín; Juan Carlos; García-Pagán

    2006-01-01

    Animal models have allowed detailed study of hemodynamic alterations typical of portal hypertension and the molecular mechanisms involved in abnormalities in splanchnic and systemic circulation associated with this syndrome. Models of prehepatic portal hypertension can be used to study alterations in the splanchnic circulation and the pathophysiology of the hyperdynamic circulation. Models of cirrhosis allow study of the alterations in intrahepatic microcirculation that lead to increased resistance to portal flow. This review summarizes the currently available literature on animal models of portal hypertension and analyzes their relative utility. The criteria for choosing a particular model,depending on the specific objectives of the study, are also discussed.

  8. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

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    G Raghavendra Prasad

    2013-01-01

    Full Text Available Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric - inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up.

  9. Portal Vein Thrombosis in non cirrhotic patients

    NARCIS (Netherlands)

    M.C.W. Spaander (Manon)

    2010-01-01

    textabstractExtrahepatic portal vein thrombosis (EPVT) is the most common cause of portal hypertension in non- cirrhotic patients. EPVT has been defined as an obstruction of the extrahepatic portal vein with or without involvement of the intrahepatic portal veins. Although the portal vein accounts f

  10. Research advances in non-cirrhotic portal hypertension

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    ZHANG Bojing

    2016-02-01

    Full Text Available Although liver cirrhosis is the most common cause of portal hypertension (PH, about 20% of PH cases are caused by non-cirrhotic reasons, which are referred to as non-cirrhotic portal hypertension (NCPH, with a high incidence rate in developing countries. NCPH is a group of heterogeneous hepatic vascular diseases, including idiopathic portal hypertension (IPH and extrahepatic portal vein obstruction (EHPVO, as well as the rare diseases in clinical practice such as Budd-Chiari syndrome, congenital hepatic fibrosis, and nodular regenerative hyperplasia. The patients with NCPH usually have the symptoms of portal hypertension, such as recurrent variceal bleeding and splenomegaly, but liver function is well preserved in these patients. At present, the diagnosis of NCPH lacks a universally accepted standard and remains a challenge. In clinical practice, the method of exclusion is usually applied for the diagnosis of HCPH, and liver biopsy is performed when necessary to make a confirmed diagnosis. This paper introduces the pathogenesis and pathological manifestations of IPH and EHPVO, as well as the selection of diagnostic methods and therapeutic strategies. If upper gastrointestinal bleeding can be effectively controlled, NCPH is considered to have a relatively good prognosis.

  11. VACTERL (vertebral anomalies, anal atresia or imperforate anus, cardiac anomalies, tracheoesophageal fistula, renal and limb defect spectrum presenting with portal hypertension: a case report

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    Losa Ignatius

    2010-05-01

    Full Text Available Abstract Introduction We report for the first time a unique case of VACTERL (vertebral anomalies, anal atresia or imperforate anus, cardiac anomalies, tracheoesophageal fistula, renal and limb defect spectrum associated with portal hypertension. The occurrence of both VACTERL spectrum and extrahepatic portal hypertension in a patient has not been reported in the literature. We examined whether or not there was any association between extrahepatic portal hypertension and VACTERL spectrum. Case Presentation A two-and-half-year-old Caucasian girl with VACTERL spectrum presented with hematemesis and abdominal distension. She had caput medusae, ascites, splenomegaly, gastric and esophageal varices. Her liver function tests were within normal limits. Magnetic resonance imaging of the liver with contrast showed a thready portal vein with collateral vessels involving both right and left portal veins without intrahepatic duct dilation. Conclusion A thready portal vein, with features of extrahepatic portal hypertension, is a rare non- VACTERL-type defect in patients with VACTERL spectrum. Understandably, clinicians should give low priority to looking for portal hypertension in VACTERL spectrum patients presenting with gastrointestinal bleeding. However before routinely looking for a thready portal vein and/or extrahepatic portal hypertension in asymptomatic VACTERL spectrum patients, we need further evidence to support this rare association.

  12. Portal hypertensive duodenal polyp: A case report

    Institute of Scientific and Technical Information of China (English)

    Jean-David Zeitoun; Ariane Chryssostalis; Benoit Terris; Frederic Prat; Marianne Gaudric; Stanislas Chaussade

    2007-01-01

    Abnormalities of gastric mucosa in patients with portal hypertension are well documented. Manifestations of portal hypertension in small bowel and colon are less common. Colonic polypoid lesions microscopically consisting of a normal mucosa, with dilatation of submucosal vessels, have been described. We here report the first case of portal hypertensive duodenal polyp, responsible for gastro-intestinal bleeding.Endoscopic treatment turned out to be successful.

  13. Multidetector CT venography and contrast-enhanced MR venography of the inferior mesenteric vein in paediatric extrahepatic portal vein obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Chennur, Vikash SrinivasaiahSetty; Sharma, Raju; Gamanagatti, Shivanand; Gupta, Arun Kumar [All India Institute of Medical Sciences (AIIMS), Department of Radiology, New Delhi (India); Bhatnagar, Veereshwar [AIIMS, Department of Paediatric Surgery, New Delhi (India); Vishnubhatla, Sreenivas [AIIMS, Department of Biostatistics, New Delhi (India)

    2011-03-15

    Extrahepatic portal vein obstruction (EHPVO) is a common cause of paediatric portal hypertension and the only permanent treatment is shunt surgery. The inferior mesenteric vein (IMV) is a portal venous channel that can be used for the shunt when the splenic vein/superior mesenteric vein is thrombosed or when a lienorenal shunt is not possible. To compare MDCT venography (MDCTV) and contrast-enhanced MR venography (CEMRV) for visualisation of the IMV in children with EHPVO. This was a prospective study of 26 children (4-12 years, median 10 years) who underwent MDCTV and CEMRV. The IMV visualisation was graded using 4- and 2-point scales and the difference in visualisation was assessed by calculating the exact significance probability (P). The IMV was visualised in all children on MDCTV and 25/26 children on CEMRV (96%). The images were diagnostic in 23/26 children (88%) on MDCTV and in 18/26 (69%) children on CEMRV (P = 0.063). MDCTV and CEMRV are comparable for IMV visualisation with a tendency toward MDCTV being superior. (orig.)

  14. Idiopathic noncirrhotic portal hypertension: current perspectives

    Directory of Open Access Journals (Sweden)

    Riggio O

    2016-07-01

    Full Text Available Oliviero Riggio,1 Stefania Gioia,1 Ilaria Pentassuglio,1 Valeria Nicoletti,1 Michele Valente,2 Giulia d’Amati2 1Department of Clinical Medicine, Center for the Diagnosis and Treatment of Portal Hypertension, 2Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy Abstract: The term idiopathic noncirrhotic portal hypertension (INCPH has been recently proposed to replace terms, such as hepatoportal sclerosis, idiopathic portal hypertension, incomplete septal cirrhosis, and nodular regenerative hyperplasia, used to describe patients with a hepatic presinusoidal cause of portal hypertension of unknown etiology, characterized by features of portal hypertension (esophageal varices, nonmalignant ascites, porto-venous collaterals, splenomegaly, patent portal, and hepatic veins and no clinical and histological signs of cirrhosis. Physicians should learn to look for this condition in a number of clinical settings, including cryptogenic cirrhosis, a disease known to be associated with INCPH, drug administration, and even chronic alterations in liver function tests. Once INCPH is clinically suspected, liver histology becomes mandatory for the correct diagnosis. However, pathologists should be familiar with the histological features of INCPH, especially in cases in which histology is not only requested to exclude liver cirrhosis. Keywords: idiopathic portal hypertension, obliterative portal venopathy, esophageal varices, splenomegaly

  15. Splenic vasculopathy in portal hypertension patients

    Institute of Scientific and Technical Information of China (English)

    Tao Li; Ji-Yuan Ni; Yan-Wu Qi; Hai-Yang Li; Tong Zhang; Zhen Yang

    2006-01-01

    AIM: To investigate the interaction between portal hypertension, splanchnic hyperdynamic circulation and splanchnic vasculopathy by observing splenic arterial and venous pathological changes and the role of extracellular matrix in the pathogenesis of portal hypertensive vasculopathy by measuring the expression of type Ⅰ and type Ⅲ procollagen mRNA in splenic venous walls of portal hypertensive patients.METHODS: Morphological changes of splenic arteries and veins taken from portal hypertensive patients (n = 20)and normal controls (n = 10) were observed under optical and electron microscope. Total RNA was extracted and the expression of type Ⅰ and type Ⅲ procollagen mRNA in splenic venous walls of portal hypertensive patients (n = 20) was semi-quantitatively detected using reverse transcription-polymerase chain reaction (RT- PCR).RESULTS: Under optical microscope, splenic arterial intima was destroyed and internal elastic membrane and medial elastic fibers of the splenic arterial walls were degenerated and broken. Splenic venous intima became remarkably thick. Endothelial cells were not intact with formation of mural thrombus. The tunica media became thickened significantly due to hypertrophy of smooth muscles. Fibers and connective tissues were increased obviously. Under electron microscope, smooth muscle cells of the splenic arteries were degenerated and necrotized. Phenotypes of smooth muscle cells changed from constrictive into synthetic type. Red blood cells and platelets accumulated around the damaged endothelial cells. Synthetic smooth muscle cells were predominant in splenic veins and their cytoplasma had plentiful rough endoplasmic reticulum ribosomes and Golgi bodies. Along the vascular wall, a lot of collagen fibers were deposited,the intima was damaged and blood components accumulated. There was no significant difference in the expression of type Ⅰ procollagen mRNA in splenic venous wall between the patients with portal hypertension and those

  16. Portal venous stent placement for treatment of portal hypertension caused by benign main portal vein stenosis

    Institute of Scientific and Technical Information of China (English)

    Hong Shan; Xiang-Sheng Xiao; Ming-Sheng Huang; Qiang Ouyang; Zai-Bo Jiang

    2005-01-01

    AIM: To evaluate the value of endovascular stent in the treatment of portal hypertension caused by benign main portal vein stenosis.METHODS: Portal vein stents were implanted in six patients with benign main portal vein stenosis (inflammatory stenosis in three cases, postprocedure of liver transplantation in another three cases). Changes in portal vein pressure, portal vein patency, relative clinical symptoms, complications, and survival were evaluated.RESULTS: Six metallic stents were successfully placed across the portal vein stenotic or obstructive lesions in six patients. Mean portal venous pressure decreased significantly after stent implantation from (37.3±4.7) cm H2O to (18.0±1.9) cm H2O. The portal blood flow restoredand the symptoms caused by portal hypertension were eliminated. There were no severe procedure-related complications. The patients were followed up for 1-48 mo. The portal vein remained patent during follow-up. All patients survived except for one patient who died of other complications of liver transplantation. CONCLUSION: Percutaneous portal vein stent placement for the treatment of portal hypertension caused by benign main portal vein stenosis is safe and effective.

  17. Autonomic dysfunction in cirrhosis and portal hypertension

    DEFF Research Database (Denmark)

    Dümcke, Christine Winkler; Møller, Søren

    2008-01-01

    Liver cirrhosis and portal hypertension are frequently associated with signs of circulatory dysfunction and peripheral polyneuropathy, which includes defects of the autonomic nervous system. Autonomic dysfunction, which is seen in both alcoholic and non-alcoholic liver cirrhosis and increases...

  18. Portal hypertension due to portal venous thrombosis: Etiology, clinical outcomes

    Institute of Scientific and Technical Information of China (English)

    Ozgur Harmanci; Yusuf Bayraktar

    2007-01-01

    The thrombophilia in adult life has major implications in the hepatic vessels. The resulting portal vein thrombosis has various outcomes and complications. Esophageal varices, portal gastropathy, ascites, severe hypersplenism and liver failure needing liver transplantation are known well. The newly formed collateral venous circulation showing itself as pseudocholangicarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of portal vein thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we present and discuss the portal vein thrombosis, etiology and the resulting clinical pictures. There are controversial issues in nomenclature,management (including anticoagulation problems), follow up strategies and liver transplantation. In the light of the current knowledge, we discuss some controversial issues in literature and present our experience and our proposals about this group of patients.

  19. Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

    Institute of Scientific and Technical Information of China (English)

    Christopher; Steevens; Maisa; Abdalla; Truptesh; H; Kothari; Vivek; Kaul; Shivangi; Kothari

    2015-01-01

    Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. However, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

  20. Ultrasonography and 3D-CT Follow-Up of Extrahepatic Portal Vein Aneurysm: A Case Report

    Directory of Open Access Journals (Sweden)

    Norio Yukawa

    2010-01-01

    Full Text Available Extrahepatic portal vein aneurysm is a rare disorder. From 1956 to 2008, we found only 43 published English-language reports, including 67 cases, using Pub Med. We report a case of a 77-year-old woman who had complaints of lower abdominal fullness and residual urine. We performed ultrasonography (US, which demonstrated a congenital extrahepatic portal vein aneurysm. She had no obvious symptoms of the extrahepatic portal vein aneurysm. She had undergone gastrectomy without blood transfusion for gastric ulcer more than 20 years ago. Physical examination revealed no abnormal findings. US revealed a 2.2×1.8 cm, round shaped hypoechogenic lesion at the hepatic hilum. Color Doppler US showed bidirectional colors due to circular flow within this lesion. 3D-CT and CT angiography demonstrated that the saccular aneurysm at the hepatic hilum was 3.0 cm in diameter and was enhanced equal to that of portal vein.Twenty-six months after the diagnosis, the aneurysm had not grown in size. Since our patient had no serious complaints or liver disease, surgical procedures had not been employed. US and 3D-CT are noninvasive diagnostic techniques and are helpful in the diagnosis and follow-up of extrahepatic portal vein aneurysms.

  1. Idiopathic Noncirrhotic Portal Hypertension: An Appraisal

    Science.gov (United States)

    Lee, Hwajeong; Rehman, Aseeb Ur; Fiel, M. Isabel

    2016-01-01

    Idiopathic noncirrhotic portal hypertension is a poorly defined clinical condition of unknown etiology. Patients present with signs and symptoms of portal hypertension without evidence of cirrhosis. The disease course appears to be indolent and benign with an overall better outcome than cirrhosis, as long as the complications of portal hypertension are properly managed. This condition has been recognized in different parts of the world in diverse ethnic groups with variable risk factors, resulting in numerous terminologies and lack of standardized diagnostic criteria. Therefore, although the diagnosis of idiopathic noncirrhotic portal hypertension requires clinical exclusion of other conditions that can cause portal hypertension and histopathologic confirmation, this entity is under-recognized clinically as well as pathologically. Recent studies have demonstrated that variable histopathologic entities with different terms likely represent a histologic spectrum of a single entity of which obliterative portal venopathy might be an underlying pathogenesis. This perception calls for standardization of the nomenclature and formulation of widely accepted diagnostic criteria, which will facilitate easier recognition of this disorder and will highlight awareness of this entity. PMID:26563701

  2. Establishment of a hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol.

    Science.gov (United States)

    Wang, Lei; He, Fu-Liang; Liu, Fu-Quan; Yue, Zhen-Dong; Zhao, Hong-Wei

    2015-08-28

    To determine the feasibility and safety of establishing a porcine hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol. Twenty-one healthy Guizhou miniature pigs were randomly divided into three experimental groups and three control groups. The pigs in the three experimental groups were subjected to hepatic arterial perfusion with 7, 12 and 17 mL of 80% alcohol, respectively, while those in the three control groups underwent hepatic arterial perfusion with 7, 12 and 17 mL of saline, respectively. Hepatic arteriography and direct portal phlebography were performed on all animals before and after perfusion, and the portal venous pressure and diameter were measured before perfusion, immediately after perfusion, and at 2, 4 and 6 wk after perfusion. The following procedures were performed at different time points: routine blood sampling, blood biochemistry, blood coagulation and blood ammonia tests before surgery, and at 2, 4 and 6 wk after surgery; hepatic biopsy before surgery, within 6 h after surgery, and at 1, 2, 3, 4 and 5 wk after surgery; abdominal enhanced computed tomography examination before surgery and at 6 wk after surgery; autopsy and multi-point sampling of various liver lobes for histological examination at 6 wk after surgery. In experimental group 1, different degrees of hepatic fibrosis were observed, and one pig developed hepatic cirrhosis. In experimental group 2, there were cases of hepatic cirrhosis, different degrees of increased portal venous pressure, and intrahepatic portal venous bypass, but neither extrahepatic portal-systemic bypass circulation nor death occurred. In experimental group 3, two animals died and three animals developed hepatic cirrhosis, and different degrees of increased portal venous pressure and intrahepatic portal venous bypass were also observed, but there was no extrahepatic portal-systemic bypass circulation. It is feasible to establish an animal model of hepatic cirrhosis and

  3. Extrahepatic portal vein obstruction with parkinsonism and symmetric hyperintense basal ganglia on T1 weighted MRI

    Directory of Open Access Journals (Sweden)

    Jayalakshmi Sita

    2006-01-01

    Full Text Available Abnormal high signal in the globus pallidus on T1 weighted magnetic resonance imaging (MRI of the brain has been well described in patients with chronic liver disease. It may be related to liver dysfunction or portal-systemic shunting. We report a case of extra hepatic portal vein obstruction with portal hypertension and esophageal varices that presented with extra pyramidal features. T1 weighted MRI brain scans showed increased symmetrical signal intensities in the basal ganglia. Normal hepatic function in this patient emphasizes the role of portal- systemic communications in the development of these hyperintensities, which may be due to deposition of paramagnetic substances like manganese in the basal ganglia.

  4. [Portal hypertension in children. Follow-up after portal systemic shunts (author's transl)].

    Science.gov (United States)

    Bernard, O; Alvarez, F; Alagille, D

    1982-01-01

    The retrospective study of 115 children in whom a successful portosystemic shunt was carried out for portal hypertension, provides the following conclusions: 1) Patency of the shunt must be checked by esophageal endoscopy, six months postoperatively. A patent shunt can be expected when the size of the spleen and/or thrombocytopenia improve in the early post-operative period. Early ultrasound examination is also very useful in that respect. 2) None of the children with extrahepatic portal vein obstruction or congenital hepatic fibrosis presented with clinical signs of portal systemic encephalopathy (PSE). 3) Eight of 30 children with cirrhosis presented with one or more clinical episodes of PSE. Some were transient allowing for a normal diet to be resumed later on. 4) It is thus advisable to give children with cirrhosis a low protein diet in the months after surgery. Protein content of the diet can usually be increased progressively over a period of one to two years. 5) Whenever splenectomy is necessary, it is mandatory to prevent pneumococcal infections with the pneumococcal vaccine and daily treatment with oral penicillin.

  5. Portacaval Shunt for Portal Hypertensive Gastropathy

    Directory of Open Access Journals (Sweden)

    John Craig Collins

    1997-01-01

    Full Text Available Portal hypertensive gastropathy is a vascular disorder of the gastric mucosa distinguished by ectasia of the mucosal capillaries and submucosal veins without inflammation. During 1988 to 1993, 12 patients with biopsyproven cirrhosis (10 alcoholic, 2 posthepatitic were evaluated and treated prospectively by portacaval shunt for active bleeding from severe portal hypertensive gastropathy. Eleven patients had been hospitalized for bleeding three to nine times previously, and one was bleeding uncontrollably for the first time. Requirement for blood transfusions ranged from 11 to 39 units cumulatively, of which 8 to 30 units were required specifically to replace blood lost from portal hypertensive gastropathy. Admission findings were ascites in 9 patients, jaundice in 8, severe muscle wasting in 10, hyperdynamic state in 9. Child's risk class was C in 7, B in 4, A in 1. Ten of the 12 patients had previously received repetitive endoscopic sclerotherapy for esophageal varices, which has been reported to precipitate portal hypertensive gastropathy. Eight patients had failed propranolol therapy for bleeding. Portacaval shunt was performed emergently in 11 patients and electively in 1, and permanently stopped bleeding in all by reducing the mean portal vein-inferior vena cava pressure gradient from 251 to 16 mm saline. There were no operative deaths, and two unrelated late deaths after 13 and 24 months. During 1 to 6.75 years of followup, all shunts remained patent by ultrasonography, the gastric mucosa reverted to normal On serial endoscopy, and there was no gastrointestinal bleeding. Recurrent portal-systemic encephalopathy developed in only 8% of patients. Quality of life was generally good. It is concluded that portacaval shunt provides definitive treatment of bleeding portal hypertensive gastropathy by eliminating the underlying cause, and makes possible prolonged survival with an acceptable quality of life.

  6. Clinical characteristics of idiopathic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Ozgur Harmanci; Yusuf Bayraktar

    2007-01-01

    Idiopathic portal hypertension is one of the interesting causes of portal hypertension. Even in very developed medical centers, this disorder is still one of the most important misdiagnoses of clinical practice. To inexperienced physicians, presenting esophageal varices and upper gastrointestinal bleeding usually prompt an unfortunate diagnosis of cirrhosis. A heterogenous clinical presentation and progression of this disorder should be recognized by physicians, and management should be directed towards some specific problems confined to this disorder. Although a genetic basis and other factors are implicated in its pathogenesis, exact underlying mechanism(s) is (are) unknown. In this review, we discuss the heterogeneity of idiopathic portal hypertension, its etiopathogenesis, clinical presentation and management issues. With the expectation of an excellent prognosis, a practicing gastroenterologist should be aware that "not all varices mean cirrhosis".

  7. Statins activate the canonical hedgehog-signaling and aggravate non-cirrhotic portal hypertension, but inhibit the non-canonical hedgehog signaling and cirrhotic portal hypertension.

    Science.gov (United States)

    Uschner, Frank E; Ranabhat, Ganesh; Choi, Steve S; Granzow, Michaela; Klein, Sabine; Schierwagen, Robert; Raskopf, Esther; Gautsch, Sebastian; van der Ven, Peter F M; Fürst, Dieter O; Strassburg, Christian P; Sauerbruch, Tilman; Diehl, Anna Mae; Trebicka, Jonel

    2015-09-28

    Liver cirrhosis but also portal vein obstruction cause portal hypertension (PHT) and angiogenesis. This study investigated the differences of angiogenesis in cirrhotic and non-cirrhotic PHT with special emphasis on the canonical (Shh/Gli) and non-canonical (Shh/RhoA) hedgehog pathway. Cirrhotic (bile duct ligation/BDL; CCl4 intoxication) and non-cirrhotic (partial portal vein ligation/PPVL) rats received either atorvastatin (15 mg/kg; 7d) or control chow before sacrifice. Invasive hemodynamic measurement and Matrigel implantation assessed angiogenesis in vivo. Angiogenesis in vitro was analysed using migration and tube formation assay. In liver and vessel samples from animals and humans, transcript expression was analyzed using RT-PCR and protein expression using Western blot. Atorvastatin decreased portal pressure, shunt flow and angiogenesis in cirrhosis, whereas atorvastatin increased these parameters in PPVL rats. Non-canonical Hh was upregulated in experimental and human liver cirrhosis and was blunted by atorvastatin. Moreover, atorvastatin blocked the non-canonical Hh-pathway RhoA dependently in activated hepatic steallate cells (HSCs). Interestingly, hepatic and extrahepatic Hh-pathway was enhanced in PPVL rats, which resulted in increased angiogenesis. In summary, statins caused contrary effects in cirrhotic and non-cirrhotic portal hypertension. Atorvastatin inhibited the non-canonical Hh-pathway and angiogenesis in cirrhosis. In portal vein obstruction, statins enhanced the canonical Hh-pathway and aggravated PHT and angiogenesis.

  8. Treatment of ectopic varices with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Ectopic varices are unusual with portal hypertension andcan involve any site along the digestive tract outsidethe gastroesophageal region. Hemorrhage from ectopicvarices generally are massive and life threatening.Diagnosis of ectopic varices is difficult and subsequenttreatment is also difficult; the optimal treatment hasnot been established. Recently, interventional radiologyand endoscopic treatments have been carried outsuccessfully for hemorrhage from ectopic varices.

  9. Portal vein thrombosis: Etiology and clinical outcome of cirrhosis and malignancy-related non-cirrhotic, non-tumoral extrahepatic portal venous obstruction

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The etiology and pathogenesis of portal vein thrombosis are unclear. Portal venous thrombosis presentation differs in cirrhotic and tumor-related versus non-cirrhotic and non-tumoral extrahepatic portal venous obstruction (EHPVO). Non-cirrhotic and non-tumoral EHPVO patients are young and present with well tolerated bleeding.Cirrhosis and tumor-related portal vein thrombosis patients are older and have a grim prognosis. Among the 118 patients with portal vein thrombosis, 15.3% had cirrhosis, 42.4% had liver malignancy (primary or metastatic), 6% had pancreatitis (acute or chronic), 5% had hypercoagulable state and 31.3% had idiopathy,12% had hypercoagulable state in the EHPVO group.

  10. Staging of portal hypertension and portosystemic shunts using dynamic nuclear medicine investigations

    Science.gov (United States)

    Dragoteanu, Mircea; Balea, Ioan A; Dina, Liliana A; Piglesan, Cecilia D; Grigorescu, Ioana; Tamas, Stefan; Cotul, Sabin O

    2008-01-01

    AIM: To explore portal hypertension and portosystemic shunts and to stage chronic liver disease (CLD) based on the pathophysiology of portal hemodynamics. METHODS: Per-rectal portal scintigraphy (PRPS) was performed on 312 patients with CLD and liver angioscintigraphy (LAS) on 231 of them. The control group included 25 healthy subjects. We developed a new model of PRPS interpretation by introducing two new parameters, the liver transit time (LTT) and the circulation time between right heart and liver (RHLT). LTT for each lobe was used to evaluate the early portal hypertension. RHLT is useful in cirrhosis to detect liver areas missing portal inflow. We calculated the classical per-rectal portal shunt index (PRSI) at PRPS and the hepatic perfusion index (HPI) at LAS. RESULTS: The normal LTT value was 24 ± 1 s. Abnormal LTT had PPV = 100% for CLD. Twenty-seven non-cirrhotic patients had LTT increased up to 35 s (median 27 s). RHLT (42 ± 1 s) was not related to liver disease. Cirrhosis could be excluded in all patients with PRSI 30% had PPV = 100% for cirrhosis. Based on PRPS and LAS we propose the classification of CLD in 5 hemodynamic stages. Stage 0 is normal (LTT = 24 s, PRSI 30%. RHLT and HPI were used to subtype stage 4. In our study stage 0 had NPV = 100% for CLD, stage 1 had PPV = 100% for non-cirrhotic CLD, stages 2 and 3 represented the transition from chronic hepatitis to cirrhosis, stage 4 had PPV = 100% for cirrhosis. CONCLUSION: LTT allows the detection of early portal hypertension and of opening of transhepatic shunts. PRSI is useful in CLD with extrahepatic portosystemic shunts. Our hemodynamic model stages the evolution of portal hypertension and portosystemic shunts. It may be of use in the selection of patients for interferon therapy. PMID:18609707

  11. Duodenal polyposis secondary to portal hypertensive duodenopathy

    Institute of Scientific and Technical Information of China (English)

    Ananta; Gurung; Philip; E; Jaffe; Xuchen; Zhang

    2015-01-01

    Portal hypertensive duodenopathy(PHD) is a recognized, but uncommon finding of portal hypertension in cirrhotic patients. Lesions associated with PHD include erythema, erosions, ulcers, telangiectasia, exaggerated villous pattern and duodenal varices. However, duodenal polyposis as a manifestation of PHD is rare. We report a case of a 52-year-old man who underwent esophagogastroduodenoscopy and was found with multiple small duodenal polyps ranging in size from 1-8 mm. Biopsy of the representative polyps revealed polypoid fragments of duodenal mucosa with villiform hyperplasia lined by reactive duodenal/gastric foveolar epithelium and underlying lamina propria showed proliferating ectatic and congested capillaries. The features were diagnostic of polyps arising in the setting of PHD.

  12. Does Helicobacter pylori affect portal hypertensive gastropathy?

    Directory of Open Access Journals (Sweden)

    Al Mofleh Ibrahim

    2007-01-01

    Full Text Available Helicobacter pylori (H. pylori is a major etiological factor of peptic ulcer disease (PUD. It is supposed to be a risk factor for the more frequently encountered PUD in patients with liver cirrhosis. Several investigators have evaluated the effect of H. pylori on liver cirrhosis, portal hypertensive gastropathy (PHG and encephalopathy with controversial results. Some reports have shown a higher seroprevalence and suggested a synergistic effect of H. pylori on liver cirrhosis and PHG. However, this increased prevalence is associated with a negative histology and is not influenced by the cause of cirrhosis, PHG, Child class or gender. Most studies have not found any correlation between H. pylori and PHG. In contrast, other studies have reported a markedly lower prevalence of H. pylori in cirrhotics with duodenal ulcer compared to controls. The aim of this article is to review the relationship between H. pylori infection and portal hypertensive gastropathy and the role of H. pylori eradication in cirrhotic patients.

  13. Management of portal hypertension in children

    Institute of Scientific and Technical Information of China (English)

    Roberto Gugig; Philip Rosenthal

    2012-01-01

    Portal hypertension can be caused by a wide variety of conditions.It frequently presents with bleeding from esophageal varices.The approach to acute variceal hemorrhage in children is a stepwise progression from least invasive to most invasive.Management of acute variceal bleeding is straightforward.But data on primary prophylaxis and long term management prevention of recurrent variceal bleeding in children is scarce,therefore prospective multicenter trials are needed to establish best practices.

  14. [HEPATIC HYDATIC CYST ASSOCIATED WITH PORTAL HYPERTENSION

    Science.gov (United States)

    Bustíos, S Carla; Uribe, M Rosario; Vargas, C Gloria; Myurí, B Corina

    1999-01-01

    We report the case of a 26-year-old woman from Cerro of Pasco - Per , with hydatid cyst in the liver associated with portal hypertension. We know that the echinococcosis in the liver is usually asymptomatic, although can produce clinical features that depend of the size and localization in the liver. The clinical, radiological and endoscopic findings are presented, due to the uncommon presentation and the few cases reported in the literature about this asociation

  15. Idiopathic non-cirrhotic portal hypertension

    Directory of Open Access Journals (Sweden)

    CHEN Jie

    2013-07-01

    Full Text Available The pathogenesis of idiopathic non-cirrhotic portal hypertension (INCPH remains unknown and the disease is diagnosed by the absence of recognized clinical indicators of cirrhosis and of any other known etiologies of portal hypertension. To promote understanding of this disease, a comprehensive overview of potential etiologies, clinical manifestations, histopathological features, methods of diagnosis and potential differential diagnoses, and outcome of clinical management is presented in this review. In particular, we discuss the findings from INCPH studies and their implications in regards to each of the above-mentioned categories. For example, associations with various comorbidities have suggested a possible immune system component to INCPH development and/or progression. In addition, the common clinical characteristics of patients upon presentation can not only help to recognize disease suspects but may also provide insights into the pathogenesis and prognosis. Finally, prognosis following the various intervention strategies appears to depend mainly on severity of the portal hypertension, as well as its various accompanying complications.

  16. Capsule Endoscopy for Portal Hypertensive Enteropathy

    Directory of Open Access Journals (Sweden)

    Seong Ran Jeon

    2016-01-01

    Full Text Available Portal hypertensive enteropathy (PHE is a mucosal abnormality of the small bowel that is observed in patients with portal hypertension (PH and can lead to gastrointestinal bleeding and anemia. The pathogenesis is still not completely understood. The introduction of new endoscopic methods, including capsule endoscopy (CE or balloon-assisted enteroscopy, has increased the detection of these abnormalities. CE can also serve as a road map for deciding subsequent interventions and evaluating the treatment effect. The prevalence of PHE is reportedly 40–70% in patients with PH. Endoscopic findings can be roughly divided into vascular and nonvascular lesions such as inflammatory-like lesions. Traditionally, PHE-associated factors include large esophageal varices, portal hypertensive gastropathy or colopathy, Child-Turcotte-Pugh class B or C, a history of variceal treatment, and acute gastrointestinal bleeding. More recently, on using scoring systems, a high computed tomography or transient elastography score was reportedly PHE-related factors. However, the prevalence of PHE and its related associated factors remain controversial. The management of PHE has not yet been standardized. It should be individualized according to each patient’s situation, the availability of therapy, and each institutional expertise.

  17. Gastric Varices in Cirrhosis vs. Extrahepatic Portal Venous Obstruction and Response to Endoscopic N-butyl-2-cyanoacrylate Injection.

    Science.gov (United States)

    Sharma, Barjesh C; Varakanahalli, Shivakumar; Singh, Jatinder P; Srivastava, Siddharth

    2017-06-01

    Gastric varices (GV) are found in patients with portal hypertension. Incidence of bleeding from GV is relatively low, but is severe, and associated with higher mortality. To compare the types of GV in cirrhosis vs. extrahepatic portal venous obstruction (EHPVO) and the results of endoscopic N-butyl-2-cyanoacrylate (NBC, glue) injection. Four hundred and fifty-four patients undergone glue injection of GV for primary prophylaxis or control of bleeding for first episode of bleeding from GV between August 2010 and August 2015 were analyzed. Of 454 patients, 64% (n = 292) were cirrhotics and 36% (n = 162) had EHPVO. Types of GV were GOV1 in 16.4% (n = 48) of cirrhotics vs. 7.4% (n = 12) of EHPVO, GOV2 in 76.7% (n = 224) of cirrhotics vs. 53.1% (n = 86) of EHPVO, Isolated gastric Varices (IGV1) in 39.5% (n = 64) of patients with EHPVO vs. 6.8% (n = 20) cirrhotics. The patients were treated with NBC injections. The mean volume of glue injected was 2.89 ± 1.59 ml over a median of 1 session (range: 1-7). The total volume of glue required was lower in cirrhotics (2.44 ± 1.17 ml vs. 3.69 ± 1.91 ml, P 1 sessions of glue injection as compared to 102 (63%) of EHPVO patients. Over mean follow up of 14.7 ± 6.46 months, rebleeding (10% vs. 13%) was similar in patients with cirrhosis and EHPVO and mortality (15.4% vs. 2.5%) was higher in cirrhotics than EHPVO. In patients with bleeding from GV, GOV2 are more common in cirrhotics and IGV1 in patients with EHPVO. Patients with EHPVO required higher total volume of glue and more glue sessions for GV obturation.

  18. Hypertensive portal colopathy in schistosomiasis mansoni: proposal for a classification

    Directory of Open Access Journals (Sweden)

    Maria Angelina C Miranda

    2004-08-01

    Full Text Available Portal hypertension is a frequent complication of chronic liver disease, detected not only in schistosomiasis, but also in cirrhosis of any etiology. Vascular alterations in the colonic mucosa are a potential source for acute or chronic bleeding and have been observed in patients with portal hypertension. The purpose of this prospective study was to describe and propose a classification for the vascular alterations of portal hypertension in the colonic mucosa among patients with hepatosplenic schistosomiasis mansoni. One or more alterations of portal colopathy were observed in all patients and they were classified according to their intensity, obeying the classification proposed by the authors. Portal colopathy is an important finding in hepatosplenic schistosomiasis and might be the cause of lower gastrointestinal bleeding in patients with severe portal hypertension.

  19. Portal hypertensive colopathy in patients with liver cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Keiichi Ito; Katsuya Shiraki; Takahisa Sakai; Hitoshi Yoshimura; Takeshi Nakano

    2005-01-01

    AIM: In patients with liver cirrhosis and porlal hypertension, portal hypertensive colopathy is thought to be an important cause of lower gastrointestinal hemorrhage. In this study, we evaluated the prevalence of colonic mucosal changes in patients with liver cirrhosis and its clinical significance. METHODS: We evaluated the colonoscopic findings and liver function of 47 patients with liver cirrhosis over a 6-year period. The main cause of liver cirrhosis was post-viral hepatitis (68%) related to hepatitis B (6%) or C (62%)infection. All patients underwent upper gastrointestinal endoscopy to examine the presence of esophageal varices, cardiac varices, and congestive gastropathy, as well as a full colonoscopy to observe changes in colonic mucosa. Portal hypertensive colopathy was defined endoscopically in patients with vascular ectasia, redness, and blue vein. Vascular ectasia was classified into two types: type 1, solitary vascular ectasia; and type 2, diffuse vascular ectasia.RESULTS: Overall portal hypertensive colopathy was present in 31 patients (66%), including solitary vascular ectasia in 17 patients (36%), diffuse vascular ectasia in 20 patients (42%), redness in 10 patients (21%) and blue vein in 6 patients (12%). As the Child-Pugh class increased in severity, the prevalence of portal hypertensive colopathy rose. Child-Pugh class B and C were significantly associated with portal hypertensive colopathy. Portal hypertensive gastropathy, esophageal varices, ascites and hepatocellular carcinoma were not related to occurrence of portal hypertensive colopathy. Platelet count was significantly associated with portal hypertensive colopathy, but prothrombin time, serum albumin level, total bilirubin level and serum ALT level were not related to occurrence of portal hypertensive colopathy. CONCLUSION: As the Child-Pugh class worsens and platelet count decreases, the prevalence of portal hypertensive colopathy increases in patients with liver cirrhosis. A colonoscopic

  20. Advances in the treatment of portal hypertension in cirrhosis

    DEFF Research Database (Denmark)

    Kimer, Nina; Wiese, S; Mo, S S

    2016-01-01

    Non-selective beta-blockers and handling of esophageal varices has been key elements in the treatment of portal hypertension in recent decades. Liver vein catheterization has been essential in diagnosis and monitoring of portal hypertension, but ongoing needs for noninvasive tools has led...... to research in areas of both biomarkers, and transient elastography, which displays promising results in discerning clinically significant portal hypertension. Novel research into the areas of hepatic stellate cell function and the dynamic components of portal hypertension has revealed promising areas...... of treatment modalities, targeting intestinal decontamination, angiogenesis, inflammation and oxidative stress. Future studies may reveal if these initiatives lead to developments of new drugs for treatment of portal hypertension....

  1. Percutaneous transarterial embolization of extrahepatic arteroportal fistula

    Institute of Scientific and Technical Information of China (English)

    Gianluca Marrone; Settimo Caruso; Roberto Miraglia; Ilaria Tarantino; Riccardo Volpes; Angelo Luca

    2006-01-01

    Arteroportal fistula is a rare cause of prehepatic portalhypertension. A 44-year-old male with hepatitis virus C infection was admitted for acute variceal bleeding.Endoscopy showed the presence of large esophageal varices. The ultrasound revealed a mass near the head of pancreas, which was characterized at the colorDoppler by a turbulent flow, and arterialization of portal vein flow. CT scan of abdomen showed a large aneurysm of the gastroduodenal artery communicating into the superior mesenteric vein. The sinusoidal portal pressure measured as hepatic vein pressure gradient was normal, confirming the pre-hepatic origin of portal hypertension. The diagnosis of extrahepatic portal hypertension secondary to arteroportal fistula was established, and the percutaneous embolization was performed.Three months later, the endoscopy showed absence of esophageal varices and ascites. At the moment, the patient is in good clinical condition, without signs of portal hypertension.

  2. Gastric Polyposis: A Rare Cause of Iron Deficiency Anemia in a Patient With Portal Hypertension

    Science.gov (United States)

    Macaron, Carole; Pai, Rish K.; Alkhouri, Naim

    2015-01-01

    Portal hypertension leading to gastric polyposis has rarely been reported. More common gastric manifestations of portal hypertension are portal hypertensive gastropathy and gastric antral vascular ectasia (GAVE). We report a case of a patient in whom portal hypertension manifested as bleeding gastric polyps leading to transfusion-dependent iron deficiency anemia. PMID:26157923

  3. Management of rectal varices in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Rectal varices are portosystemic collaterals that form asa complication of portal hypertension, their prevalencehas been reported as high as 94% in patients withextrahepatic portal vein obstruction. The diagnosis istypically based on lower endoscopy (colonoscopy orsigmoidoscopy). However, endoscopic ultrasonographyhas been shown to be superior to endoscopy in diagnosingrectal varices. Color Doppler ultrasonography isa better method because it allows the calculation of thevelocity of blood flow in the varices and can be used topredict the bleeding risk in the varices. Although rare,bleeding from rectal varices can be life threatening. Themanagement of patients with rectal variceal bleedingis not well established. It is important to ensurehemodynamic stability with blood transfusion and tocorrect any coagulopathy prior to treating the bleedingvarices. Endoscopic injection sclerotherapy has beenreported to be more effective in the management ofactive bleeding from rectal varices with less rebleedingrate as compared to endoscopic band ligation. Transjugularintrahepatic portsystemic shunt alone or incombination with embolization is another method usedsuccessfully in control of bleeding. Balloon-occludedretrograde transvenous obliteration is an emergingprocedure for management of gastric varices that hasalso been successfully used to treat bleeding rectalvarices. Surgical procedures including suture ligationand porto-caval shunts are considered when othermethods have failed.

  4. Gastric adenocarcinoma inducing portal hypertension: A rare presentation

    Institute of Scientific and Technical Information of China (English)

    Pradipta Ghosh; Katsumi Miyai; Mario Chojkier

    2007-01-01

    Advanced gastric cancer usually presents with symptoms due to direct extension into adjacent viscera, distant metastases from lymphatic or hematogenic dissemination and peritoneal seeding. However, portal hypertension as a presentation of metastatic gastric cancer is rare and usually seen in association with other malignancies, e.g. hepatocellular and pancreatic carcinoma. We report a case of signet ring adenocarcinoma of the stomach that presented with esophageal and duodenal varices and bleeding due to portal hypertensive gastropathy. Pagetoid spread of cancer cells likely caused early metastasis and the unusual presentation. We also discussed the pathophysiology of development of portal hypertension in association with malignancies.

  5. ‘Latent’ Portal Hypertension in Benign Biliary Obstruction

    Science.gov (United States)

    Ibrarullah, Md.; Sikora, S. S.; Agarwal, D. K.; Kapoor, V. K.; Kaushik, S. P.

    1996-01-01

    A prospective study was undertaken to evaluate the changes in portal venous pressure in patients with benign biliary obstruction (BBO) but without overt clinical, endoscopic or radiological evidence of portal hypertension. Portal venous pressure was measured at laparotomy in 20 patients (10 each with either benign biliary stricture or choledocholithiasis) before and after biliary decompression. Pressure was found to be on the high side in seven patients (>25 cm of saline in three patients and > 30 cm of saline in four). The mean fall of pressure was 3.4 cm of saline after biliary decompression. No correlation could, however, be found between portal venous pressure and duration of biliary obstruction, serum bilirubin or bile duct pressure. Liver histology showed mild to moderate cholestatic changes but maintained portal architecture in all. Benign biliary obstruction may therefore, lead to elevation of portal pressure, even though the patient may not necessarily have any clinical, endoscopic or radiological manifestations of portal hypertension. The pathogenesis of this ‘latent’ portal hypertension is probably multifactorial. If biliary obstruction is left untreated the development of overt portal hypertension may become a possibility in the future. PMID:8725455

  6. Measuring of Gastric Emptying in Egyptian Pediatric Patients with Portal Hypertension by Using Real-time Ultrasound

    Science.gov (United States)

    Fahmy, Mona E.; Osman, Mahmoud A.; Mahmoud, Rehab A.; Mohamed, Lamiaa K.; Seif-elnasr, Khaled I.; Eskander, Ayman E.

    2012-01-01

    Background/Aim: Among the various methods for evaluating gastric emptying, the real-time ultrasound is safe, does not require intubation, or rely on either radiologic or radionuclide technique. The aim of our work was to measure the gastric emptying in pediatric patients with portal hypertension by using the real-time ultrasound. Patients and Methods: Forty patients with portal hypertension with mean age 7 ± 2.8 years and 20 healthy children as a control group underwent gastric emptying study by using real-time ultrasound. The cross-sectional area of the gastric antrum was measured in the fasting state and then each subject was allowed to drink tap water then calculated by using formula area (π longitudinal × anteroposterior diameter/4). The intragastric volume was assumed to be directly proportional to the cross-sectional area of the antrum. Results: The mean gastric emptying half-time volume was significantly delayed in portal hypertension patients (40 ± 6.8 min) compared with the control subjects (27.1 ± 3.6) min (P<0.05). Patients with extrahepatic portal vein obstruction had significant delayed gastric emptying in comparison to patients with portal hypertension due to other etiologies (36.14 ± 4.9 vs 44.41 ± 6.04 min; P<0.01). Conclusion: Ultrasound is a noninvasive and a reliable method for measuring gastric emptying in pediatric patients. Gastric emptying was significantly delayed in patients with portal hypertension. Etiology of portal hypertension may influence gastric emptying time in patients with chronic liver disease. PMID:22249091

  7. Portal hypertensive colopathy is associated with portal hypertension severity in cirrhotic patients

    Institute of Scientific and Technical Information of China (English)

    Antonio Diaz-Sanchez; Oscar Nu(n)ez-Martinez; Cecilia Gonzalez-Asanza; Ana Matilla; Beatriz Merino; Diego Rincon; Inmaculada Beceiro; Maria Vega Catalina; Magdalena Salcedo; Rafael Ba(n)ares; Gerardo Clemente

    2009-01-01

    AIM: To assess the prevalence of portal hypertension (PH) related colorectal lesions in liver transplant candidates, and to evaluate its association with the severity of PH.METHODS: Between October 2004 and December 2005, colonoscopy was performed in 92 cirrhotic liver transplant candidates. We described the lesions resulting from colorectal PH and their association with the grade of PH in 77 patients who underwent measurement of hepatic venous pressure gradient (HVPG). RESULTS: Mean age was 55 years and 80.7% of patients were men. The main etiology of cirrhosis was alcoholism (45.5%). Portal hypertensive colopathy (PHC) was found in 23.9%, colonic varices in 7.6% and polyps in 38% of patients (adenomatous type 65.2%). One asymptomatic patient had a well-differentiated adenocarcinoma. The manifestations of colorectal PH were not associated with the etiology of liver disease or with the Child-Pugh grade. Ninety percent of patients with colopathy presented with gastroesophageal varices (GEV), and 27.5% of patients with GEV presented with colopathy ( P = 0.12). A relationship between higher values of HVPG and presence of colopathy was observed (19.9 ± 6.2 mmHg vs 16.8 ± 5.4 mmHg, P = 0.045), but not with the grade of colopathy ( P = 0.13). Preneoplastic polyps and neoplasm ( P = 0.02) and spontaneous bacterial peritonitis ( P = 0.006) were more prevalent in patients with colopathy. We did not observe any association between previous β-blocker therapy and the presence of colorectal portal hypertensive vasculopathy. CONCLUSION: PHC is common in cirrhotic liver transplant candidates and is associated with higher portal pressure.

  8. Endovascular interventions for traumatic portal venous hemorrhage complicated by portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Dinesh; Kumar; Sundarakumar; Crysela; Mirta; Smith; Jorge; Enrique; Lopera; Matthew; Kogut; Rajeev; Suri

    2013-01-01

    Life-threatening hemorrhage rarely occurs from the portal vein following blunt hepatic trauma.Traditionally,severe portal bleeding in this setting has been controlled by surgical techniques such as packing,ligation,and venorrhaphy.The presence of portal hypertension could potentially increase the amount of hemorrhage in the setting of blunt portal vein trauma making it more difficult to control.This case series describes the use of indirect carbon dioxide portography to identify portal hemorrhage.Furthermore,these cases illustrate attempted endovascular treatment utilizing a transjugular intrahepatic portosystemic shunt in one scenario and transmesocaval shunt coiling of a jejunal varix in the other.

  9. Staging of portal hypertension and portosystemic shunts using dynamic nuclear medicine investigations

    Institute of Scientific and Technical Information of China (English)

    Mircea Dragoteanu; Ioan A Balea; Liliana A Dina; Cecilia D Piglesan; Ioana Grigorescu; Stefan Tamas; Sabin O Cotul

    2008-01-01

    AIM: To explore portal hypertension and portosystemic shunts and to stage chronic liver disease (CLD)based on the pathophysiology of portal hemodynamics.METHODS: Per-rectal portal scintigraphy (PRPS) was performed on 312 patients with CLD and liver angioscintigraphy (LAS) on 231 of them.The control group included 25 healthy subjects.We developed a new model of PRPS interpretation by introducing two new parameters,the liver transit time (LIT) and the circulation time between right heart and liver (RHLT).LTT for each lobe was used to evaluate the early portal hypertension.RHLT is useful in cirrhosis to detect liver areas missing portal inflow.We calculated the classical per-rectal portal shunt index (PRSI) at PRPS and the hepatic perfusion index (HPI) at LAS.RESULTS: The normal LTT value was 24 ±1 s.Abnormal LTT had PPV = 100% for CLD.Twenty-seven noncirrhotic patients had L-IT increased up to 35 s (median 27 s).RHLT (42 ±1 s) was not related to liver disease.Cirrhosis could be excluded in all patients with PRSI< 5% (P < 0.01).PRSI > 30% had PPV = 100% for cirrhosis.Based on PRPS and LAS we propose the classification of CLD in 5 hemodynamic stages.Stage 0 is normal (LIT = 24 s,PRSI < 5%).In stage 1,LIT is increased,while PRSI remains normal.In stage 2,LIT is decreased between 16 s and 23 s,whereas PRSI is increased between 5% and 10%.In stage 3,PRSI is increased to 10%-30%,and LTT becomes undetectable by PRPS due to the portosystemic shunts.Stage 4 includes the patients with PRSI > 30%.RHLT and HPI were used to subtype stage 4.In our study stage 0 had NPV = 100% for CLD,stage 1 had PPV = 100% for non-cirrhotic CLD,stages 2 and 3 represented the transition from chronic hepatitis to cirrhosis,stage 4 had PPV = 100% for cirrhosis.CONCLUSION: LTT allows the detection of early portal hypertension and of opening of transhepatic shunts.PRSI is useful in CLD with extrahepatic portosystemic shunts.Our hemodynamic model stages the evolution of portal hypertension

  10. Bilateral varicoceles as an indicator of underlying portal-hypertension

    African Journals Online (AJOL)

    A. Adam

    2016-08-01

    Aug 1, 2016 ... b Department of Urology, 1 Military Hospital, Pretoria, South Africa c Department of Radiology, ... 'Bilateral varicoceles an indicator of portal-hypertension'. 211. Table 1 ... W.C. Mamitele: Patient report and management.

  11. [PORTAL HYPERTENSIVE GASTROPATHY AT HOSPITAL NACIONAL DELSUR - IPSS AREQUIPA

    Science.gov (United States)

    Cerpa Polar, Rusby; Castro Valdivia, Raúl; Valdez Herrera, Jesús

    1998-01-01

    An analytic prospective study was done in cirrhotic patients with Portal hypertension to study a new pathology known as Portal Hypertensive Gastropathy. In 73.3 per cent of patients with cirrhosis, hospitalized inthe Gastroenterology Area, Portal Hypertensive Gastropathy was present. Males in the 4th decade of their life were predominant. Mild gastropathy with a mosaic or snake skin endoscopy pattern was the most frequent (60.6%), while in severe gastropathy, the most common pattern was cherry red spots. These lesions were often located in the stomach fundus and body. All the patients presented some vascular alteration and lymphoplasmocytic inflammatory infiltration. No relation was found between the severity of Portal Hypertension or Advanced Liver Disease and changes of the gastric mucosa.

  12. Contemporary use of elastography in liver fibrosis and portal hypertension

    DEFF Research Database (Denmark)

    Thiele, Maja; Kjærgaard, Maria; Thielsen, Peter

    2017-01-01

    significant portal hypertension, techniques and limitations. Four types of ultrasound elastography exist, but there is scarce evidence comparing the different techniques. The majority of experience concern transient elastography for diagnosing fibrosis and cirrhosis in patients with chronic viral hepatitis C...

  13. The value of Doppler ultrasound in cirrhosis and portal hypertension

    NARCIS (Netherlands)

    Kok, T; van der Jagt, EJ; Haagsma, EB; Bijleveld, CMA; Jansen, PLM; Boeve, WJ

    1999-01-01

    Background: Cirrhosis and portal hypertension affect the flow profile of the liver vasculature. In these conditions Doppler ultrasound can provide important information on the hemodynamics of the portal venous system, the hepatic artery and the hepatic veins. Methods: The value of Doppler ultrasound

  14. Clinical role of non-invasive assessment of portal hypertension.

    Science.gov (United States)

    Bolognesi, Massimo; Di Pascoli, Marco; Sacerdoti, David

    2017-01-07

    Measurement of portal pressure is pivotal in the evaluation of patients with liver cirrhosis. The measurement of the hepatic venous pressure gradient represents the reference method by which portal pressure is estimated. However, it is an invasive procedure that requires significant hospital resources, including experienced staff, and is associated with considerable cost. Non-invasive methods that can be reliably used to estimate the presence and the degree of portal hypertension are urgently needed in clinical practice. Biochemical and morphological parameters have been proposed for this purpose, but have shown disappointing results overall. Splanchnic Doppler ultrasonography and the analysis of microbubble contrast agent kinetics with contrast-enhanced ultrasonography have shown better accuracy for the evaluation of patients with portal hypertension. A key advancement in the non-invasive evaluation of portal hypertension has been the introduction in clinical practice of methods able to measure stiffness in the liver, as well as stiffness/congestion in the spleen. According to the data published to date, it appears to be possible to rule out clinically significant portal hypertension in patients with cirrhosis (i.e., hepatic venous pressure gradient ≥ 10 mmHg) with a level of clinically-acceptable accuracy by combining measurements of liver stiffness and spleen stiffness along with Doppler ultrasound evaluation. It is probable that the combination of these methods may also allow for the identification of patients with the most serious degree of portal hypertension, and ongoing research is helping to ensure progress in this field.

  15. Systemic sclerosis with portal hypertensive ascites responded to corticosteroid treatment

    Institute of Scientific and Technical Information of China (English)

    LENG Xiao-mei; SUN Xue-feng; ZHANG Xuan; ZHANG Wen; LI Meng-tao; ZENG Xiao-feng

    2012-01-01

    We describe a case of systemic sclerosis (SSc) complicated with portal hypertensive ascites which did not improve with diuretics and ascitic drainage.When corticosteroid added,her ascites diminished dramatically.Though portal hypertension can be imputed to other causes,such as polycystic liver in this case,it can occur in limited SSc with positive anti-centromere antibody and respond to corticosteroid treatment.

  16. Ultra Sound Evaluation of Choledochal Cyst With Portal Hypertension

    Directory of Open Access Journals (Sweden)

    Alam P

    2016-05-01

    Full Text Available Choledochal cyst is an uncommon congenital cystic dilatation of the bile duct. The underlying etiology is believed to be an anomalous junction of the pancreatic duct and common bile duct (CBD that allows free reflux of pancreatic enzymes into the CBD, weakening its wall. Portal hypertension is a rare complication of choledochal cyst. We report a case of choledochal cyst with portal hypertension confirmed by surgery

  17. [Results of partial splenic resection and transposition to the lateral abdominal wall in portal hypertension in childhood].

    Science.gov (United States)

    Bennek, J; Tröbs, R B; Mühlig, K; Richter, T

    1996-01-01

    Between 1977 and 1995, 19 children with portal hypertension (nine extrahepatic, ten intrahepatic) were treated by transpositioning the spleen into the left abdominal wall. Among the patients with intrahepatic portal hypertension three died. Two patients underwent secondary diminuition of the transposed spleen due to relapsed hypersplenism. In one of our first patients the transposed spleen atrophied after tangential resection. All surviving patients except one preserved hepatic function. The serum colloid osmotic pressure was stable. Plasma ammonia levels were normal. Serum immunoglobulins (IgG, IgM, IgA and IgG subclasses) and complement components (C3c, C4) were analyzed. After transposition patients had normal or slightly elevated values of these proteins compared with controls.

  18. Pulmonary dysfunction and hepatopulmonary syndrome in cirrhosis and portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Krag, Aleksander; Madsen, Jan L

    2009-01-01

    BACKGROUND: Pulmonary dysfunction including the hepatopulmonary syndrome (HPS) is an important complication to cirrhosis and portal hypertension. However, the precise relation to liver dysfunction and the prevalence of HPS are unclear. AIMS: We therefore aimed to assess (i) the prevalence of HPS......, Pportal hypertension (post-sinusoidal resistance, P

  19. IMPROVEMENT OF SCHISTOSOMAL PORTAL HYPERTENSIVE COLOPATHY AFTER SURGICAL TREATMENT

    Directory of Open Access Journals (Sweden)

    Maria Angelina Carvalho MIRANDA

    2013-04-01

    Full Text Available Context Data on vascular alterations in patients with hepatosplenic schistosomiasis and portal hypertensive colopathy and changes in these after surgery to decrease portal hypertension are limited. Objective The purpose of this study was to analyse the alterations of portal hypertensive colopathy previously and 6-12 months after splenectomy and gastric devascularization. Methods Twelve patients with hepatosplenic schistosomiasis who also had upper gastrointestinal bleeding were studied prospectively. Their endoscopic findings before and 6-12 months after the surgery were analysed. In addition, mucosal biopsies from ascending colon, sigmoid colon and rectum at these time points were subjected to histological and histomorphometric assessment. It was used a control group due to lack of normal pattern of the histomorphometric measures of vessels in individuals without portal hypertension. The critical level of significance adopted in all tests was of a maximum probability error of 5%. Results Surgery did not lead to significant improvement in histological and endoscopic findings. However, on histomorphometry, there was a significant decrease in the area, diameter and thickness of the vessels in mucosa at all colonic sites. Conclusion Surgery for decompression of schistosomal portal hypertension has a beneficial effect on the associated colopathy, being best indicated in patients with gastrointestinal bleeding and esophageal varices.

  20. Nitroglycerine effects on portal vein mechanics and oxidative stress in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Andreja Vujanac; Vladimir Jakovljevic; Dusica Djordjevic; Vladimir Zivkovic; Mirjana Stojkovic; Dragan Celikovic; Nebojsa Andjelkovic; Aleksandra Jurisic Skevin; Dragan Djuric

    2012-01-01

    vein haemodynamics and oxidative stress in patients with portal hypertension. METHODS: Thirty healthy controls and 39 patients with clinically verified portal hypertension and increasedvascular resistance participated in the study. Liver diameters, portal diameters and portal flow velocities were recorded using color flow imaging/pulsed Doppler detection. Cross-section area, portal flow and index of vascular resistance were calculated. In collected blood samples, superoxide anion radical (O2 -), hydrogen peroxide (H2O2), index of lipid peroxidation (measured as TBARS) and nitric oxide (NO) as a marker of endothelial response (measured as nitrite-NO2 -) were determined. Time-dependent analysis was performed at basal state and in 10th and 15th min after nitroglycerine (sublingual 0.5 mg) administration. RESULTS: Oxidative stress parameters changed significantly during the study. H2O2 decreased at the end of study, probably via O2 -mediated disassembling in Haber Weiss and Fenton reaction; O2 -increased significantly probably due to increased diameter and tension and decreased shear rate level. Consequently O2 -and H2O2 degradation products, like hydroxyl radical, initiated lipid peroxidation. Increased blood flow was to some extent lower in patients than in controls due to double paradoxes, flow velocity decreased, shear rate decreased significantly indicating non Newtonian characteristics of portal blood flow. CONCLUSION: This pilot study could be a starting point for further investigation and possible implementation of some antioxidants in the treatment of portal hypertension.

  1. Advances in diagnosis and treatment of portal hypertensive biliopathy

    Directory of Open Access Journals (Sweden)

    WENG Ningna

    2014-08-01

    Full Text Available With the progress in research on portal hypertension in recent years, portal hypertensive biliopathy (PHB has attracted more and more attention. The pathophysiology and clinical manifestations of PHB, as well as the main methods for the diagnosis and treatment of this disease, are briefly described. The pathogenesis of PHB remains unclear, and it has been postulated that the external pressure of portal cavernoma and the ischemic stricture of the bile duct may play a role. Magnetic resonance cholangiopancreatography is the primary diagnostic tool for PHB. Currently, it is thought that asymptomatic PHB patients do not require any treatment, and symptomatic PHB patients should receive individualized treatment, which mainly included reducing portal pressure and relieving biliary obstruction. Transjugular intrahepatic portosystemic shunt has become the first-line therapy for symptomatic PHB. More research and practice are needed for further understanding of PHB.

  2. Idiopathic non-cirrhotic intrahepatic portal hypertension: common cause of cryptogenic intrahepatic portal hypertension in a Southern Indian tertiary hospital.

    Science.gov (United States)

    Madhu, Kadiyala; Avinash, Balekuduru; Ramakrishna, Banumathi; Eapen, C E; Shyamkumar, N K; Zachariah, Uday; Chandy, George; Kurian, George

    2009-01-01

    Patients with intrahepatic portal hypertension and negative etiological work-up for liver disease are often labeled as having cryptogenic cirrhosis. The aim of this study was to evaluate causes of liver disease in patients with unexplained intrahepatic portal hypertension. We retrospectively analyzed cause of liver disease in all patients with cryptogenic intrahepatic portal hypertension who underwent liver biopsies between June 2005 to June 2007 in our center. Five hundred and seventeen patients underwent liver biopsies of whom 227 had portal hypertension. Of these, the cause of liver disease could not be detected prior to liver biopsy in 62 patients. Causes of liver disease identified after liver biopsy in these 62 patients were: idiopathic non-cirrhotic intrahepatic portal hypertension (NCIPH) (30 patients, 48%), cirrhosis (14), fatty liver disease (7) and other causes (11). Initial presentations in idiopathic NCIPH patients were splenomegaly and anemia (18 patients), variceal bleed (9) and ascites (3). Median age (range) of patients at first presentation was 32 (15-57) years, and 19 were male. Majority (90%) were in Child's class A. Hepatic vein pressure gradient was <5 mmHg in 2 of 7 NCIPH patients tested. We identified 30 patients with idiopathic NCIPH at our center over the 2 year study period. The clinical presentation and investigations of NCIPH closely mimic cryptogenic cirrhosis. Idiopathic NCIPH should be considered as a differential diagnosis of cryptogenic cirrhosis in India.

  3. Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension

    Directory of Open Access Journals (Sweden)

    Takahiro Sato

    2011-01-01

    Full Text Available Bleeding from ectopic varices, which is rare in patients with portal hypertension, is generally massive and life-threatening. Forty-three patients were hospitalized in our ward for gastrointestinal bleeding from ectopic varices. The frequency of ectopic varices was 43/1218 (3.5% among portal hypertensive patients in our ward. The locations of the ectopic varices were rectal in thirty-two, duodenal in three, intestinal in two, vesical in three, stomal in one, and colonic in two patients. Endoscopic or interventional radiologic treatment was performed successfully for ectopic varices. Hemorrhage from ectopic varices should be kept in mind in patients with portal hypertension presenting with lower gastrointestinal bleeding.

  4. Gastrointestinal motor function in patients with portal hypertension

    DEFF Research Database (Denmark)

    Madsen, Jan Lysgård; Brinch, K; Hansen, Erik Feldager

    2000-01-01

    BACKGROUND: Existing data on gastric emptying and small-intestinal transit rates in portal-hypertensive patients are scarce and contradictory, and so far, the motor function of the colon has not been assessed in these patients. In this study we evaluated the propulsive effect of all main segments...... of the gastrointestinal tract in patients with well-characterized portal hypertension. METHODS: Eight patients with a postsinusoidal hepatic pressure gradient of at least 13 mmHg and eight age- and sex-matched healthy controls participated in the study. Gastric emptying, small-intestinal transit, and colonic transit...... the test meal between patients and controls. CONCLUSIONS: These data suggest that the colonic transit is often accelerated in patients with portal hypertension, whereas the motor function of the stomach and the small intestine is unaffected....

  5. Gastrointestinal motor function in patients with portal hypertension

    DEFF Research Database (Denmark)

    Madsen, Jan Lysgård; Brinch, K; Hansen, Erik Feldager

    2000-01-01

    BACKGROUND: Existing data on gastric emptying and small-intestinal transit rates in portal-hypertensive patients are scarce and contradictory, and so far, the motor function of the colon has not been assessed in these patients. In this study we evaluated the propulsive effect of all main segments...... of the gastrointestinal tract in patients with well-characterized portal hypertension. METHODS: Eight patients with a postsinusoidal hepatic pressure gradient of at least 13 mmHg and eight age- and sex-matched healthy controls participated in the study. Gastric emptying, small-intestinal transit, and colonic transit...... the test meal between patients and controls. CONCLUSIONS: These data suggest that the colonic transit is often accelerated in patients with portal hypertension, whereas the motor function of the stomach and the small intestine is unaffected....

  6. Novel Rat Model of Repetitive Portal Venous Embolization Mimicking Human Non-Cirrhotic Idiopathic Portal Hypertension

    DEFF Research Database (Denmark)

    Klein, Sabine; Hinüber, Christian; Hittatiya, Kanishka

    2016-01-01

    BACKGROUND: Non-cirrhotic idiopathic portal hypertension (NCIPH) is characterized by splenomegaly, anemia and portal hypertension, while liver function is preserved. However, no animal models have been established yet. This study assessed a rat model of NCIPH and characterized the hemodynamics......, and compared it to human NCIPH. METHODS: Portal pressure (PP) was measured invasively and coloured microspheres were injected in the ileocecal vein in rats. This procedure was performed weekly for 3 weeks (weekly embolization). Rats without and with single embolization served as controls. After four weeks (one...... in the weekly embolization group. Fibrotic markers αSMA and Desmin were upregulated in weekly embolized rats. DISCUSSION: This study establishes a model using repetitive embolization via portal veins, comparable with human NCIPH and may serve to test new therapies....

  7. APPLICATION OF MAGNETIC RESONANCE ANGIOGRAPHY IN PORTAL HYPERTENSIVE SURGERY

    Institute of Scientific and Technical Information of China (English)

    LIU Hua; CHEN Zhi-ping; WU Zhi-yong

    2005-01-01

    Objective To compare magnetic resonance angiography (MRA) with traditional angiography and doppler ultrasonography (DUS) in the assessment of portal venous anatomy and its hemodynamics. MethodsThree dimensional dynamic contrast-enhanced (3D-DCE) MRA and two dimensional phase-contrast (2D-PC) MR were used for the study of portal venous system in the patients with portal hypertension and those without liver cirrhosis. The comparison of the portal blood flow (PBF) measured with 2D-PC MR and DUS was made. ResultsThe portal vein, splenic vein, superior mesenteric vein, cephalic collateral veins and anastomotic stoma of surgical shunting were clearly displayed in 3D-DCE MRA. There was no significant difference between PBF measured with 2D-PC MR and DUS. Conclusion The results of present study indicate that the anatomical imaging of the portal venous system can be clearly revealed in MRA and the PBF can be accurately measured with 2D-PC MR. It is believed that MRA is a useful tool in the management of the patients with portal hypertension.

  8. Role of endoscopy in management of gastrointestinalcomplications of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Carmelo Luigiano; Giuseppe Iabichino; Antonino Judica; Clara Virgilio; Valentina Peta; Ludovico Abenavoli

    2015-01-01

    The management of patients with gastrointestinalcomplications of portal hypertension is often complexand challenging. The endoscopy plays an importantrole in the management of these patients. The role ofendoscopy is both diagnostic and interventional andin the last years the techniques have undergone arapid expansion with the advent of different and novelendoscopic modalities, with consequent improvementof investigation and treatment of these patients. Thechoice of best therapeutic strategy depends on manyfactors baseline disease, patient's clinical performanceand the timing when it is done if in emergency or aprophylactic approaches. In this review we evaluatethe endoscopic management of patients with thegastrointestinal complications of portal hypertension.

  9. Prognosis in patients with cirrhosis and mild portal hypertension

    DEFF Research Database (Denmark)

    Ytting, Henriette; Møller, Søren; Henriksen, Jens Henrik

    2006-01-01

    HVPG has been sparse. In this study, long-term survival and the risk of complications in mild portal hypertension were analysed. MATERIAL AND METHODS: Sixty-one patients with cirrhosis and HVPG below 10 mmHg were included in the study. Data were collected from medical files and National Patient...... with that in the background population. CONCLUSIONS: The frequency of complications in patients with mild portal hypertension is considerable, and guidelines for follow-up or medical prophylaxis are warranted. The risk of bleeding from oesophageal varices is low and bleeding-related deaths rare....

  10. Prognosis in patients with cirrhosis and mild portal hypertension

    DEFF Research Database (Denmark)

    Ytting, Henriette; Møller, Søren; Henriksen, Jens Henrik

    2006-01-01

    HVPG has been sparse. In this study, long-term survival and the risk of complications in mild portal hypertension were analysed. MATERIAL AND METHODS: Sixty-one patients with cirrhosis and HVPG below 10 mmHg were included in the study. Data were collected from medical files and National Patient...... with that in the background population. CONCLUSIONS: The frequency of complications in patients with mild portal hypertension is considerable, and guidelines for follow-up or medical prophylaxis are warranted. The risk of bleeding from oesophageal varices is low and bleeding-related deaths rare....

  11. Effect of Fluid Shear Stress on Portal Vein Remodeling in a Rat Model of Portal Hypertension

    Directory of Open Access Journals (Sweden)

    Bin Wen

    2015-01-01

    Full Text Available Aims. To explore the effects and mechanisms of fluid shear stress on portal vein remodeling in a rat model of portal hypertension. Methods. Subcutaneous injections of CCl4 were given to establish a rat model of liver cirrhosis and portal hypertension. Biomechanical technology was adopted to determine the dynamic changes of haemodynamic indices and fluid shear stress. Nitric oxide (NO, synthase (NOS, and endothelin-1 (ET-1 of the portal vein blood were measured. Changes in geometric structure and ultrastructure of the portal vein were observed using optical and electron microscopy. Results. After the CC14 injections, rat haemodynamics were notably altered. From week 4 onwards, PVP, PVF, and PVR gradually and significantly increased (P<0.05 versus baseline. The fluid shear stress declined from week 4 onwards (P<0.01 versus control group. NO, NOS, and ET-1 increased after repeated CCI4 injections. Hematoxylin and eosin staining showed thickened portal vein walls, with increased inside and outside diameters. Electron microscopy revealed different degrees of endothelial cell degeneration, destruction of basement membrane integrity, proliferating, and hypertrophic smooth muscle cells. Conclusions. Fluid shear stress not only influenced the biomechanical environment of the portal vein but also participated in vascular remodeling.

  12. Non-Hodgkin lymphoma as a cause of obstructive jaundice with simultaneous extrahepatic portal vein obstruction: A case report

    Institute of Scientific and Technical Information of China (English)

    Masao Hashimoto; Nobutaka Umekita; Kazumasa Noda

    2008-01-01

    Non-Hodgkin lymphoma is a rare cause of biliary obstruction. To the best of our knowledge, non-Hodgkin lymphoma in the peripancreatic region causing obstructive jaundice with simultaneous portal vein (PV) invasion has not yet been reported. We present a 50-year-old patient with obstructive jaundice whose extrahepatic portal vein was obstructed by the invasion of a peripancreatic non-Hodgkin lymphoma. The patient denied any other symptoms such as recurrent fever, night sweat and loss of body weight. Computed tomography (CT) revealed a 10cm mass in the retroperitoneal space behind the head of the pancreas causing obstruction of the distal bile duct and the PV. A pylorus-preserving pancreaticoduodenectomy combined with a PV resection was performed. The PV was reconstructed using an autologous right internal jugular vein graft. The resected specimen showed endoluminal invasion of both the bile duct and the PV. Histological examination showed the mass consisting of diffuse sheets of large malignant lymphoid cells. These cells were positive for CD20 and CD79a, partially positive for CD10, and negative for CD3, CD4, CD5, CD8 and CD30. The pathologic diagnosis was diffuse large B-cell type non-Hodgkin lymphoma and the patient was transferred to the Department of Hematology and Oncology for chemotherapy. He received four cycles of combined chemotherapy including cyclophosphamide, doxorubicin, vincristine and prednisone plus rituximab, and three cycles of intrathecal chemoprophylaxis including methotorexate, cytosine arbinoside and prednisone. The patient is alive with no evidence of the disease for 7 mo after operation and will receive additional courses of chemotherapy.

  13. Increased angiogenesis in portal hypertensive rats: role of nitric oxide.

    Science.gov (United States)

    Sumanovski, L T; Battegay, E; Stumm, M; van der Kooij, M; Sieber, C C

    1999-04-01

    Systemic and especially splanchnic arterial vasodilation accompany chronic portal hypertension. Different soluble mediators causing this vasodilation have been proposed, the strongest evidence being for nitric oxide (NO). No data exist if structural vascular changes may partly account for this vasodilatory state. Here, we developed a new in vivo quantitative angiogenesis assay in the abdominal cavity and determined if: 1) portal hypertensive rats show increased angiogenesis; and 2) angiogenesis is altered by inhibiting NO formation. Portal hypertension was induced by partial portal vein ligation (PVL). Sham-operated rats served as controls (CON). During the index operation (day 0), a teflon ring filled with collagen I (Vitrogen 100) was sutured in the mesenteric cavity. After 16 days, rings were explanted, embedded in paraffin, and ingrown vessels counted using a morphometry system. The role of NO was tested by adding an antagonist of NO formation (Nomega-nitro-L-arginine [NNA], 3.3 mg/kg/d) into the drinking water. The mean number of ingrown vessels per implant was significantly higher in PVL rats compared with CON rats, i.e., 1,453 +/- 187 versus 888 +/- 116, respectively (P <.05; N = 5 per group). NNA significantly (P <.01) inhibited angiogenesis in PVL (202 +/- 124; N = 5) and in CON (174 +/- 25; N = 6) rats, respectively. In contrast, the beta-adrenergic blocker, propranolol, did not prevent angiogenesis either in PVL or CON rats in a separate set of experiments (data not shown). The conclusions drawn from this study are that: 1) rats with portal hypertension show increased angiogenesis; and 2) inhibition of NO formation significantly prevents angiogenesis in both PVL and CON rats. Therefore, splanchnic vasodilation in chronic portal hypertension may also be a result of structural changes.

  14. Esophagogastric variceal bleeding in cirrhotic portal hypertension:consensus on prevention and management(2008)

    Institute of Scientific and Technical Information of China (English)

    Task Force for the Prevention and Management of Esophagogastric Variceal Bleeding of the Chinese Society of Gastroenterology,Chinese Society of Hepatology,and Chinese Society of Digestive Endoscopy

    2009-01-01

    @@ Portal hypertension is a clinical syndrome which is a consequence of a pathological increase in portal vein pressure due to various causes,liver cirrhosis being the most common.The basic pathophysioiogical characteristic of portal hypertension is resistance to portal vein flow or an increase in portal vein flow,which results in elevation of ressure in the portal vein and its tributaries and the formation of collateral circulation.Portal hypertension is manifested as a clinical syndrome including ascites,hepatoencephalopathy,esophagogastric variceal bleeding (EVB),etc.Among these manifestations,EVB has the highest mortality which is also one of the most common emergencies of the digestive system.

  15. The Interstitial Lymphatic Peritoneal Mesothelium Axis in Portal Hypertensive Ascites: When in Danger, Go Back to the Sea

    Directory of Open Access Journals (Sweden)

    M. A. Aller

    2010-01-01

    Full Text Available Portal hypertension induces a splanchnic and systemic low-grade inflammatory response that could induce the expression of three phenotypes, named ischemia-reperfusion, leukocytic, and angiogenic phenotypes.During the splanchnic expression of these phenotypes, interstitial edema, increased lymph flow, and lymphangiogenesis are produced in the gastrointestinal tract. Associated liver disease increases intestinal bacterial translocation, splanchnic lymph flow, and induces ascites and hepatorenal syndrome. Extrahepatic cholestasis in the rat allows to study the worsening of the portal hypertensive syndrome when associated with chronic liver disease. The splanchnic interstitium, the mesenteric lymphatics, and the peritoneal mesothelium seem to create an inflammatory pathway that could have a key pathophysiological relevance in the production of the portal hypertension syndrome complications. The hypothetical comparison between the ascitic and the amniotic fluids allows for translational investigation. From a phylogenetic point of view, the ancestral mechanisms for amniotic fluid production were essential for animal survival out of the aquatic environment. However, their hypothetical appearance in the cirrhotic patient is considered pathological since ultimately they lead to ascites development. But, the adult human being would take advantage of the potential beneficial effects of this “amniotic-like fluid” to manage the interstitial fluids without adverse effects when chronic liver disease aggravates.

  16. Investigating the efficacy of subharmonic aided pressure estimation for portal vein pressures and portal hypertension monitoring.

    Science.gov (United States)

    Dave, Jaydev K; Halldorsdottir, Valgerdur G; Eisenbrey, John R; Merton, Daniel A; Liu, Ji-Bin; Zhou, Jian-Hua; Wang, Hsin-Kai; Park, Suhyun; Dianis, Scott; Chalek, Carl L; Lin, Feng; Thomenius, Kai E; Brown, Daniel B; Forsberg, Flemming

    2012-10-01

    The efficacy of using subharmonic emissions from Sonazoid microbubbles (GE Healthcare, Oslo, Norway) to track portal vein pressures and pressure changes was investigated in 14 canines using either slow- or high-flow models of portal hypertension (PH). A modified Logiq 9 scanner (GE Healthcare, Milwaukee, WI, USA) operating in subharmonic mode (f(transmit): 2.5 MHz, f(receive): 1.25 MHz) was used to collect radiofrequency data at 10-40% incident acoustic power levels with 2-4 transmit cycles (in triplicate) before and after inducing PH. A pressure catheter (Millar Instruments, Inc., Houston, TX, USA) provided reference portal vein pressures. At optimum insonification, subharmonic signal amplitude changes correlated with portal vein pressure changes; r ranged from -0.82 to -0.94 and from -0.70 to -0.73 for PH models considered separately or together, respectively. The subharmonic signal amplitudes correlated with absolute portal vein pressures (r: -0.71 to -0.79). Statistically significant differences between subharmonic amplitudes, before and after inducing PH, were noted (p ≤ 0.01). Portal vein pressures estimated using subharmonic aided pressure estimation did not reveal significant differences (p > 0.05) with respect to the pressures obtained using the Millar pressure catheter. Subharmonic-aided pressure estimation may be useful clinically for portal vein pressure monitoring.

  17. Portal hypertensive polyps, a new entity?

    Directory of Open Access Journals (Sweden)

    Verónica Martín-Domínguez

    Full Text Available Presentamos el caso clínico de una mujer de 62 años de edad, con antecedentes de cirrosis hepática secundaria a hepatitis autoinmune, hipertensión portal y coagulopatía, quien presenta en gastroscopia, unas lesiones polipoideas, semipediculadas, polilobuladas en la región prepilórica, que se extirpan y cuya anatomía patológica se describe como pólipos hiperplásicos con edema, congestión vascular e hiperplasia del músculo liso, sin displasia ni cambios adenomatosos, correspondientes a "pólipos de la hipertensión portal" (PHP.

  18. Interobserver variability of ultrasound parameters in portal hypertension

    Directory of Open Access Journals (Sweden)

    Patricia Moreno Sebastianes

    2010-07-01

    Full Text Available The aim of this study was to assess interobserver agreement of ultrasound parameters for portal hypertension in hepatosplenic mansonic schistosomiasis. Spleen size, diameter of the portal, splenic and superior mesenteric veins and presence of thrombosis and cavernous transformation were determined by three radiologists in blinded and independent fashion in 30 patients. Interobserver agreement was measured by the kappa index and intraclass correlation coefficient. Interobserver agreement was considered substantial (κ = 0.714-0.795 for portal vein thrombosis and perfect (κ = 1 for cavernous transformation. Interobserver agreement measured by the intraclass correlation coefficient was excellent for longitudinal diameter of the spleen (r = 0.828-0.869 and splenic index (r = 0.816-0.905 and varied from fair to almost perfect for diameter of the portal (r = 0.622-0.675, splenic (r = 0.573-0.913 and superior mesenteric (r = 0.525-0.607 veins. According to the results, ultrasound is a highly reproducible method for the main morphological parameters of portal hypertension in schistosomiasis patients.

  19. Prevalence and pattern of growth abnormalities in children with extrahepatic portal vein obstruction: Response to shunt surgery

    Directory of Open Access Journals (Sweden)

    Toufeeq Ahmad Mir

    2016-01-01

    Full Text Available Objective: Growth retardation is common in children with extrahepatic portal vein obstruction (EHPVO and growth hormone (GH resistance may play a dominant role. The aim of this study was to ascertain growth parameters and growth-related hormones in children with EHPVO, comparing with controls and to study the response of shunt surgery on growth parameters. Materials and Methods: The auxological and growth-related hormone profile (GH; insulin-like growth factor binding protein-3 [IGFBP-3] and IGF-1 of thirty children with EHPVO were compared with controls. The effect of shunt surgery on growth parameters in 12 children was also studied. Results: The mean height standard deviation score (HSDS of cases (−1.797 ± 1.146 was significantly lower than that of controls (−0.036 ± 0.796; the mean weight SDS of cases (−1.258 ± 0.743 was also lower than that of controls (−0.004 ± 0.533. The mean GH level of cases (5.00 ± 6.46 ng/ml was significantly higher than that of controls (1.78 ± 2.04 ng/ml. The mean IGF-1 level of cases (100.25 ± 35.93 ng/ml was significantly lower as compared to controls (233.53 ± 115.06 ng/ml as was the mean IGFBP-3 level (2976.53 ± 1212.82 ng/ml in cases and 5183.28 ± 1531.28 ng/ml in controls. In 12 patients who underwent shunt surgery, growth parameters significantly improved. Conclusions: Marked decrease in weight and height SDSs associated with GH resistance is seen in children with EHPVO, which improves with shunt surgery.

  20. Role of acute elevation of portal venous pressure by exogenous glucagon on gastric mucosal injury in rats with portal hypertension.

    Science.gov (United States)

    Tsui, C P; Sung, Joseph J Y; Leung, Felix W

    2003-07-18

    Time-course studies revealed the increased susceptibility of the gastric mucosa to noxious injury in portal hypertension correlates with the level of elevated portal venous pressure and hyperglucagonemia. Whether acute elevation of portal venous pressure by exogenous glucagon aggravates such injury is not known. We tested the hypothesis that glucagon in a dose sufficient to acutely elevate portal venous pressure aggravates noxious injury of the gastric mucosa in rats with portal hypertension. Infusion of a portal hypotensive dose of somatostatin should reverse these changes. In anesthetized rats with portal vein ligation, glucagon, somatostatin or the combination was administered intravenously in a randomized, coded fashion. Acidified ethanol-induced gastric mucosal injury was determined. Portal venous pressure and gastric mucosal perfusion and oxygenation (reflectance spectrophotometry) were monitored to confirm the effects of the respective intravenous treatments. Exogenous glucagon exacerbated acidified ethanol-induced gastric mucosal injury. The exacerbation was attenuated by somatostatin. These changes paralleled the portal hypertensive and hypotensive effects of glucagon and somatostatin, respectively. Our data suggest that a unique mechanism is triggered with the onset of portal hypertension. In an antagonistic manner, glucagon and somatostatin modulate this novel mechanism that controls portal venous pressure and susceptibility of the gastric mucosa to noxious injury.

  1. Extrahepatic portal venous obstruction: The effects of early ligation of splenic artery during splenectomy

    Directory of Open Access Journals (Sweden)

    Gazula Suhasini

    2009-01-01

    Full Text Available Aim: To objectively demonstrate the gain in blood volume and blood components following early ligation of splenic artery during splenectomy and splenorenal shunts in children with extra hepatic portal venous obstruction (EHPVO. Methods: Twenty-eight children (20 males and 8 females, mean age: 9.9 (±3.2 years with EHPVO and hypersplenism were recruited. We followed a protocol of systematically locating and ligating the splenic artery first, followed by a 30-minute waiting period to allow the massive spleen to decongest via the splenic vein and venous collaterals and then completing the splenectomy by standard procedure. No intravenous fluid was administered during this 30-minute period. Blood samples were drawn just prior to splenic artery ligation and soon after splenectomy for the estimation of hematological and biochemical parameters. Results: We noticed a highly significant increase in the hemoglobin, hematocrit, leukocyte, platelet, and RBC counts by early ligation of the splenic artery (p < 0.0004. The gain in hemoglobin and hematocrit was equivalent to a transfusion of atleast 100-150 ml of packed RBC. The increase in platelet count was equivalent to a platelet transfusion of atleast 4 units of platelet concentrates in an adult. There is a positive correlation between the splenic weight and the platelet gain (p= 0.0568 and the splenic volume on preoperative imaging and the platelet gain (p= 0.0251. Conclusion: Early ligation of the splenic artery during splenectomy results in passive splenic decongestion and thereby a significant gain in blood components. This protocol appears to be a feasible blood conservation method to avoid blood transfusions in this group of hypersplenic EHPVO patients.

  2. Adrenomedullin in cirrhotic and non-cirrhotic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    V Tahan; C Kalayci; A Okten; N Tozun; E Avsar; C Karaca; E Uslu; F Eren; S Aydin; H Uzun; HO Hamzaoglu; F Besisik

    2003-01-01

    AIM:Adrenomedullin (ADM) is a potent vasodilator peptide.ADM and nitric oxide (NO) are produced in vascular endothelial cells. Increased ADM level has been linked to hyperdynamic circulation and arterial vasodilatation in cirrhotic portal hypertension (CPH). The role of ADM in non-cirrhotic portal hypertension (NCPH) is unknown, plasma ADM levels were studied in patients with NCPH, compensated and decompensated cirrhosis in order to determine its contribution to portal hypertension (PH) in these groups.METHODS: There were 4 groups of subjects. Group 1consisted of 27 patients (F/M: 12/15) with NCPH due to portal and/or splenic vein thrombosis (mean age: 41±12years), group 2 consisted of 14 patients (F/M: 6/8) with compensated (Child-Pugh A) cirrhosis (mean age: 46±4),group 3 consisted of 16 patients (F/M: 6/10) with decompensated (Child-Pugh C) cirrhosis (mean age: 47±12).Fourteen healthy subjects (F/M: 6/8) (mean age: 44±8) were used as controls in Group 4. ADM level was measured by ELISA. NO was determined as nitrite/nitrate level by chemoluminescence.RESULTS: Adl level in Group 11 (236±61.4 pg/mL) was significantly higher than that in group 2 (108.4±28.3 pg/mL)and group 4 (84.1±31.5 pg/mL) (both P<0.0001) but was lower than that in Group3 (324±93.7 pg/mL) (P=0.002). NO level in group 1 (27±1.4 μmol/L) was significantly higher than that in group 2 (19.8±2.8 μmol/L) and group 4 (16.9±1.6μmol/L) but was lower than that in Group 3 (39±3.6 μmol/L)(for all three P<0.0001). A strong correlation was observed between ADM and NO levels (r=0.827, P<0.0001).CONCLUSION: Adrenomedullin and NO levels were high in both non-cirrhotic and cirrhotic portal hypertension and were closely correlated, Adrenomedullin and NO levels increased proportionally with the severity of cirrhosis, and were significantly higher than those in patients with NCPH.Portal hypertension plays an important role in the increase of ADM and NO. Parenchymal damage in cirrhosis may

  3. Malignant solid pseudopapillary tumor of pancreas causing sinistral portal hypertension

    Directory of Open Access Journals (Sweden)

    Nisar Ahmad Wani

    2011-01-01

    Full Text Available Solid pseudopapillary tumor (SPT of the pancreas is a rare benign or low-grade malignant epithelial tumor that occurs mainly in young females in second to fourth decades of life. Pathologic and imaging findings include a well-defined, encapsulated pancreatic mass with cystic and solid components with evidence of hemorrhage. We report a 23-year-old female who presented with upper abdominal pain of long duration and epigastric mass on palpation. Multidetector-row CT (MDCT demonstrated a large well-defined heterogeneous attenuation mass, containing hyperdense areas of hemorrhage mixed with solid enhancing and cystic non-enhancing areas, arising from the pancreatic body and tail. Splenic vein thrombosis was present with dilated splenoportal collateral vessels between splenic hilum and portal/superior mesenteric veins, with dilated vessels seen in the gastric wall, with patent portal vein, compatible with sinistral portal hypertension. Typical imaging features and age and sex of the patient suggested a diagnosis of SPT of pancreas complicated by segmental portal hypertension due to splenic vein thrombosis. Histopathology of the biopsy material was confirmatory.

  4. Portal hypertension and variceal bleeding: Clinical and pharmacological aspects

    DEFF Research Database (Denmark)

    Hobolth, Lise

    2010-01-01

    Blødende esophagus varicer er en af den mest frygtede komplikationer til cirrose og portal hypertension pga. den høje mortalitet. Et klassisk studie fra 1981 opgjorde 6-ugers mortaliteten til 42%, hvoraf 75% døde indenfor den første uge. Gennem de sidste 2-3 årtier er der introduceret en række nye...

  5. Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

    Science.gov (United States)

    Biecker, Erwin

    2013-01-01

    Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

  6. Effects of somatostatin on splanchnic hemodynamics in cirrhotic patients with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Ji Ye Zhu; Xi Sheng Leng; Dong Wang; Ru Yu Du

    2000-01-01

    @@ INTRODUCTION Esophageal variceal bleeding (EVB) is one of the most common complications of cirrhosis with portal hypertension. In recent years, great progress has been made in medicinal treatment. Somatostatin has been widely used in clinics, for it can effectively lower the portal venous pressure (PVP) with little side effect. The aim of this study is to assess the effect of somatostatin on portal venous pressue and splanchnic hemodynamics in patients with liver cirrhosis and portal hypertension.

  7. Fathal pulmonary hypertension after distal splenorenal shunt in schistosomal portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Roberto de Cleva; Paulo Herman; Vincenzo Pugliese; Bruno Zilberstein; William Abr(a)o Saad; Joaquim Jos(e)Gama- Rodrigues

    2004-01-01

    @@ INTRODUCTION Mansonic schistosomiasis is the main cause of portal hypertension in Brazil. Hepatosplenic (HS) form is manifested by hepatomegaly mainly on the left hepatic lobe associated with large splenomegaly and bleeding due to esophageal varices with high mortality rates[1,2].

  8. The role of the liver histological and necroinflammatory activity in the development of portal hypertension syndrome

    Directory of Open Access Journals (Sweden)

    Dzyubanovsky I.Ya.

    2013-01-01

    Full Text Available Background. Liver cirrhosis is the most often cause of the portal hypertension syndrome development, though structural and morphological liver remodeling usually begins on the stage of chronic hepatitis. Morphologic patterns of the development of portal hypertension syndrome on the pre-clinical stage are still poorly investigated. Objective. To determine the histological and necroinflammatory activity of the liver in patients with portal hypertension. Methods. Patients were divided into four groups: I group (n=38 – chronic hepatitis without clinical signs of portal hypertension; II group (n=42 - chronic hepatitis transforming to cirrhosis with clinical signs of portal hypertension (varicose veins of the esophagus and/or the cardia, splenomegaly, ascitis; III group (n=34 – complicated portal hypertension on the background of liver cirrhosis (bleeding from the varices of the esophagus and/or the cardia, hypersplenism; control group (n=30 - physically healthy individuals aged 23-37 years. An integrated evaluation of the liver histological and necroinflammatory activity through the set of laboratory tests was performed (the method of “FibroTest-ActiTest”; immunofermental analysis of L-FABP concentration. Results. It is found that the patients with pre-clinical stage of portal hypertension syndrome show portal and periportal fibrosis with single septa, and the patients with clinical stages of portal hypertension show portal and periportal cirrhosis with multiple septa. Patients with the complications of portal hypertension show cirrhosis of the liver. With the increase of the necroinflammatory activity the portal pressure increases directly. This fact was confirmed with the increase of L-FABP protein level in the plasma, along with the increase of the actitest results. Conclusion. The diagnostic methodic of “FibroTest-ActiTest” and the plasma level of L-FABP are the modern models for chronic liver disease histological and

  9. PORTAL-HYPERTENSION AS PRESENTING FEATURE OF A MYELOPROLIFERATIVE DISORDER - DIAGNOSIS AND THERAPEUTIC DILEMMAS

    NARCIS (Netherlands)

    MULLER, EW; DEWOLF, JTM; HAAGSMA, EB

    1993-01-01

    In some patients presenting with complications of portal hypertension, thrombosis of hepatic or portal veins is identified as the cause. Hepatic or portal vein thrombosis may be secondary to recognized etiologies like infection or malignancy. When no etiology for the thrombosis is found, it is

  10. PORTAL-HYPERTENSION AS PRESENTING FEATURE OF A MYELOPROLIFERATIVE DISORDER - DIAGNOSIS AND THERAPEUTIC DILEMMAS

    NARCIS (Netherlands)

    MULLER, EW; DEWOLF, JTM; HAAGSMA, EB

    1993-01-01

    In some patients presenting with complications of portal hypertension, thrombosis of hepatic or portal veins is identified as the cause. Hepatic or portal vein thrombosis may be secondary to recognized etiologies like infection or malignancy. When no etiology for the thrombosis is found, it is likel

  11. Difference in gene expression of macrophage between normal spleen and portal hypertensive spleen idendified by cDNA microarray

    OpenAIRE

    2007-01-01

    AIM: To identify the difference in gene expression of microphage (Mφ) between normal spleen and portal hypertensive spleen using cDNA microarrays and find new gene functions associated with hypersplenism in portal hypertension.

  12. Portal hypertension in children: expert pediatric opinion on the report of the Baveno v Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension.

    Science.gov (United States)

    Shneider, Benjamin L; Bosch, Jaime; de Franchis, Roberto; Emre, Sukru H; Groszmann, Roberto J; Ling, Simon C; Lorenz, Jonathan M; Squires, Robert H; Superina, Riccardo A; Thompson, Ann E; Mazariegos, George V

    2012-08-01

    Complications of portal hypertension in children lead to significant morbidity and are a leading indication for consideration of liver transplantation. Approaches to the management of sequelae of portal hypertension are well described for adults and evidence-based approaches have been summarized in numerous meta-analyses and conferences. In contrast, there is a paucity of data to guide the management of complications of portal hypertension in children. An international panel of experts was convened on April 8, 2011 at The Children's Hospital of Pittsburgh of UPMC to review and adapt the recent report of the Baveno V Consensus Workshop on the Methodology of Diagnosis and Therapy in Portal Hypertension to the care of children. The opinions of that expert panel are reported.

  13. Portal hypertension: Imaging of portosystemic collateral pathways and associated image-guided therapy.

    Science.gov (United States)

    Bandali, Murad Feroz; Mirakhur, Anirudh; Lee, Edward Wolfgang; Ferris, Mollie Clarke; Sadler, David James; Gray, Robin Ritchie; Wong, Jason Kam

    2017-03-14

    Portal hypertension is a common clinical syndrome, defined by a pathologic increase in the portal venous pressure. Increased resistance to portal blood flow, the primary factor in the pathophysiology of portal hypertension, is in part due to morphological changes occurring in chronic liver diseases. This results in rerouting of blood flow away from the liver through collateral pathways to low-pressure systemic veins. Through a variety of computed tomographic, sonographic, magnetic resonance imaging and angiographic examples, this article discusses the appearances and prevalence of both common and less common portosystemic collateral channels in the thorax and abdomen. A brief overview of established interventional radiologic techniques for treatment of portal hypertension will also be provided. Awareness of the various imaging manifestations of portal hypertension can be helpful for assessing overall prognosis and planning proper management.

  14. Value of spleen stiffness measured by noninvasive method in evaluating the severity of cirrhotic portal hypertension

    Directory of Open Access Journals (Sweden)

    WU Lingzhi

    2016-08-01

    Full Text Available Cirrhotic portal hypertension can lead to serious complications including esophageal variceal bleeding. Hepatic venous pressure gradient (HVPG and upper gastrointestinal endoscopy can be used to evaluate the severity of portal hypertension and predict the risk of bleeding. However, both methods are invasive, which limits their clinical practice. Therefore, noninvasive techniques for the evaluation of portal hypertension will have certain advantages in clinical practice. This article introduces the noninvasive methods for the measurement of spleen stiffness, including transient elastography, acoustic radiation force impulse, real-time tissue elastography, and magnetic resonance elastography, as well as the value of these methods in evaluation of portal hypertension and influencing factors. It is pointed out that the difference in the diagnostic efficiency of spleen stiffness measured by these methods in portal hypertension needs to be verified by further studies.

  15. Salvianolic Acid B Reducing Portal Hypertension Depends on Macrophages in Isolated Portal Perfused Rat Livers with Chronic Hepatitis

    Science.gov (United States)

    Zhao, Xin; Jia, Hongmei; Yang, Shijun; Liu, Yuetao; Deng, Bo; Xu, Xueyan; Zhang, Tao; Zhou, Hang; Zu, Chengzhe; Yin, He; Li, Ting; Song, Yijun; Wang, Yueqi; Li, Pengtao; Zou, Zhongmei; Cai, Dayong

    2012-01-01

    This study is aimed to investigate the effects of Sal B on portal hypertension (PH). PH with chronic hepatitis was induced by carbon tetrachloride (CCl4) in rats. The model was confirmed with elevated portal pressures and increased serum CD163 levels. The inducible nitric oxide synthase (iNOS) or heme oxygenase-1 (HO-1) in portal triads was assessed. The isolated portal perfused rat liver (IPPRL) was performed at d0, d28, d56 , and d84 in the progression of chronic hepatitis. After constricting with phenylephrine, the portal veins were relaxed with Sal B. The EC50 of Sal B for relaxing portal veins was −2.04 × 10−9, 7.28 × 10−11, 1.52 × 10−11, and 8.44 × 10−11 mol/L at d0, d28, d56, and d84, respectively. More macrophages infiltrated in portal triads and expressed more iNOS or HO-1 as PH advanced. The areas under the curve (AUCs) of Sal B for reducing PH were positively correlated with the levels of iNOS or HO-1 in portal triads, and so did with serum CD163 levels. Sal B reduces PH in IPPRL with chronic hepatitis, via promoting portal relaxation due to macrophage-originated NO or CO in portal triads, partly at least. PMID:23118797

  16. Transjugular intrahepatic portosystemic shunt in patients with active variceal bleeding due to portal hypertension and portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Hyun Woong; Ryeom, Hun Kyu; Lee, Sang Kwon; Lee, Jong Min; Kim, Young Sun; Suh, Kyung Jin; Kim, Tae Hun; Kim, Yong Joo [Kyungpook National Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-10-01

    To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) in patients with active variceal bleeding due to liver cirrhosis and pre-existing portal vein thrombosis. Of a total of 123 patients who underwent TIPS, 14 patients with intractable variceal bleeding due to portal hypertension and portal vein thrombosis were included in this study. Noncavernomatous portal vein occlusion was seen in eight patients, and complete portal vein occlusion with cavernomatous trans-formation in six. For all patients, the methods used for TIPS placement were the same as those used in patients with patents portal veins. In seven of eight patients with noncavernomatous occlusion, right hepatic vein-right portal vein shunting was performed; in one with knoncavernomatous occlusion, a shunt was created between the right hepatic and left portal vein. In five of six patients with cavernomatous occlusion, the right hepatic and main portal vein were connected via a collateral vein. The procedures were technically successful in all except one patient. Immediate hemostatis was achieved after all technically successful procedures, and no significant complications were encountered. Minor complications were noted in six patients (three biliary tree punctures, one transperitoneal puncture, one splenic vein perforation, one hepatic subcapsular hematoma). TIPS is a technically feasible and hemodynamically effective procedure, even in patients with active variceal bleeding due to cirrhosis and complete portal vein occlusion.

  17. Histologic features of the portal plate in extrahepatic biliary atresia and their impact on prognosis--a Danish study

    DEFF Research Database (Denmark)

    Mirza, Qazaz; Kvist, Nina; Petersen, Bodil Laub

    2009-01-01

    BACKGROUND/PURPOSE: The aims of this study are as follows: METHOD: From 1979 to 2003, 57 children have been operated by the Kasai procedure. Only 40 of these have had their portal plate removed for histologic examination. We divided the patients according to clinical outcome into a successful...... and a failure group and compared the histologic features of the portal plates in the 2 groups. Afterward, the portal plate histology from EHBA was compared with the porta hepatis area from patients dead from other causes. RESULTS: A significant difference between the success and the failure group was found...... with regard to the number of bile ducts, the maximal length measurable in any direction for bile duct structures, and the proliferation, but not for any type of diameter. The normal portal plate was different from the portal plate of children with biliary atresia by always having 2 large biliary structures...

  18. Laparoscopic and open splenectomy and azygoportal disconnection for portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Xiao-Zhong Jiang; Shao-Yong Zhao; Hong Luo; Bin Huang; Chang-Song Wang; Lei Chen; You-Jiang Tao

    2009-01-01

    AIM: To compare the outcomes of laparoscopic and open splenectomy and azygoportal devascularization for portal hypertension.METHODS: From June 2006 to March 2009, laparoscopic splenectomy and azygoportal disconnection (LSD) were performed on 28 patients with cirrhosis, bleeding due to portal hypertension, and secondary hypersplenism. Success was achieved in 26 patients.Demographic, intraoperative, and postoperative variables of the patients were compared.RESULTS: Success of laparoscopic splenectomy and azygoportal disconnection was achieved in all but two patients (7.14%) who required open splenectomy and azygoportal devascularization (OSD). The operation time was significantly longer in patients undergoing LSD than in those undergoing OSD (235± 36 min vs 178 ±47 min, P < 0.05). The estimated intraoperative blood loss was much more in patients receiving OSD than in those receiving LSD (420 ± 50 mL vs 200 ±30 mL, P < 0.01). The proportion of patients undergoing laparoscopic and open splenectomy and azygoportal disconnection who received transfusion of packed red blood cells during or after the operation was 23.08%and 38.46%, respectively ( P < 0.05). The time of first oral intake was faster in patients after LSD than in those after OSD (1.5 ± 0.7 d vs 3.5 ± 1.6 d, P < 0.05). The hospital stay of patients after LSD was shorter than that of patients after OSD (6.5 ± 2.3 d vs 11.7 ± 4.5 d, P <0.05). The pain requiring medication was less severe in patients after LSD than in those after OSD (7.69% vs 73.08%, P < 0.001). The overall complication rate was lower in patients after LSD than in those after OSD (19.23% vs 42.31%, P < 0.05).CONCLUSION: Laparoscopic splenectomy and azygoportal disconnection are the feasible, effective, and safe surgical procedure, and are advantageous over minimally invasive surgery for bleeding portal hypertension and hypersplenism.

  19. Hepatic Arterioportal Fistula: A Curable Cause of Portal Hypertension in Infancy

    Directory of Open Access Journals (Sweden)

    J. S. Billing

    1997-01-01

    Full Text Available Hepatic arterioportal fistulae are a rare cause of portal hypertension. The case is reported of a twoyear old girl with a congenital arterioportal fistula, who presented with splenomegaly and ascites. Colour doppler ultrasound showed a large shunt between the left hepatic artery and a branch of the left portal vein, producing a reversal of flow in the main portal vein. She was treated by a formal left hemihepatectomy, which has been successful in eliminating the fistula and its consequent portal hypertension in the long term. The literature regarding arterioportal fistulae and their treatment is reviewed.

  20. Gastrointestinal motor function in patients with portal hypertension

    DEFF Research Database (Denmark)

    Madsen, Jan Lysgård; Brinch, K; Hansen, Erik Feldager

    2000-01-01

    rates were evaluated in all subjects by means of a gamma camera technique. The technique was also used to measure the frequency of antral contractions. RESULTS: No difference was observed in gastric mean emptying time or small-intestinal mean transit time of liquid and solid markers between patients...... and controls. After 24 h, however, the geometric center of the liquid marker had a more caudal localization in the colon of the patient group than in the controls (P = 0.04); that is, the patients had a faster colonic transit. No difference was found in the frequency of antral contractions 45 min after...... the test meal between patients and controls. CONCLUSIONS: These data suggest that the colonic transit is often accelerated in patients with portal hypertension, whereas the motor function of the stomach and the small intestine is unaffected....

  1. Morphological changes of blood spleen barrier in portal hypertensive spleen

    Institute of Scientific and Technical Information of China (English)

    LI Zong-fang; ZHANG Shu; HUANG Ying; XIA Xian-ming; LI Ai-min; PAN Dun; ZHANG Wei; WANG Juan

    2008-01-01

    Background The pathogenesis of hypersplenism and the immune function of the spleen in patients with portal hypertension(PH)remain obscure.This study aimed to evaluate the morphological changes of blood spleen barrier in spleen with hypersplenism due to PH and provide evidence for an in-depth investigation of the immune function of the spleen with hypersplenism and the mechanism of hypersplenism.Methods Spleen samples from 12 portal hypertensive patients and 4 patients with traumatic ruptures of spleen were examined.The samples of spleen were made into pathological sections,stained with Masson trichrome stain,Gomori stain,and CD68,CD34 immunohistochemistry,and were examined microscopically for the changes in the distribution of collagen fibers,reticular fibers,macrophages,and vascular endothelial cells.The changes in ultrastructure of macrophages and endothelial cells in marginal zone were also evaluated by transmission electron microscopy.Results As compared to the normal spleen,the density of macrophage in the PH spleen was decreased,but the macrophages were mainly located in the marginal zone and distributed around the splenic corpuscle,with many villi and pseudopodium-like protrusion on the cell surface.The accrementition of collagen fibers was obvious around the splenic corpuscle and central artery.The increased reticulate fibers encircled the splenic corpuscle with more connection between the fibers.The vascular endothelial cells were in diffused distribution,without any regionality in PH spleen,but the vessel with enlarged lumina increased in red pulp.Conclusions The morphological changes of the blood spleen barrier can be one of the pathological fundaments for the abnormality of the immune function and the increased destruction of blood cells located in the spleens of patients with PH.However,this still entails clarification.

  2. Prolonged Q-T(c) interval in mild portal hypertensive cirrhosis

    DEFF Research Database (Denmark)

    Ytting, Henriette; Henriksen, Jens H; Fuglsang, Stefan

    2005-01-01

    BACKGROUND/AIMS: The Q-T(c) interval is prolonged in a substantial fraction of patients with cirrhosis, thus indicating delayed repolarisation. However, no information is available in mild portal hypertensive patients. We therefore determined the Q-T(c) interval in cirrhotic patients with hepatic...... venous pressure gradient (HVPG) portal hypertension (HVPG> or = 12 mmHg) and controls without liver disease. RESULTS......), values which are significantly above that of the controls (0.410 s(1/2), P portal hypertensive group, the Q-T(c) interval was inversely related to indicators of liver function, such as indocyanine green clearance (r = -0.34, P

  3. Prolonged Q-T(c) interval in mild portal hypertensive cirrhosis

    DEFF Research Database (Denmark)

    Ytting, Henriette; Henriksen, Jens Henrik; Fuglsang, Stefan

    2005-01-01

    BACKGROUND/AIMS: The Q-T(c) interval is prolonged in a substantial fraction of patients with cirrhosis, thus indicating delayed repolarisation. However, no information is available in mild portal hypertensive patients. We therefore determined the Q-T(c) interval in cirrhotic patients with hepatic...... venous pressure gradient (HVPG) portal hypertension (HVPG> or = 12 mmHg) and controls without liver disease. RESULTS......), values which are significantly above that of the controls (0.410 s(1/2), P portal hypertensive group, the Q-T(c) interval was inversely related to indicators of liver function, such as indocyanine green clearance (r = -0.34, P

  4. Establishment of a reversible model of prehepatic portal hypertension in rats.

    Science.gov (United States)

    Zhao, Xin; Dou, Jian; Gao, Qing-Jun

    2016-08-01

    The aim of the present study was to improve upon the traditional model of pre-hepatic portal hypertension in rats, and simulate the anhepatic phase of orthotopic liver transplantation without veno-venous bypass. A reversible model of portal hypertension was induced by portal vein ligation, with a label ring ligated along the portal vein. A total of 135 male Wistar rats were divided into three groups: i) Normal control (NC) group; ii) portal hypertensive control (PHTC) group; and iii) reperfusion (R) group. In the R group, rats with portal hypertension underwent simultaneous clamping of the portal triad and retrohepatic vena cava for 1 h, followed by removal of the clamps to enable blood reperfusion. Portal venography and portal vein pressure were recorded during the surgery. Arterial oxygen pressure (PaO2), and alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) levels were determined, and pathological changes of the liver were investigated by immunohistochemical staining. The results demonstrated that, 3 weeks after portal vein ligation, the vein area and the free portal pressures in the PHTC group were significantly increased compared with those in the NC group. The serum ALT and AST levels in the R group at different time points were significantly elevated compared with those in the PHTC group, and reached their maximal levels at 24 h after reperfusion. Furthermore, the PaO2 at 24 h after reperfusion was significantly decreased. In conclusion, the reversible model of pre-hepatic portal hypertension in rats was successfully established using the introduction of a label ring. This model may be useful for basic research focusing on the anhepatic phase of orthotopic liver transplantation without veno-venous bypass.

  5. Altered blood-brain barrier permeability in rats with prehepatic portal hypertension turns to normal when portal pressure is lowered

    Institute of Scientific and Technical Information of China (English)

    Francisco Eizayaga; Camila Scorticati; Juan P Prestifilippo; Salvador Romay; Maria A Fernandez; José L Castro; Abraham Lemberg; Juan C Perazzo

    2006-01-01

    AIM: To study the blood-brain barrier integrity in prehepatic portal hypertensive rats induced by partial portal vein ligation, at 14 and 40 d after ligation when portal pressure is spontaneously normalized.METHODS: Adult male Wistar rats were divided into four groups: Group Ⅰ: Sham14d, sham operated; Group Ⅱ: PH14d, portal vein stenosis; (both groups were used 14 days after surgery); Group Ⅲ: Sham40d, Sham operated and Group Ⅳ: PH40d Portal vein stenosis (Groups Ⅱ and Ⅳ used 40 d after surgery). Plasma ammonia,plasma and cerebrospinal fluid protein and liver enzymes concentrations were determined. Trypan and Evans blue dyes, systemically injected, were investigated in hippocampus to study blood-brain barrier integrity. Portal pressure was periodically recorded.RESULTS: Forty days after stricture, portal pressure was normalized, plasma ammonia was moderately high,and both dyes were absent in central nervous system parenchyma. All other parameters were reestablished.When portal pressure was normalized and ammonia level was lowered, but not normal, the altered integrity of blood-brain barrier becomes reestablished.CONCLUSION: The impairment of blood-brain barrier and subsequent normalization could be a mechanism involved in hepatic encephalopathy reversibility. Hemodynamic changes and ammonia could trigger blood-brain barrier alterations and its reestablishment.

  6. THE CHANGES OF RENAL HEMODYNAMICS IN THE FORMATION OF ASCITES INDUCED BY PORTAL HYPERTENSION

    Institute of Scientific and Technical Information of China (English)

    詹锋; 黄烈城

    2002-01-01

    Objective The renal hemodynamic alteration was sequentially studied in dogs with ascites due to portal hypertension.Methods The model of portal hypertension was established by the constriction of hepatic vein. Effective renal plasma flow (ERPF), systemic blood pressure, urinary excretion of sodium were measured. Eighteen dogs were studied until the ascites occurred.Results The ascites was generally detected between the sixth day and the eighth day after the portal hypertension occurred, the average being the seventh day. Mean artery pressure (MAP) and renal vascular resistance (RVR) were firstly changed after the portal vein pressure increased. MAP fell 17% (130.37mmHg±16.2 mmHg before the portal hypertension, 108.32 mmHg±10.47 mmHg after the portal hypertension on the 1st day, p<0.001) and RVR increased by 31% (0.38 mmHg. ml-1. min-1±0.09 mmHg. ml-1. min-1 before the portal hypertension, 0.5 mmHg. ml-1. min-1±0.15mmHg. ml-1. min-1 after the portal hypertension, P<0.05) after the portal hypertension occurred on the 2nd day, thereafter, MAP decreased and RVR increased continually. ERPF also fell in the forepart, but there was only significant difference in the appearance of ascites (P<0.05). Urinary excretion of sodium gradually fell after portal hypertension and reached the lowest value on the 7th day, and there was statistical significance from the 2nd day (59.86 mmol/min±25.96 mmol/min before portal hypertension, 31.95 mmol/min±18.79mmol/min after the portal hypertension on the 2nd day, p<0.05).Conclusion Our research indicates that the hemodynamics has been changed before the ascites occurred. The earliest change occurs in MAP and RVR, but no marked change is found in ERPF.

  7. [The normal ultrastructure of the erythrocytes and in experimental portal hypertension].

    Science.gov (United States)

    Gaĭvoronskiĭ, I V; Chepur, S V; Nichiporuk, G I; Tikhonova, L P

    1997-01-01

    Erythrocyte types were studied in portal and femoral veins blood in intact dog and in the experimental portal hypertension under scanning electron microscope. Three basic types (discoid, polygonal and spherocyte) were distinguished. Analysis of the material obtained confirmed the suggestion on the existence of stable erythrocyte types both in normal conditions and pathology. Content of these types in blood of vessels named is different. Inferior caval vein system is inaccessible for erythrocytes with significantly altered shape because they are unable to penetrate liver sinusoids. In portal hypertension essential increase of these erythrocytes number occurs and they are encountered in femoral vein blood. These forms obviously pass into the general blood flow through multiple collaterals. One of the criteria for portal hypertension diagnostics is suggested so as the method of evaluating portal vein shunts in conditions of the formed collateral blood stream.

  8. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization

    Directory of Open Access Journals (Sweden)

    Damiano Patrono

    2014-01-01

    CONCLUSION: Splenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy.

  9. Ascites due to pre-sinusoidal portal hypertension in dogs: a retrospective analysis of 17 cases.

    Science.gov (United States)

    James, F E; Knowles, G W; Mansfield, C S; Robertson, I D

    2008-05-01

    Accumulation of a pure transudate abdominal effusion in the absence of significant hypoalbuminaemia is uncommon in dogs and is due to pre-sinusoidal portal hypertension. Reported causes of pre-sinusoidal portal hypertension vary, but suggest a reasonable prognosis. A retrospective analysis of 17 dogs that presented to our institution with ascites due to pre-sinusoidal portal hypertension identified idiopathic hepatic fibrosis or canine chronic hepatitis as the underlying cause in the majority of cases. Twelve (70.5%) dogs were 4 years of age or younger at time of presentation. Total serum protein was higher in dogs with chronic hepatitis than it was in dogs without inflammatory disease. The prognosis was generally poor and no histological, imaging or biochemical parameters were useful as prognostic indicators. Dogs died or were euthanased due to severe clinical signs associated with the portal hypertension and/or perceived poor prognosis.

  10. Novel serological neo-epitope markers of extracellular matrix proteins for the detection of portal hypertension

    DEFF Research Database (Denmark)

    Leeming, Diana Julie; Karsdal, M A; Byrjalsen, I

    2013-01-01

    The hepatic venous pressure gradient (HVPG) is an invasive, but important diagnostic and prognostic marker in cirrhosis with portal hypertension (PHT). During cirrhosis, remodelling of fibrotic tissue by matrix metalloproteinases (MMPs) is a permanent process generating small fragments of degraded...

  11. The use of hemospray in portal hypertensive bleeding; a case series.

    Science.gov (United States)

    Smith, L A; Morris, A J; Stanley, A J

    2014-02-01

    Hemospray is a haemostatic agent licensed for endoscopic haemostasis of non-variceal upper gastrointestinal bleeding (NVUGIB) in Europe and Canada. Hemospray has been shown to be safe and effective in achieving haemostasis in bleeding peptic ulcers in a prospective clinical study and several further case series have described the use of hemospray in other non-variceal causes of gastrointestinal bleeding. Portal hypertensive gastropathy and colopathy are common in patients with portal hypertension. As hemospray is an easy to apply, non-contact method, which can cover large areas of mucosa, it may be of benefit in acute non-variceal portal hypertensive bleeding. We present data from the first four consecutive patients presenting to our institution with acute haemorrhage secondary to non-variceal diffuse portal hypertensive bleeding treated with hemospray.

  12. Trans-anastomotic porto-portal varices in patients with gastrointestinal haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, A.W.M.; Jackson, J.E

    2000-03-01

    AIM: Porto-portal varices are commonly seen in patients with segmental extra-hepatic portal hypertension and develop to provide a collateral circulation around an area of portal venous obstruction. It is not well recognized that such communications may also develop across surgical anastomoses and be the source of gastrointestinal haemorrhage. The possible mode of development of such communications has not been previously discussed. MATERIALS AND METHODS: Over a 3-year period between 1995 and 1998, porto-portal varices were demonstrated across surgical anastomoses in four patients who were referred for the investigation of acute (two), acute-on-chronic (one) and chronic gastrointestinal bleeding (one). Their medical notes and the findings at angiography were reviewed. RESULTS: Three patients had segmental portal hypertension due to extra-hepatic portal vein (one) or superior mesenteric vein (two) stenosis/occlusion. One patient had mild portal hypertension due to hepatic fibrosis secondary to congenital biliary atresia. At angiography all patients were shown to have varices crossing previous surgical anastomoses. These varices were presumed to be the cause of bleeding in three of the four patients; the site of bleeding in the fourth individual was not determined. CONCLUSIONS: Trans-anastomotic porto-portal varices are rare. They develop in the presence of extra-hepatic portal hypertension and presumably arise within peri-anastomotic inflammatory tissue. Such varices may be difficult to manage and their prognosis is poor when bleeding occurs. Mitchell, A.W.M., Jackson, J.E. (2000)

  13. Hepatic-associated immunoglobulin-A nephropathy in a child with liver cirrhosis and portal hypertension.

    Science.gov (United States)

    Alghamdi, Sharifa A; Saadah, Omar I; Almatury, Nesreen; Al-Maghrabi, Jaudah

    2012-01-01

    Hepatic-associated immunoglobulin A (IgA) nephropathy is a relatively common condition that occurs in adults with liver cirrhosis and portal hypertension. However, it is rare in children. This condition is characterized by the deposition of IgA in the renal glomeruli. The present report describes a 14-year-old boy with cryptogenic liver cirrhosis and portal hypertension who presented with hematuria and proteinuria associated with histological changes of IgA nephropathy.

  14. Hepatic-associated immunoglobulin-A nephropathy in a child with liver cirrhosis and portal hypertension

    Directory of Open Access Journals (Sweden)

    Sharifa A Alghamdi

    2012-01-01

    Full Text Available Hepatic-associated immunoglobulin A (IgA nephropathy is a relatively common condition that occurs in adults with liver cirrhosis and portal hypertension. However, it is rare in children. This condition is characterized by the deposition of IgA in the renal glomeruli. The present report describes a 14-year-old boy with cryptogenic liver cirrhosis and portal hypertension who presented with hematuria and proteinuria associated with histological changes of IgA nephropathy.

  15. Neutrophil gelatinase-associated lipocalin and cystatin C in cirrhosis and portal hypertension

    DEFF Research Database (Denmark)

    Hurry, Preete Kapisha; Poulsen, Jørgen Hjelm; Bendtsen, Flemming

    2017-01-01

    and kinetics are sparsely studied in cirrhosis. In patients with cirrhosis and portal hypertension, we studied plasma levels and renal, hepatic, and peripheral extraction of NGAL and cystatin C and relations to patients characteristics, liver dysfunction, and hemodynamics. METHODS: Forty-five cirrhotic...... have the potential of being both valuable in diagnosing renal failure and reflecting the degree of portal hypertension and systemic haemodynamic changes....

  16. Portal biliopathy, magnetic resonance imaging and magnetic resonance cholangiopancreatography findings: a case series

    Science.gov (United States)

    Baskan, Ozdil; Erol, Cengiz; Sahingoz, Yusuf

    2016-01-01

    Portal biliopathy (PB) is a rare disorder, characterized by biliary ductal and gallbladder wall abnormalities seen in patients with portal hypertension. It most commonly occurs due to idiopathic extrahepatic portal vein obstruction (EHPVO). The abnormalities consist mainly of bile duct compression, stenoses, fibrotic strictures and dilation of both extrahepatic and intrahepatic bile ducts, as well as gallbladder varices. PB may mimic cholangiocarcinoma, sclerosing cholangitis, or choledocholithiasis. Misdiagnosis can be avoided using appropriate imaging modalities to prevent complications. We present the magnetic resonance imaging (MRI) and magnetic resonance cholangiography (MRCP) features of three patients with PB. PMID:25216728

  17. Partial splenic embolization in patients with idiopathic portal hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Romano, Maurizio E-mail: maurizio.romano@ibb.cnr.it; Giojelli, Angela; Capuano, Gaetano; Pomponi, Domenico; Salvatore, Marco

    2004-03-01

    Purpose: To evaluate the effectiveness of partial splenic embolization (PSE) in patients with idiopathic portal hypertension (IPH) in reducing variceal bleeding episodes, splenomegaly and thrombocytopenia. Materials and methods: Six patients (2M, 4F, mean age 30.3 years) with IPH presenting with splenomegaly, thrombocytopenia and recurrent variceal bleeding were treated with PSE using gelatin sponge (four patients) or Contour particles (two patients) as embolization material. Results: PSE was performed successfully in all cases; 3F coaxial microcatheters were necessary in two patients due to extreme splenic artery tortuosity. The average amount of devascularized parenchyma at CT 1 week after PSE was 71%. Splenomegaly and thrombocytopenia improved in all cases, with a mean platelet count increase of 120000/mm{sup 3} and an average 68% reduction of spleen volume at follow up. Variceal bleeding did not recur after PSE. Esophageal or gastroesophageal varices disappeared (one patient) or significantly reduced (five patients) at endoscopic controls. No significant complications were noted. The follow up was of at least 18 months in all patients; mean follow up was 28.2 months. Conclusion: In patients with IPH PSE can be effective in preventing variceal bleedings, in reducing spleen volume and in significantly increasing platelet count; therapeutic results were durable in our population.

  18. Effect of Gingko Injection on the Expression of NF-κB in Pulmonary Vessels of Rats with Portal Hypertension

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    1 Introduction Domestic scholars have originated the conception of “portal hypertensive vasculopathy(PHV)”, which concerns multiple organ vasculopathies in portal hypertensive patients. Portal hypertensive pulmonary vasculopathy is also a kind of internal organ vasculopathy. The transcription factor nuclear factor κB (NF-κB) regulates the expressions of genes that contribute to acute inflammatory reactions in endothelium. Few have reported about the expression of NF-κB in pulmonary vessels of rats related w...

  19. Therapeutic effect of captopril, pentoxifylline, and cordyceps sinensis in pre-hepatic portal hypertensive rats

    Directory of Open Access Journals (Sweden)

    Ahmed F Ahmed

    2012-01-01

    Full Text Available Background/Aim: Portal hypertension is an important and potentially fatal complication of liver disease whereby cellular and fibrotic alterations manifest to increase portal venous pressure. The aim of this study is to investigate the effect of captopril, pentoxifylline (PTX, and cordyceps sinensis in pre-hepatic portal hypertensive rats. Settings and Design: Wister male rats were divided at random into 3 main groups: the first group: control rats. The second group: sham-operated rats and the third group: prehepatic portal hypertensive rats (PHPHT induced by regulated pre-hepatic portal vein ligation. After 14 days, Group 3 was subdivided into 5 subgroups. Subgroup (1: portal vein-ligated (PVL was killed at once; Subgroup (2: received distilled water for 30 days (untreated PVL group; subgroups 3-5 were treated with captopril (60 mg/kg, orally; PTX (100 mg/kg, orally; and C. sinensis (200 mg/kg, orally, respectively, as a single daily dose for 30 days. Patients a nd M ethods: Portal pressure, nitric oxide (NO, antioxidant enzymes, Liver enzymes, and creatinine levels were measured to evaluate the status of the liver state. Results: Portal vein ligation produced significant increments in liver enzymes, NO, creatinine and portal pressure concomitant with significant decrements in glutathione content and superoxide dismutase activity. Treatment with captopril, PTX, and C. sinensis resulted in a significant reduction in liver enzymes, NO, creatinine and portal pressure and observable increase in antioxidant enzymes. Conclusions: captopril, PTX, and C. sinensis have promising effect in controlling PHPHT and reducing hyperdynamic circulatory state through reduction of portal pressure and NO level.

  20. Therapeutic Effect of Captopril, Pentoxifylline, and Cordyceps Sinensis in Pre-Hepatic Portal Hypertensive Rats

    Science.gov (United States)

    Ahmed, Ahmed F.; El-Maraghy, Nabila N.; Ghaney, Rasha H. Abdel; Elshazly, Shimaa M.

    2012-01-01

    Background/Aim: Portal hypertension is an important and potentially fatal complication of liver disease whereby cellular and fibrotic alterations manifest to increase portal venous pressure. The aim of this study is to investigate the effect of captopril, pentoxifylline (PTX), and cordyceps sinensis in pre-hepatic portal hypertensive rats. Settings and Design: Wister male rats were divided at random into 3 main groups: the first group: control rats. The second group: sham-operated rats and the third group: prehepatic portal hypertensive rats (PHPHT) induced by regulated pre-hepatic portal vein ligation. After 14 days, Group 3 was subdivided into 5 subgroups. Subgroup (1): portal vein-ligated (PVL) was killed at once; Subgroup (2): received distilled water for 30 days (untreated PVL group); subgroups 3-5 were treated with captopril (60 mg/kg, orally); PTX (100 mg/kg, orally); and C. sinensis (200 mg/kg, orally), respectively, as a single daily dose for 30 days. Patients and Methods: Portal pressure, nitric oxide (NO), antioxidant enzymes, Liver enzymes, and creatinine levels were measured to evaluate the status of the liver state. Results: Portal vein ligation produced significant increments in liver enzymes, NO, creatinine and portal pressure concomitant with significant decrements in glutathione content and superoxide dismutase activity. Treatment with captopril, PTX, and C. sinensis resulted in a significant reduction in liver enzymes, NO, creatinine and portal pressure and observable increase in antioxidant enzymes. Conclusions: captopril, PTX, and C. sinensis have promising effect in controlling PHPHT and reducing hyperdynamic circulatory state through reduction of portal pressure and NO level. PMID:22626797

  1. Different survival of Barcelona clinic liver cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread.

    Science.gov (United States)

    Sinn, Dong Hyun; Cho, Ju-Yeon; Gwak, Geum-Youn; Paik, Yong-Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon; Yoo, Byung Chul

    2015-01-01

    Portal vein invasion (PVI) and extrahepatic spread (ES) are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC) staging system (BCLC stage C), and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%), hepatitis B virus (458, 78.7%)], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES), C2 (PVI-II/III without distant ES), C3 (PVI-0/I with distant ES), and C4 (PVI-II/III with distant ES), respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

  2. Different survival of Barcelona clinic liver cancer stage C hepatocellular carcinoma patients by the extent of portal vein invasion and the type of extrahepatic spread.

    Directory of Open Access Journals (Sweden)

    Dong Hyun Sinn

    Full Text Available Portal vein invasion (PVI and extrahepatic spread (ES are two tumor-related factors that define advanced stage in the Barcelona Clinic Liver Cancer (BCLC staging system (BCLC stage C, and the recommended first line therapy in this stage is sorafenib. However, the extent of PVI and the type of ES may affect patient prognosis as well as treatment outcome. This study analyzed survival of BCLC stage C HCC patients in order to see whether sub-classification of BCLC stage C is necessary. A total of 582 treatment naïve, BCLC stage C HCC patients [age: 54.3 ± 10.8 years, males = 494 (84.9%, hepatitis B virus (458, 78.7%], defined by PVI and/or ES, were analyzed. Extent of PVI was divided into none, type I-segmental/sectoral branches, type II-left and/or right portal vein, and type III-main portal vein trunk. Type of ES was divided into nodal and distant metastasis. The extent of PVI and type of ES were independent factors for survival. When patients were sub-classified according to the extent of PVI and type of ES, the median survival was significantly different [11.7 months, 5.7 months, 4.9 months and 2.3 months for C1 (PVI-O/I without distant ES, C2 (PVI-II/III without distant ES, C3 (PVI-0/I with distant ES, and C4 (PVI-II/III with distant ES, respectively, P = 0.01]. Patients' survival was different according to the treatment modality in each sub-stage. Sub-classification of BCLC stage C according to the extent of PVI and type of ES resulted in a better prediction of survival. Also, different outcome was observed by treatment modalities in each sub-stage. Sub-classification of BCLC stage C is required to minimize heterogeneity within the same tumor stage, that will help better predict survival and to select optimal treatment strategies.

  3. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy.

    Science.gov (United States)

    Gjeorgjievski, Mihajlo; Cappell, Mitchell S

    2016-02-08

    To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: "portal" and "gastropathy"; or "portal" and "hypertensive"; or "congestive" and "gastropathy"; or "congestive" and "gastroenteropathy". The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa in PHG shows increased susceptibility to gastrotoxic

  4. Idiopathic portal hypertension regarding thiopurine treatment in patients with inflammatory bowel disease

    Directory of Open Access Journals (Sweden)

    Cristina Suárez-Ferrer

    2016-02-01

    Full Text Available Introduction: The possibility of developing idiopathic portal hypertension has been described with thiopurine treatment despite compromises the prognosis of these patients, the fact its true prevalence is unknown. Material and methods: A cross-sectional study was conducted in a cohort of inflammatory bowel disease (IBD patients followed at our unit, to determine the prevalence of diagnosis of idiopathic portal hypertension (IPH and its relationship with thiopurine treatment. Results: At the time of the analysis, 927/1,419 patients were under treatment with thiopurine drugs (65%. A total of 4 patients with IBD type Crohn's disease with idiopathic portal hypertension probably related to the thiopurine treatment were identified (incidence of 4.3 cases per 1,000. Seventy-five percent of patients started with signs or symptoms of portal hypertension. Only one patient was asymptomatic but the diagnosis of IPH because of isolated thrombocytopenia is suspected. However, note that all patients had thrombocytopenia previously. Abdominal ultrasound with fibroscan, hepatic vein catheterization and liver biopsy were performed on all of them as part of the etiology of portal hypertension. In the abdominal ultrasound, indirect portal hypertension data were observed in all patients (as splenomegaly cirrhosis was also ruled out. The fibroscan data showed significant liver fibrosis (F2-F3. Conclusion: Idiopathic portal hypertension following thiopurine treatment in IBD patients is a rare occurrence, but it must be borne in mind in the differential diagnosis for early diagnosis, especially in patients undergoing thiopurine treatment over a long period. The presence of thrombocytopenia is often the only predictor of its development in the preclinical stage.

  5. Intraoperative pulmonary hypertension occurred in an asymptomatic patient with pre-existent liver cirrhotic and portal hypertension

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Portopulmonary hypertension (PPH) is clinically defined as the development of pulmonary arterial hypertension complicated by portal hypertension, with or without advanced hepatic disease. Physical signs may be absent in mild to moderate PPH and only appear in a hyperdynamic circulatory state. Similar signs of advanced liver disease can be observed in severe PPH, with ascites and lower extremity edema. Pulmonary hypertension is usually diagnosed after anesthetic induction during liver transplantation (LT). We present intraoperative pulmonary hypertension in a 41-year-old male patient with hepatic cirrhosis. Since this patient had no preoperation laboratory data supporting the diagnosises of pulmonary hypertension and was asymptomatic for a number of years, it was necessary to send him to the intensive care unit after operation. Further study should be focued on the diagnosis and treatment of pulmonary arterial hypertension in order to reduce its mortality.

  6. Propranolol for portal hypertension. Evaluation of therapeutic response by direct measurement of portal vein pressure.

    Science.gov (United States)

    Rector, W G

    1985-04-01

    Portal vein pressure was measured before and after a week of oral propranolol hydrochloride therapy in 27 patients with alcoholic liver disease. Mean net portal pressure fell (14.5 +/- 3.3 to 12.5 +/- 4.5 mm Hg), but there was wide variation in individual response to the drug. Simultaneous transhepatic portal vein pressure and wedged hepatic vein pressure were similar before and one hour after a single oral dose of 40 mg of propranolol hydrochloride in six additional patients. Arterial, portal, and hepatic vein oxygen content did not change significantly. Propranolol hydrochloride appears not to dissociate portal and wedged hepatic vein pressure or to impair liver oxygenation. Because of variability of response, the portal hypotensive effect of propranolol should be documented before beginning therapy with the drug.

  7. Portal Vein Thrombosis

    OpenAIRE

    Hakan Demirci

    2016-01-01

    Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low...

  8. Diagnosis and treatment of portal hypertension in children (Part II: treatment

    Directory of Open Access Journals (Sweden)

    Rafael Trinchet Soler

    2005-12-01

    Full Text Available The portal hypertension is the clinical syndrome characterized by the increase of pressure in portal system. Undoubtedly the gastrointestinal bleeding due to esopagheal and gastroesophageal varices, erosive gastritis and peptic ulcers constitute the most difficult and dangerous challenge for doctors and patients. Although most patients are treated by non-surgical methods, the surgical treatment correctly realized in chosen patients according to the current protocols is the most effective method to diminish the portal pressure definitively and can be carried out in more than 88% of patients smaller than 2 years old with a near elective mortality to 0% in some countries. We presented the Second Part of Good Clinical Practices Guideline for Portal hypertension (management, approved by consensus in the 1st National Good Clinical Practices Workshop in Pediatric Surgery (Cienfuegos, Cuba, March 7 – 9, 2002.

  9. Effect of portal hypertension and duct ligature on pancreatic fluid pressures in cats

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Heyeraas, K J

    1990-01-01

    In two groups of cats recordings were performed, during laparotomy, of pancreatic tissue fluid pressure measured by a needle technique, interstitial fluid pressure measured by micropipette technique, pancreatic intraductal pressure, and portal vein pressure. In one group of cats the pressures were...... measured before and after acutely induced portal hypertension; in the other group of cats the pressures were measured after an overnight ligature of the pancreatic main duct. At rest the needle pressure was equal to duct pressure but significantly lower than interstitial fluid pressure and portal pressure....... Acute portal hypertension caused no significant changes in micropipette, needle, or duct pressures. Pancreatic duct ligature increased duct pressure, interstitial fluid pressure, and needle pressure. We conclude that the fluid pressure in the pancreas is probably influenced by the production...

  10. Association of three H - Hookworm, hemosuccus pancreaticus, and hypertension (portal in a patient with melena

    Directory of Open Access Journals (Sweden)

    Pratibha Kale

    2017-01-01

    Full Text Available Hookworm infestations, endemic in India, are a common cause of iron deficiency anemia. Hemosuccus pancreaticus, a rare clinical condition, is due to passage of blood into the pancreatic duct possibly through a route between an aneurysm of an artery close to the pancreas and/or pancreatic duct, leading to gastrointestinal (GI bleeding. Portal hypertensive upper GI bleed is also known since long. We report a case of a 38-year-old male with a history of alcoholism who was being investigated for GI bleeding who had concomitant hookworm infestation, hemosuccus pancreaticus as well as portal hypertension. To the best of our knowledge, this is the first report of common occurrence of hemosuccus pancreaticus and portal hypertension with hookworm infection. This case signifies the importance of infectious causes of GI bleeding to be considered even in cases where anatomic malformations or pathophysiological alterations are predominant.

  11. Development of optimal management of upper gastrointestinal bleeding secondary to pancreatic sinistral portal hypertension

    Directory of Open Access Journals (Sweden)

    SONG Yang

    2014-08-01

    Full Text Available The pathogenesis of pancreatic sinistral portal hypertension (PSPH is quite different from that of cirrhotic portal hypertension, and PSPH is the only curable type of portal hypertension. Gastric variceal bleeding is a less common manifestation of PSPH; however, it probably exacerbates the patient’s condition and leads to critical illness, and inappropriate management would result in death. Therefore, it is necessary to develop the optimal management of upper gastrointestinal bleeding in PSPH patients. Splenectomy is considered as a definitive procedure, together with surgical procedures to treat underlying pancreatic diseases. For patients in poor conditions or ineligible for surgery, splenic artery coil embolization is a preferable and effective method to stop bleeding before second-stage operation. The therapeutic decision should be made individually, and the further multi-center study to optimize the management of upper gastrointestinal bleeding from PSPH is warranted.

  12. Portaltrykket skal måles ved mistanke om portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming

    2010-01-01

    Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival and deve......Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival...... and development in connection with ascites, HCC and variceal bleeding. Measurement of HVPG is a simple and safe method and it can, moreover, be used to guide pharmacotherapy for primary and secondary prophylaxis of variceal bleeding. Assessment of HVPG should be available in larger centres that manage portal...... hypertensive patients....

  13. Delayed liver laceration following transjugular intrahepatic portosystemic shunt for portal hypertension.

    Science.gov (United States)

    Liu, Kai; Fan, Xin-Xin; Wang, Xu-Lin; He, Chang-Sheng; Wu, Xing-Jiang

    2012-12-28

    The transjugular intrahepatic portosystemic shunt (TIPS) is an acceptable procedure that has proven benefits in the treatment of patients who have complications from portal hypertension due to liver cirrhosis. Delayed liver laceration is a rare complication of the TIPS procedure. We describe a patient with portal hypertension due to liver cirrhosis, who suddenly presented with abdominal hemorrhage and liver laceration 8 d after TIPS. Few reports have described complications after TIPS placement. To the best of our knowledge, this is the first report describing delayed liver laceration. This potential and serious complication appears to be specific and fatal for TIPS in portal hypertension. We advocate careful attention to the technique to avoid this complication, and timely treatment is extremely important.

  14. Peliosis hepatis as an early histological finding in idiopathic portal hypertension: A case report

    Institute of Scientific and Technical Information of China (English)

    Annalisa Berzigotti; Donatella Magalotti; Paola Zappoli; Cristina Rossi; Francesco Callea; Marco Zoli

    2006-01-01

    Peliosis hepatis is a rare condition characterized by dilatation of hepatic sinusoids and blood-filled spaces in the liver mainly observed in subjects exposed to toxic substances or estrogens, which is frequently asymptomatic. Non-cirrhotic idiopathic portal hypertension (NCIPH) is also a vascular disease of the liver rarely observed in European countries, which is usually diagnosed only when the hemorrhagic complications of portal hypertension occur. We report a case of NCIPH in a young Caucasian male who was diagnosed with liver peliosis, showing ultrasonographic and endoscopic signs of portal hypertension four years after. A second biopsy was diagnostic for NCIPH. Even if the pathogenesis remains obscure, peliosis hepatis can be considered as an early sign of vascular disease of the liver, which may progress to more definite conditions.

  15. Non-cirrhotic portal hypertension with large regenerative nodules: A diagnostic challenge

    Institute of Scientific and Technical Information of China (English)

    Umberto Vespasiani Gentilucci; Antonio Picardi; Paolo Gallo; Giuseppe Perrone; Riccardo Del Vescovo; Giovanni Galati; Sandro Spataro; Chiara Mazzarelli; Adriano Pellicelli; Antonella Afeltra

    2011-01-01

    Non-cirrhotic portal hypertension is a poorly understood condition characterized by portal hypertension in the absence of conventional hepatic cirrhosis and described in association with blood coagulation disorders, myeloproliferative and immunological diseases and with exposure to toxic drugs. Very recently, precise classification criteria have been proposed in order to define four distinct subcategories. The present case highlights how the clinical presentation, the confounding results from imaging studies, and the difficulties in the histological evaluation often render cases of non-cirrhotic portal hypertension a real diagnostic challenge. It also underscores the classification problems which can be faced once this diagnosis is performed. Indeed, the different subcategories proposed result from the prevalent subtypes in a spectrum of hepatic regenerative responses to a variety of injuries determining microcirculatory disturbances. More flexibility in classification should derive from this etiopathogenic background.

  16. Glutamine synthetase activity and glutamate uptake in hippocampus and frontal cortex in portal hypertensive rats

    Institute of Scientific and Technical Information of China (English)

    Gabriela Beatriz Acosta; María Alejandra Fernández; Diego Martín Roselló; María Luján Tomaro; Karina Balestrasse; Abraham Lemberg

    2009-01-01

    AIM: To study glutamine synthetase (GS) activity and glutamate uptake in the hippocampus and frontal cortex (FC) from rats with prehepatic portal vein hypertension. METHODS: Male Wistar rats were divided into shamoperated group and a portal hypertension (PH) group with a regulated stricture of the portal vein. Animals were sacrificed by decapitation 14 d after portal vein stricture. GS activity was determined in the hippocampus and FC. Specific uptake of radiolabeled L-glutamate was studied using synaptosome-enriched fractions that were freshly prepared from both brain areas. RESULTS: We observed that the activity of GS increased in the hippocampus of PH rats, as compared to control animals, and decreased in the FC. A significant decrease in glutamate uptake was found in both brain areas, and was more marked in the hippocampus. The decrease in glutamate uptake might have been caused by a deficient transport function, significantly and persistent increase in this excitatory neurotransmitter activity. CONCLUSION: The presence of moderate ammonia blood levels may add to the toxicity of excitotoxic glutamate in the brain, which causes alterations in brain function. Portal vein stricture that causes portal hypertension modifies the normal function in some brain regions.

  17. Effect of portal hypertension and duct ligature on pancreatic fluid pressures in cats

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Heyeraas, K J

    1990-01-01

    In two groups of cats recordings were performed, during laparotomy, of pancreatic tissue fluid pressure measured by a needle technique, interstitial fluid pressure measured by micropipette technique, pancreatic intraductal pressure, and portal vein pressure. In one group of cats the pressures were...... measured before and after acutely induced portal hypertension; in the other group of cats the pressures were measured after an overnight ligature of the pancreatic main duct. At rest the needle pressure was equal to duct pressure but significantly lower than interstitial fluid pressure and portal pressure...

  18. Laparoscopic distal splenoadrenal shunt for the treatment of portal hypertension in children with congenital hepatic fibrosis

    Science.gov (United States)

    Zhang, Jin-Shan; Cheng, Wei; Li, Long

    2017-01-01

    Abstract Background: The distal splenorenal shunt is an effective procedure for the treatment of portal hypertension in children. However, there has been no report about laparoscopic distal splenorenal shunt in the treatment of portal hypertension in children. Methods: From December 2015 to August 2016, 4 children with upper gastrointestinal bleeding underwent laparoscopic distal splenoadrenal shunt. Portal hypertension and splenomegaly were demonstrated on the preoperative computed tomography (CT) and sonography. The distal splenic vein was mobilized and anastomosed to the left adrenal vein laparoscopically. All patients were followed-up postoperatively. Results: The laparoscopic distal splenoadrenal shunt was successfully performed in all patients. The liver fibrosis was diagnosed by postoperative liver pathology. The operative time ranged from 180 to 360 minutes. The blood loss was minimal. The length of hospital stay was 6 to 13 days. The duration of following-up was 1 to 9 months (median: 3 months). The portal pressure and splenic size were decreased postoperatively. The complete blood count normalized and the biochemistry tests were within normal range after surgery. Postoperative ultrasound and CT confirmed shunt patency and satisfactory flow in the splenoadrenal shunt in all patients. No patient developed recurrence of variceal bleeding. Conclusions: The laparoscopic splenoadrenal shunt is a feasible treatment of portal hypertension in children. PMID:28099341

  19. Heat shock protein 90 is responsible for hyperdynamic circulation in portal hypertensive rats

    Institute of Scientific and Technical Information of China (English)

    Jian-Hua Ai; Zhen Yang; Fa-Zu Qiu; Tong Zhu

    2003-01-01

    AIM: To examine the participation of HSP90 in portal hypertensive rat mesentery in vitro.METHODS: Immunohistochemistry and Western-blot were used to examine the expression of HSP90 in mesenteric vasculature. HSP90 mRNA was detected by RT-PCR, and the role of HSP90 in hyperdynamic circulation was examined by in vitro mesenteric perfusion studies.RESULTS: HSP90 was overexpressed in endothelium of mesentery vasculature in animals with experimental portal hypertension induced by partial portal vein ligation (PVL) compared with normal animals. Geldanamycin (GA), a special inhibitor of HsPg0 signaling, attenuated ACh-dependent vasodilation but did not affect vasodilation in response to sodium nitroprusside in normal rats. In PVL animals, the perfused mesentery was hyporesponsive to vasoconstrictor methoxamine. GA significantly potentiated methoxamineinduced vasoconstrictor after PVL.CONCLUSION: HsPg0 plays a key role in NO-dependent hyperdynamic circulation in portal hypertension and provides a novel method for future treatment of portal hypertension.

  20. Portal vein omentin is increased in patients with liver cirrhosis but is not associated with complications of portal hypertension.

    Science.gov (United States)

    Eisinger, Kristina; Krautbauer, Sabrina; Wiest, Reiner; Karrasch, Thomas; Hader, Yvonne; Scherer, Marcus N; Farkas, Stefan; Aslanidis, Charalampos; Buechler, Christa

    2013-09-01

    Omentin is a visceral fat-derived adipokine associated with endothelium-dependent vasodilation. Impaired endothelial function is a major cause of portal hypertension in liver cirrhosis. The aim was to assess associations of omentin with systemic markers of endothelial function, namely arginine and asymmetric dimethylarginine (ADMA) and complications of portal hypertension in liver cirrhosis. Systemic omentin was measured by ELISA in portal venous serum (PVS), systemic venous serum (SVS) and hepatic venous serum (HVS) of 40 patients with liver cirrhosis and 10 liver-healthy controls. ADMA and arginine were determined in SVS of the patients by ELISA. Omentin is elevated in PVS and tends to be increased in SVS and HVS of patients with liver cirrhosis compared with controls. Omentin is principally expressed in visceral fat, and PVS omentin tends to be higher than SVS levels. Lower HVS than PVS omentin suggests that omentin may be partly removed from the circulation by the liver. Omentin in serum is not associated with stages of liver cirrhosis defined by CHILD-POUGH or MELD score and is not affected in patients with ascites. HVS omentin tends to be reduced in patients with large varices compared with patients without/with small varices. Arginine/ADMA ratio is reduced in patients with massive ascites but is not associated with variceal size. Further, Arginine/ADMA ratio does not correlate with omentin. Current data show that PVS omentin is increased in liver cirrhosis but is not associated with complications of portal hypertension. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

  1. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy

    Science.gov (United States)

    Gjeorgjievski, Mihajlo; Cappell, Mitchell S

    2016-01-01

    AIM: To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review. METHODS: Computerized search of the literature was performed via PubMed using the following medical subject headings or keywords: “portal” and “gastropathy”; or “portal” and “hypertensive”; or “congestive” and “gastropathy”; or “congestive” and “gastroenteropathy”. The following criteria were applied for study inclusion: Publication in peer-reviewed journals, and publication since 1980. Articles were independently evaluated by each author and selected for inclusion by consensus after discussion based on the following criteria: Well-designed, prospective trials; recent studies; large study populations; and study emphasis on PHG. RESULTS: PHG is diagnosed by characteristic endoscopic findings of small polygonal areas of variable erythema surrounded by a pale, reticular border in a mosaic pattern in the gastric fundus/body in a patient with cirrhotic or non-cirrhotic portal hypertension. Histologic findings include capillary and venule dilatation, congestion, and tortuosity, without vascular fibrin thrombi or inflammatory cells in gastric submucosa. PHG is differentiated from gastric antral vascular ectasia by a different endoscopic appearance. The etiology of PHG is inadequately understood. Portal hypertension is necessary but insufficient to develop PHG because many patients have portal hypertension without PHG. PHG increases in frequency with more severe portal hypertension, advanced liver disease, longer liver disease duration, presence of esophageal varices, and endoscopic variceal obliteration. PHG pathogenesis is related to a hyperdynamic circulation, induced by portal hypertension, characterized by increased intrahepatic resistance to flow, increased splanchnic flow, increased total gastric flow, and most likely decreased gastric mucosal flow. Gastric mucosa

  2. An Adult Form of Gaucher Disease Associated with Portal Hypertension: A Case

    Directory of Open Access Journals (Sweden)

    Ahmet Dulger

    2013-04-01

    Full Text Available Gaucher disease (GD is an inborn error of metabolism that affects the recycling of cellular glycolipids. Glucosylceramide (also called glucocerebroside accumulate within the lysosomes of cells. Gaucher%u2019s disease is most common lysosomal storage disease and its incidence is 1/75.000. Three types of this disease have been defined. During the course of disease, it was reported that hepatosplenomegaly, portal hypertension, hyperferritinemia, splenic infarcts and splenic nodules might develop. Therefore, as in our case; Gaucher%u2019s disease must be remembered in the setting of hepatosplenomegaly, portal hypertension, hyperferritinemia, splenic infarcts and splenic nodules of unknown etiology.

  3. Splenic autotransplantation and oesophageal transection anastomosis in patients with portal hypertension(26 years clinical observation)

    Institute of Scientific and Technical Information of China (English)

    CHEN Jisheng; HUO Jinshan; ZHANG Hongwei; SHANG Changzhen; CHEN Rufu; ZHANG Jie; Obetien Mapudengo; CHEN Yajin; ZHANG Lei

    2007-01-01

    The surgical treatment methods for cirrhosis patients complicated with portal hypertension are complicated.In this study,we evaluated the effectiveness of a new treatment strategy:splenic auto-transplantation and oesophageal transection anastomosis on 274 patients from three aspects:clinical observation,splenic immunology and portal dynamics.From 1979 to 2005,274 cirrhosis patients with portal hypertension who underwent the new treatment strategy were followed up to observe different clinical indexes,which were then compared with those of the traditional surgery treatment.From 1999 to 2002,a randomized control trial (RCT) was performed on 40 patients to compare their immune function after operation.From 1994 to 2004,another RCT.was carried out on 28 patients to compare the portal dynamics through three-dimensional dynamic contrast enhanced MR angiography (3D DEC MR.A) investigation after operation.Among 274 patients (mean age 41.8 years),the emergency operative mortality (4.4%),selective operative mortality (2.2%),complication rate (17.9%),morbidity of hepatic encephalopathy ( < 1%),bleeding rate of portal hypertension gastritis (PHG) (9.1%),and morbidity of hepatic carcinoma (8%) were similar to those under traditional operation;the spleen immunology function (Tuftsin,IgM)decreased among the groups 2 months after operation.Through 3D DCE MRA,the cross section area,the velocity and volume of blood flow of main portal vein decrease significantly after operation in both groups,the auto transplantation group was significantly lower in velocity and volume of blood flow than in the control group.Splenic auto transplantation and esophageal transection anastomosis are a safe,effective,and reasonable treatment strategy for portal hypertension with varicial bleeding.It can not only correct hypersplenism but also completely stanch blood,and auto transplanted spleen in the retroperitoneal space can preserve immune function and establish abroad collateral circulation.

  4. Hyposensitivity to nerve stimulation in portal hypertensive rats: role of nitric oxide.

    Science.gov (United States)

    Sieber, C C; Sumanovski, L T; Moll-Kaufmann, C; Stalder, G A

    1997-11-01

    Portal hypertension goes along with vascular hyporeactivity, partly mediated by nitric oxide (NO). Interactions between the adrenergic nervous system and NO in portal hypertension are undetermined. We tested (1) whether superior mesenteric arterial beds of portal hypertensive rats have an altered sensitivity to periarterial nerve stimulation (PNS) and (2) the role of NO in modulating nerve-stimulated responses. Vasopressor responses to PNS (Hz, 2-32) were similar in preparations of partial portal vein-ligated (PVL, n = 12) and control (CON, n = 12) rats (60.0 +/- 6.7 and 47.8 +/- 6.1 CmH2O respectively) for 24 Hz (NS), but sensitivity of vessels of portal hypertensive animals displayed a significant rightward shift [Hz needed for 50% of maximal response (HZ50) being 15.5 +/- 0.4 and 12.9 +/- 0.6 for PVL and CON respectively, P < 0.001]. NO formation inhibition by N omega-nitro-L-arginine (10(-4) mol L-1) significantly increased responses to PNS (P < 0.05), the absolute values for 24 Hz being 101.4 +/- 11.7 cmH2O for PVL (n = 8) and 86.4 +/- 11.4 cmH2O for CON (n = 7) (NS). NO formation inhibition reversed the hyposensitivity in preparations of PVL, Hz50 being 13.9 +/- 0.5 and 13.2 +/- 0.2 for PVL and CON respectively (NS). Adrenergic receptor antagonism with prazosin (10(-7) mol L-1) and yohimbine (10(-6) mol L-1) inhibited PNS-mediated vasopressor reactivity (n = 6 per group, P < 0.001), confirming the nervous origin of vasoconstrictor responses. It is concluded that (1) portal hypertension goes along with a significant hyposensitivity to PNS and (2) this hyposensitivity is reversed by NO-formation inhibition

  5. New insights into impairment of mucosal defense in portal hypertensive gastric mucosa.

    Science.gov (United States)

    Tomikawa, M; Akiba, Y; Kaunitz, J D; Kawanaka, H; Sugimachi, K; Sarfeh, I J; Tarnawski, A S

    2000-01-01

    Portal hypertension (PHT) increases susceptibility of the gastric mucosa to injury. The aim of this study was to investigate whether PHT affects rat gastric mucosal defense mechanisms in vivo at the pre-epithelial, epithelial, and/or post-epithelial levels. PHT was produced in rats by staged portal vein ligation and sham-operated (SO) rats served as controls. The gastric mucosa was exposed, chambered, and continuously superfused with buffers under in vivo microscopy. We measured gastric mucosal gel layer thickness, surface epithelial cell intracellular pH (pHi), mucosal blood flow, and mucosal/serosal oxygenation. In PHT rats, gastric mucosal gel layer thickness was significantly reduced (88 +/- 16 microm in PHT rats vs. 135 +/- 25 microm in SO rats; P oxygenation of the gastric mucosal surface was decreased by 42% (P portal hypertensive gastric mucosa to injury.

  6. Effect of anesthetics on gastric damage using two models of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Paula; RS; Camara; Gisele; P; Moi; José; Geraldo; P; Ferraz; José; Murilo; R; Zeitune

    2010-01-01

    AIM:To investigate the effect of sodium pentobarbitone(SP) or ketamine/xylazine(KX) anesthetics on acute gastric injury.METHODS:Portal hypertension was induced by bile duct ligation(BDL) or portal vein stenosis(PVS).Ethanol(EtOH)-induced gastric damage was assessed using ex vivo gastric chamber experiments.Gastric blood flow(GBF) was also measured by laser doppler flowmetry.RESULTS:EtOH-induced gastric damage was reduced in BDL rats under KX anesthesia in comparison to those under SP anesthesia.GBF dysfunction in fasted BDL rats was partially restored under KX anesthesia.In contrast,in fasted PVS rats,EtOH-induced gastric damage was increased under KX anesthesia while GBF was reduced.CONCLUSION:The use of KX anesthesia in experimental procedures involving cirrhotic rats(but not those with pure portal hypertension) is preferable to SP anesthesia.

  7. Association of liver cirrhosis related IgA nephropathy with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A high incidence of IgA nephropathy has been reported in patients with liver cirrhosis, though, clinically evident nephrotic syndrome is very uncommon. Impaired hepatic clearance of circulating IgA immune complexes and subsequent deposition in renal glomeruli has been considered principally in the pathogenesis of liver cirrhosis associated IgA nephropathy. Here we report on a patient with cryptogenic liver cirrhosis and splenic vein thrombosis, who presented with nephrotic syndrome. Renal biopsy showed findings consistent with IgA nephropathy. Lower endoscopy showed features of portal hypertensive colopathy. Following initiation of propranolol and anticoagulant treatment to reduce portal pressure, a gradual decrease of proteinuria and hematuria to normal range was noted. The potential pathogenetic role of portal hypertension in the development of IgA nephropathy in cirrhotic patients is discussed.

  8. Association of liver cirrhosis related IgA nephropathy with portal hypertension.

    Science.gov (United States)

    Kalambokis, Georgios; Christou, Leonidas; Stefanou, Dimitrios; Arkoumani, Evdokia; Tsianos, Epameinondas V

    2007-11-21

    A high incidence of IgA nephropathy has been reported in patients with liver cirrhosis, though, clinically evident nephrotic syndrome is very uncommon. Impaired hepatic clearance of circulating IgA immune complexes and subsequent deposition in renal glomeruli has been considered principally in the pathogenesis of liver cirrhosis associated IgA nephropathy. Here we report on a patient with cryptogenic liver cirrhosis and splenic vein thrombosis, who presented with nephrotic syndrome. Renal biopsy showed findings consistent with IgA nephropathy. Lower endoscopy showed features of portal hypertensive colopathy. Following initiation of propranolol and anticoagulant treatment to reduce portal pressure, a gradual decrease of proteinuria and hematuria to normal range was noted. The potential pathogenetic role of portal hypertension in the development of IgA nephropathy in cirrhotic patients is discussed.

  9. Portaltrykket skal måles ved mistanke om portal hypertension

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming

    2010-01-01

    Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival and deve......Portal hypertension leads to serious complications such as oesophageal varices, ascites, and in some patients hepatocellular carcinoma (HCC). The importance of measurement of the hepatic venous pressure gradient (HVPG) has recently been substantiated as it independently predicts survival...... and development in connection with ascites, HCC and variceal bleeding. Measurement of HVPG is a simple and safe method and it can, moreover, be used to guide pharmacotherapy for primary and secondary prophylaxis of variceal bleeding. Assessment of HVPG should be available in larger centres that manage portal...

  10. Colonic mucosal changes in Egyptian patients with liver cirrhosis and portal hypertension

    Directory of Open Access Journals (Sweden)

    Zakaria A Salama

    2013-01-01

    Conclusion The prevalence of PHC and haemorrhoids increases with the progression of liver disease and worsening of the Child-Pugh grading in cirrhotic patients. However, haemorrhoids, rectal varices, hyperaemia and colonic angiodysplasia are not affected by the presence of portal hypertensive gastropathy.

  11. Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Jamilé Wakim-Fleming; Nizar N Zein; Ana Bennett; Rocio Lopez; Janice Santisi; William D Carey

    2008-01-01

    AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Harsh criteria. METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Harsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence. RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of I was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension. CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continu-ous reliance on the Marsh criteria when the diagnosis of coeliac disease is to be made in the presence of cirrhosis.

  12. Nodular regenerative hyperplasia: Evolving concepts on underdiagnosed cause of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Marek Hartleb; Krzysztof Gutkowski; Piotr Milkiewicz

    2011-01-01

    Nodular regenerative hyperplasia (NRH) is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules. NRH may lead to the development of non-cirrhotic portal hypertension. There are no published systematic population studies on NRH and our current knowledge is limited to case reports and case series. NRH may develop via autoimmune, hematological, infectious, neoplastic, or drug-related causes. The disease is usually asymptomatic, slowly or nonprogressive unless complications of portal hypertension develop. Accurate diagnosis is made by histopathology, which demonstrates diffuse micronodular transformation without fibrous septa. Lack of perinuclear collagen tissue distinguishes NRH from typical regenerative nodules in the cirrhotic liver. While the initial treatment is to address the underlying disease, ultimately the therapy is directed to the management of portal hypertension. The prognosis of NRH depends on both the severity of the underlying illness and the prevention of secondary complications of portal hypertension. In this review we detail the epidemiology, pathogenesis, diagnosis, management, and prognosis of NRH.

  13. IgA Myeloma, Portal Hypertension and Normal Skeletal Survey—A Triad

    OpenAIRE

    Waseem Raja Dar

    2015-01-01

    Multiple myeloma is a neoplastic plasma cell dyscrasia. Patients usually present with bone pain, anemia, hypercalcemia and renal failure. Unusual presentations include progressive bilateral carpal tunnel syndrome, polyarthritis, amyloidosis of the tongue, and involvement of pulmonary parenchyma. Early diagnosis is important for timely therapy. We present the case of a patient with clinical features of portal hypertension that ultimately proved to be multiple myeloma.

  14. Etiology and Management of Hemorrhagic Complications of Portal Hypertension in Children

    Directory of Open Access Journals (Sweden)

    Alejandro Costaguta

    2012-01-01

    Full Text Available Portal hypertension in children represents a particular diagnostic and management challenge for several reasons: (1 treatment outcomes should be evaluated in relationship with a long-life expectancy, (2 pediatric patients with portal hypertension constitute an heterogeneous population, both in terms of individual characteristics and diversity of liver diseases; making comparison between treatment outcomes very difficult, (3 application of techniques and procedures developed in adult patients (v.gr. TIPS face size limitations in small children, and (4 absence of data from well-controlled trials in children forces pediatric specialists to adapt results obtained from adult cohorts suffering from diseases such as HCV and alcoholic cirrhosis. Despite those limitations, substantial progress in the treatment of children with portal hypertension has been achieved in recent years, with better outcomes and survival. Two main factors influence our therapeutic decision: age of the patient and etiology of the liver disease. Therefore, diagnosis and treatment of complications of portal hypertension in children need to be described taking such factors into consideration. This paper summarizes current knowledge and expert opinion.

  15. Effect of early propranolol administration on portal hypertensive gastropathy in cirrhotic rats

    Institute of Scientific and Technical Information of China (English)

    Savas Rafailidis; Charalampos Demertzidis; Konstantinos Ballas; Michail Alatsakis; Nikolaos Symeonidis; Theodoros Pavlidis; Kyriakos Psarras; Valentini Tzioufa-Asimakopoulou; Athanassios Sakadamis

    2009-01-01

    AIM: To investigate any protective effect of early propranolol administration in the development of portal hypertensive gastropathy in cirrhotic rats. METHODS: For the development of liver cirrhosis and portal hypertensive gastropathy, 60 rats underwent ligation of the left adrenal vein and complete devascularization of the left renal vein, followed by phenobarbital and carbon tetrachloride (CCl4) administration. After two weeks of CCl4 administration, the rats were randomly separated into two groups. In group A, propranolol was continuously administered intragastrically throughout the study, whereas in group B normal saline (placebo) was administered instead. Hemodynamic studies and vascular morphometric analysis of gastric sections were performed after complete induction of cirrhosis. RESULTS: Vascular morphometric studies showed higher numbers of vessels in all mucosal layers in the control group. Statistical analysis revealed a significantly higher total vascular surface in the control group compared to the propranolol group, but with no statistically significant difference between the mean vascular surfaces between the groups. Our study clearly shows that the increased mucosal blood flow is manifested by a marked increase of vessel count. CONCLUSION: Early propranolol's administration in portal hypertensive cirrhotic rats seems to prevent intense gastric vascular congestion that characterizes portal hypertensive gastropathy.

  16. Nodular regenerative hyperplasia: Evolving concepts on underdiagnosed cause of portal hypertension

    Science.gov (United States)

    Hartleb, Marek; Gutkowski, Krzysztof; Milkiewicz, Piotr

    2011-01-01

    Nodular regenerative hyperplasia (NRH) is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules. NRH may lead to the development of non-cirrhotic portal hypertension. There are no published systematic population studies on NRH and our current knowledge is limited to case reports and case series. NRH may develop via autoimmune, hematological, infectious, neoplastic, or drug-related causes. The disease is usually asymptomatic, slowly or non-progressive unless complications of portal hypertension develop. Accurate diagnosis is made by histopathology, which demonstrates diffuse micronodular transformation without fibrous septa. Lack of perinuclear collagen tissue distinguishes NRH from typical regenerative nodules in the cirrhotic liver. While the initial treatment is to address the underlying disease, ultimately the therapy is directed to the management of portal hypertension. The prognosis of NRH depends on both the severity of the underlying illness and the prevention of secondary complications of portal hypertension. In this review we detail the epidemiology, pathogenesis, diagnosis, management, and prognosis of NRH. PMID:21472097

  17. Liver perfusion scintigraphy prior to and after transjugular intrahepatic portosystemic shunts (TIPS) in patients with portal hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Willkomm, P.; Schomburg, A.; Reichmann, K.; Bangard, M.; Overbeck, B.; Biersack, H.J. [Dept. of Nuclear Medicine, Univ. Bonn (Germany); Brensing, K.A.; Sauerbruch, T. [Dept. of Internal Medicine, Univ. Bonn (Germany)

    2000-08-01

    Purpose: This investigation was performed to compare the hemodynamic results of the transjugular intrahepatic portosystemic shunt, a new interventional treatment for portal hypertension, with those observed after the established surgical shunt interventions. Methods: We examined 22 patients with portal hypertension due to liver cirrhosis before and after elective TIPS by liver perfusion scintigraphy. The relative portal perfusion was determined before and after the shunt procedure. Additionally, we measured the portal pressure gradient (PPG: Portal-central venous pressure, mmHg). Results: Prior to TIPS, the relative portal perfusion was significantly reduced to 22{+-}9.1%. After the intervention we calculated values of 23.1{+-}10.7% in the TIPS-group (p=0.67; not significant). In spite of unchanged portal perfusion, the portal pressure was significantly (p<0.001) reduced from 25.6{+-}5.3 to 14.8{+-}4 mm Hg. Conclusion: These results suggest that the reduction of portal hypertension by TIPS is effective. The portal perfusion is maintained by TIPS suggesting that liver perfusion is preserved to a higher degree. (orig.) [German] Ziel der Untersuchung war der Vergleich der haemodynamischen Ergebnisse nach transjugulaerem intrahepatischen portosystemischen Shunt, einem neuen interventionellen Verfahren bei portaler Hypertension, mit denen etablierter chirurgischer Verfahren. Methoden: Wir untersuchten 22 Patienten mit durch Leberzirrhose verursachter portaler Hypertension mittels Leberperfusionsszintigrahie vor und nach elektiver TIPS-Anlage. Die relative portale Perfusion wurde vor und nach der Shuntanlage bestimmt. Ausserdem wurde der portale Druckgradient (PPG: portal-central venoeser Druck, mmHg) gemessen. Ergebnisse: Vor TIPS-Anlage war die relative portale Perfusion signifikant auf 22{+-}9,1% reduziert. Nach der Intervention ermittelten wir Werte von 23,1{+-}10,7% in der TIPS-Gruppe (p=0.67; nicht signifikant). Trotz unveraenderter portaler Perfusion wurde der

  18. Hydrogen sulfide attenuates carbon tetrachloride-induced hepatotoxicity, liver cirrhosis and portal hypertension in rats.

    Directory of Open Access Journals (Sweden)

    Gang Tan

    Full Text Available BACKGROUND: Hydrogen sulfide (H(2S displays vasodilative, anti-oxidative, anti-inflammatory and cytoprotective activities. Impaired production of H(2S contributes to the increased intrahepatic resistance in cirrhotic livers. The study aimed to investigate the roles of H(2S in carbon tetrachloride (CCl(4-induced hepatotoxicity, cirrhosis and portal hypertension. METHODS AND FINDINGS: Sodium hydrosulfide (NaHS, a donor of H(2S, and DL-propargylglycine (PAG, an irreversible inhibitor of cystathionine γ-lyase (CSE, were applied to the rats to investigate the effects of H(2S on CCl(4-induced acute hepatotoxicity, cirrhosis and portal hypertension by measuring serum levels of H(2S, hepatic H(2S producing activity and CSE expression, liver function, activity of cytochrome P450 (CYP 2E1, oxidative and inflammatory parameters, liver fibrosis and portal pressure. CCl(4 significantly reduced serum levels of H(2S, hepatic H(2S production and CSE expression. NaHS attenuated CCl(4-induced acute hepatotoxicity by supplementing exogenous H(2S, which displayed anti-oxidative activities and inhibited the CYP2E1 activity. NaHS protected liver function, attenuated liver fibrosis, inhibited inflammation, and reduced the portal pressure, evidenced by the alterations of serum alanine aminotransferase (ALT, aspartate aminotransferase (AST, hyaluronic acid (HA, albumin, tumor necrosis factor (TNF-α, interleukin (IL-1β, IL-6 and soluble intercellular adhesion molecule (ICAM-1, liver histology, hepatic hydroxyproline content and α-smooth muscle actin (SMA expression. PAG showed opposing effects to NaHS on most of the above parameters. CONCLUSIONS: Exogenous H(2S attenuates CCl(4-induced hepatotoxicity, liver cirrhosis and portal hypertension by its multiple functions including anti-oxidation, anti-inflammation, cytoprotection and anti-fibrosis, indicating that targeting H(2S may present a promising approach, particularly for its prophylactic effects, against liver

  19. The role of the color doppler ultrasonography and computed tomography in estimation of portal hypertension

    Directory of Open Access Journals (Sweden)

    Nićiforović Dijana

    2016-01-01

    Full Text Available Introduction. Liver diseases with disturbances of hepatic and splanchnic circulation lead to the portal hypertension, with or without a portal vein thrombosis. Objective. This study was based on the testing of hypothesis that more data and more precise diagnosis in patients with disorders of portal circulation can be obtained by using color Doppler ultrasonography (CDU and computed tomography (CT with contrast. Methods. The study was conducted from February 2011 to May 2014 and it comprised 120 patients who were suspected to have portal hypertension or already had clinical confirmation of the portal hypertension, patients with hepatitis, and some patients with hematological diseases. The first group of 40 patients was examined by conventional ultrasonography and CDU, the second group by contrast CT, and the third group of patients was examined by both methods (CDU and contrast CT. After six months of adequate therapy, the patients had control examinations with the same diagnostic technique used during their first examination. Results. Retrospective analysis showed that CDU is more sensitive than CT in the assessment of presence and age of thrombi (CDU 93.9%; CT 86.1%. CT gives precise data in detection of portosystemic collaterals. Sensitivity of CT is 100% and its specificity is 67%. Cumulative sensitivity and specificity for most parameters were increased in patients with portal hypertension when both methods were applied. Conclusion. This study emphasizes the possibility of early and more accurate diagnosis achieved when combining two radiological techniques (CDU and contrast CT scan, which is not the case when these methods are used separately.

  20. Correlation between Endosonographic and Doppler Ultrasound Features of Portal Hypertension in Patients with Cirrhosis

    Directory of Open Access Journals (Sweden)

    A. Wiechowska-Kozłowska

    2012-01-01

    Full Text Available Purpose. Endoscopic ultrasound (EUS permits the detailed visualization of clinically significant features of portal hypertension; however, it is an invasive procedure that is not widely available. The aim of this cross-sectional study was to determine whether a correlation exists between the features of portal hypertension detected using both Doppler ultrasound and EUS in subjects with liver cirrhosis. Materials and Methods. Analyzed cohort included 42 patients who underwent a detailed Doppler ultrasound focusing on the parameters of blood flow in the portal/splenic vein as well as an endoscopic/EUS procedure that included the assessment of the size and localization of “deep” varices. Results. The size of “deep” oesophageal varices detected with EUS exhibited no correlation with the parameters assessed by Doppler ultrasound. However, the size of the “deep” gastric varices detected using EUS correlated with the time averaged maximum velocity (Tmax as well as Vmin, Vmax for the portal vein using Doppler ultrasound and exhibited a correlation with the Vmax and Tmax for the splenic vein. No significant correlation was determined between the diameter of the azygous vein and the thickness of the gastric wall when seen on EUS versus the parameters measured with Doppler ultrasound. Conclusion. EUS provides important information regarding the features of portal hypertension, and in the case of “deep” oesophageal varices exhibits a limited correlation with the parameters detected by Doppler ultrasound. Thus, despite its invasiveness, EUS is a method that provides a reliable and unique assessment of the features of portal hypertension in patients with liver cirrhosis.

  1. Isolated splenic calcifications in two patients with portal hypertension; Calcificaciones esplenicas aisladas en dos pacientes con hipertension portal

    Energy Technology Data Exchange (ETDEWEB)

    Aleixandre, A.; Cugat, A. [Hospital de la Malvarrosa. Valencia (Spain); Ruiz, A.; Marti-Bonmati, L. [Hosptial Universitario Dr. Peset. Valencia (Spain); Tardaguila, F. [Clinica Provisa. Vigo (Spain)

    2002-07-01

    Calcification of the walls of the veins of the portal hypertension (PHT) (1-0), is uncommon. Calcification of the intra splenic vessels is exceptional. We report two cases of isolated calcification of intra splenic vessels, without calcification of the splenoportal venous axis, in patients with liver cirrhosis and PHT. The calcification was not clear. Computed tomography identified the calcification as linear tubular, branched structures located in the wall of intra splenic vessels. magnetic resonance imaging disclosed signs of cirrhosis and PHT but did not show the splenic classifications because of technical limitations. The cause of these calcifications was sustained PHT due to chronic liver disease. (Author) 15 refs.

  2. Tetrandrine Ameliorates Cirrhosis and Portal Hypertension by Inhibiting Nitric Oxide in Cirrhotic Rats

    Institute of Scientific and Technical Information of China (English)

    王海; 陈孝平

    2004-01-01

    To examine the role and effect of nitric oxide synthase type Ⅱ (NOSⅡ) in cirrhotic rats,expression of NOSⅡ mRNA was detected by real time RT-PCR. The enzymatic activity of nitric oxide synthase and the circulating levels of NO, systemic and portal hemodynamics and quantification of cirrhosis were measured. Chinese traditional medicine was used to treat cirrhotic rats and the effect of NO was evaluated. Double-blind method was used in experiment. Our results showed the concentration of NO and the enzymatic activity of NOS increased markedly at all stages of cirrhosis and iNOSmRNA was strongly expressed. Meanwhile, the portal-venous-pressure (PVP) and portal-venous-flow (PVF) were significantly increased. NO, NOS and iNOSmRNA were positively correlated to the degree of hepatic fibrosis. Tetrandrine significantly inhibited NO production and the expression of iNOSmRNA. Our results suggested that increased hepatic expression of NOS Ⅱ is one of the important factors causing cirrhosis and portal hypertension. Tetrandrine can significantly ameliorate cirrhosis and portal hypertension.

  3. Hyperammonemia,brain edema and blood-brain barrier alterations in prehepatic portal hypertensive rats and paravrtamol intoxication

    Institute of Scientific and Technical Information of China (English)

    Camila Scorticati; Juan P. Prestifilippo; Francisco X. Eizayaga; José L. Castro; Salvador Romay; Maria A. Fernández; Abraham Lemberg; Juan C. Perazzo

    2004-01-01

    AIM: To study the blood-brain barrier integrity, brain edema,animal behavior and ammonia plasma levels in prehepatic portal hypertensive rats with and without acute liver intoxication.METHODS: Adults male Wistar rats were divided into four groups. Group Ⅰ: sham operation; Ⅱ: Prehepatic portal hypertension, produced by partial portal vein ligation; Ⅲ:Acetaminophen intoxication and Ⅳ: Prehepatic portal hypertension plus acetaminophen. Acetaminophen was administered to produce acute hepatic injury. Portal pressure, liver serum enzymes and ammonia plasma levels were determined. Brain cortex water content was registered and trypan blue was utilized to study blood brain barrier integrity. Reflexes and behavioral tests were recorded.RESULTS: Portal hypertension was significantly elevated in groups Ⅱ and Ⅳ. Liver enzymes and ammonia plasma levels were increased in groups Ⅱ, Ⅳ and Ⅳ. Prehepatic portal hypertension (group Ⅱ), acetaminophen intoxication (group Ⅲ) and both (group Ⅳ) had changes in the blood brain-barrier integrity (trypan blue) and hyperammonemia. Cortical edema was present in rats with acute hepatic injury in groups Ⅲ and Ⅳ. Behavioral test (rota rod) was altered in group Ⅳ.CONCLUSION: These results suggest the possibility of another pathway for cortical edema production because blood brain barrier was altered (vasogenic) and hyperammonemia was registered (cytotoxic). Group Ⅳ, with behavioral altered test, can be considered as a model for study at an early stage of portal-systemic encephalopathy.

  4. Therapeutic effects of endoscopic variceal ligation combined with partial splenic embolization for portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Rui-Yun Xu; Bo Liu; Nan Lin

    2004-01-01

    AIM: To evaluate the feasibility of a new strategy of endoscopic variceal ligation combined with partial splenic embolization (EVL-PSE) for patients with cirrhosis and portal hypertension.METHODS: From May 1999 to May 2002, 41 cases with cirrhosis and portal hypertension underwent EVL-PSE.Hemodynamics of the main portal vein (MPV), the left gastric vein (LGV) and azygos vein, including maximum velocity,flow rate and vein diameter, were assessed by Doppler ultrasonography.RESULTS: One case died from pulmonary artery embolism.One case complicated with splenic abscess was successfully managed by laparotomy. The esophageal varices and hypersplenism were well controlled after EVL-PSE in other patients. After EVL-PSE, the flow rate and velocity of MPV was significantly reduced (P<0.05), as well as the flow rate of the LGV and azygos vein. During the follow-up, no recurrent bleeding was found.CONCLUSION: Being more convenient and less invasive,EVL-PSE is hopeful to be a proper intervention strategy for portal hypertensive patients with impaired hepatic function or those intolerant to shunting or devascularization surgery.

  5. Effects of raloxifene on portal hypertension and hepatic encephalopathy in cirrhotic rats.

    Science.gov (United States)

    Chang, Ching-Chih; Lee, Wen-Shin; Chuang, Chiao-Lin; Hsin, I-Fang; Hsu, Shao-Jung; Chang, Ting; Huang, Hui-Chun; Lee, Fa-Yauh; Lee, Shou-Dong

    2017-05-05

    Raloxifene, a selective estrogen receptor modulator, has been used extensively for osteoporosis. In addition to the effect of osteoporosis treatment, emerging evidences show that raloxifene affects the vascular function in different tissues. Cirrhosis is characterized with portal hypertension and complicated with hepatic encephalopathy. Portal hypertension affects portal-systemic shunt which leads to hepatic encephalopathy that the vascular modulation might influence severity of hepatic encephalopathy. Herein, we evaluated the impact of raloxifene on bile duct ligation (BDL)-induced cirrhotic rats. The female Sprague-Dawley rats received BDL plus ovariectomy or sham-operation. Four weeks later, rats were divided into 2 subgroups respectively to receive of raloxifene (10mg/kg/day) or saline (vehicle) for 14 days. On the 43th day, motor activities and hemodynamic parameters were measured. Hepatic and vascular mRNA and protein expressions were determined. The histopathological change of liver was examined. We found that the liver biochemistry, ammonia level and motor activity were similar between cirrhotic rats with or without raloxifene administration. The hemodynamic parameters were not significantly different except that raloxifene reduced portal venous inflow. Raloxifene exacerbated hepatic fibrosis and up-regulated hepatic endothelin-1 and cyclooxygenase 2 protein expressions. In addition, raloxifene modulated the mRNA expressions of endothelial nitric oxide synthase, cyclooxygenase and endothelin-1 in the superior mesenteric artery and collateral vessel. In conclusion, raloxifene aggravates hepatic fibrosis and decreases portal venous inflow in cirrhotic rats without adversely affecting portal hypertension and hepatic encephalopathy. The modulation of hepatic and vascular endothelin-1, endothelial nitric oxide synthase and cyclooxygenase expressions may play a role in the mechanism.

  6. Modifications produced by selective inhibitors of cyclooxygenase and ultra low dose aspirin on platelet activity in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To study the mechanism involved in the potentially beneficial effect of ultra low dose aspirin (ULDA) in prehepatic portal hypertension, rats were pretreated with selective COX 1 or 2 inhibitors (SC-560 or NS-398 respectively), and subsequently injected with ULDA or placebo.METHODS: Portal hypertension was induced by portal vein ligation. Platelet activity was investigated with an in-vivo model of laser induced thrombus production in mesenteric circulation and induced hemorrhagic time (IHT). Platelet aggregation induced by ADP and dosing of prostanoid products 6-keto-PGF1α, TXB2, PGE2 and LTB4 were also performed.RESULTS: The portal hypertensive group receiving a placebo showed a decreased in vivo platelet activity with prolonged IHT, an effect that was normalized by ULDA. SC-560 induced a mild antithrombotic effect in the normal rats, and an unmodified effect of ULDA. NS-398 had a mild prothrombotic action in portal hypertensive rats, similar to ULDA, but inhibited a further effect when ULDA was added. An increased 6-keto-PGF1α was observed in portal hypertensive group that was normalised after ULDA administration. TXA2 level after ULDA, remained unchanged.CONCLUSION: These results suggest that the effect of ULDA on platelet activity in portal hypertensive rats,could act through a COX 2 pathway more than the COX 1,predominant for aspirin at higher doses.

  7. Hepatic lipid metabolism changes in short-and long-term prehepatic portal hypertensive rats

    Institute of Scientific and Technical Information of China (English)

    Maria-Angeles Aller; Elena Vara; Cruz García; Maria-Paz Nava; Alejandra Angulo; Fernando Sánchez-Patán; Ana Calderón; Patri Vergara; Jaime Arias

    2006-01-01

    AIM:To verify the impairment of the hepatic lipid metabolism in prehepatic portal hypertension.METHODS:The concentrations of free fatty acids,diacylglycerol, triglycerides, and phospholipids were assayed by using D-[U-14C] glucose incorporation in the different lipid fractions and thin-layer chromatography and cholesterol was measured by spectrophotometry,in liver samples of Wistar rats with partial portal vein ligation at short- (1 mo) and long-term (1 year) (i.e.portal hypertensive rats) and the control rats.RESULTS:In the portal hypertensive rats, liver phospholipid synthesis significantly decreased (7.42 ±0.50 vs 4.70 ± 0.44 nCi/g protein; P < 0.01) and was associated with an increased synthesis of free fatty acids (2.08 ± 0.14 vs 3.36 ± 0.33 nCi/g protein; P < 0.05),diacylglycerol (1.93 ± 0.2 vs 2.26 ± 0.28 nCi/g protein),triglycerides (2.40 ± 0.30 vs 4.49 ± 0.15 nCi/g protein)and cholesterol (24.28 ± 2.12 vs 57.66 ± 3.26 mg/gprotein; P < 0.01).CONCLUSION:Prehepatic portal hypertension in rats impairs the liver lipid metabolism. This impairment consists in an increase in lipid deposits (triglycerides,diacylglycerol and cholesterol) in the liver, accompanied by a decrease in phospholipid synthesis.

  8. Small-diameter prosthetic H-graft portacaval shunts in the treatment of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    胡何节; 许戈良; 李建生; 杨树高; 柴仲培; 徐荣楠

    2004-01-01

    Background Portasystemic shunts, especially total shunts, are effective tools for reducing portal pressure and controlling variceal bleeding but lead to high risk of encephalopathy and accelerating liver ailure. The purpose of this study is to evaluate the clinical effects of small-diameter expanded polytetrafluoroethylene (ePTFE) H-graft portacaval shunts in the treatment of portal hypertension. Methods Thirty-one patients with portal hypertension were treated with ePTFE small-diameter H-graft portacaval shunts from December 1995 to April 2002. Twenty-one had externally ringed grafts and 10 had non-ringed grafts; 20 had 10 mm diameter grafts and 11 had 8 mm grafts. The left gastric artery and coronary vein were ligated in 22 patients. Additionally, 6 patients underwent pericardial devascularization, and splenectomies were performed on 30 patients. Results An average decrease of free portal pressure (FPP) from (32.13 ~4.86) cmH2O before shunting to (12.55±5. 57) cmH2O after shunting was observed. Portal blood flow was reduced by 1/3 compared with the levels measured before shunting. Twenty-eight patients survived after the operation, and no upper gastrointestinal rebleeding occurred in the follow-up period (40.2 months on average). We lost contact with one patient. Color Doppler ultrasonography and/or portography revealed the shunts to be patent in 28 cases and occluded in 2 (6.4% ) cases. Encephalopathy developed in 4 patients (12.9%). Conclusion Small-diameter ePTFE H-graft portacaval shunts can effectively reduce portal pressure. Moreover, the majority of the hepatopetal flow from the portal vein can be adequately maintained. The reinforced shunts may achieve a higher rate of patency. Morbidity from encephalopathy was less frequent than in pateints receiving total shunts. Small-diameter H-graft portacaval shunts are also effective in preventing recurrent variceal bleeding.

  9. Portal vein thrombosis in children and adolescents.

    Science.gov (United States)

    Schettino, Graziela C M; Fagundes, Eleonora D T; Roquete, Mariza L V; Ferreira, Alexandre R; Penna, Francisco J

    2006-01-01

    To review the literature on portal vein thrombosis in children and adolescents, focusing on its diagnosis, complications and treatment. The medical literature of the past 10 years was reviewed using the PubMed and MEDLINE search engines, with major focus on portal vein thrombosis and its clinical outcomes. The following keywords or expressions were used for the web search: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Additionally, we also reviewed the articles cited in the references of the initially selected papers, as well as relevant textbooks. Portal vein thrombosis is one of the most common causes of portal hypertension among children. The initial clinical manifestation is characterized either by episodes of upper gastrointestinal bleeding or by splenomegaly on routine clinical examination. The major complications include upper gastrointestinal bleeding, hypersplenism secondary to splenomegaly, growth retardation, and portal biliopathy. The diagnosis is made by abdominal Doppler ultrasonography. Treatment is targeted at the complications and includes primary and secondary prophylaxis against upper gastrointestinal bleeding (which results from the rupture of esophageal varices), and portosystemic shunting in selected cases. Portal vein thrombosis is one of the major triggers of upper gastrointestinal bleeding in children. Bleeding episodes have a remarkable effect on the quality of life of affected patients. Thus, appropriate diagnosis and treatment are needed in order to reduce morbidity and mortality.

  10. Expression of NALP3 in the Spleen of Mice with Portal Hypertension

    Institute of Scientific and Technical Information of China (English)

    夏泽锋; 王国斌; 万赤丹; 刘涛; 王帅; 王博; 程锐

    2010-01-01

    This study examined the mRNA expression of NALP3 in the spleen of the mice with hypersplenism due to portal hypertension(PH).The mouse hypersplenism models were established by oral administration of tetrachloromethane(2 mL/kg/week for 12 weeks by oral gavage).All the mice were randomly divided into a control group and an experimental group.The blood routine test was conducted,spleen index was calculated and spleen was histologically examined.Portal vein sera were taken for detection of the level of uric aci...

  11. Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension

    DEFF Research Database (Denmark)

    Jansen, Christian; Bogs, Christopher; Verlinden, Wim

    2017-01-01

    BACKGROUND & AIMS: Clinically significant portal hypertension (CSPH) is associated with severe complications and decompensation of cirrhosis. Liver stiffness measured either by transient elastography (TE) or Shear-wave elastography (SWE) and spleen stiffness by TE might be helpful in the diagnosis...... correlate with portal pressure and can both be used as a non-invasive method to investigate CSPH. Even though external validation is still missing, these algorithms to rule-out and rule-in CSPH using sequential SWE of liver and spleen might change the clinical practice....

  12. Circulating nitric oxide products do not solely reflect nitric oxide release in cirrhosis and portal hypertension

    DEFF Research Database (Denmark)

    Afzelius, P.; Bazeghi, N.; Bie, P.

    2011-01-01

    (x) and exhaled NO were determined in the supine and sitting positions and related to haemodynamics, RAAS and lung diffusing capacity (D(L)CO). Eight matched healthy individuals served as controls. Results: All patients with cirrhosis had portal hypertension. We found no significant difference in exhaled...... NO between patients and controls and no changes from the supine to the sitting position. Exhaled NO in the patients correlated significantly with plasma volume, heart rate and DLCO. NO(x) concentrations were not significantly increased in the patients. NO(x) correlated with portal pressure and haemodynamic...

  13. Attenuation of portal hypertension by natural taurine in rats with liver cirrhosis

    Institute of Scientific and Technical Information of China (English)

    Jian Liang; Xin Deng; Zhi-Xiu Lin; Li-Chun Zhao; Xi-Liu Zhang

    2009-01-01

    AIM: To investigate the inhibitory effect of natural taurine (Ntau) on portal hypertension (PHT) in rats with experimentally-induced liver cirrhosis (LC).METHODS: Experimentally-induced LC Wistar rats (20 rats/group) were treated with either oral saline or oral Ntau for 6 consecutive weeks. Evaluation parameters included portal venous pressure (PVP), portal venous resistance (PVR), portal venous flow (PVF), splanchnic vascular resistance (SVR) and mean arterial pressure (MAP). Vasoactive substance levels including nitric oxide (NO), nitric oxide synthase (NOS) and cyclic guanosine monophosphate (cGMP) were also measured.Histological investigation of type Ⅰ and Ⅲ collagen (COL Ⅰ and Ⅲ) and transforming growth factor-β1 (TGF-β1) was also performed. RESULTS: Treatment with Ntau (1) significantly decreased PVP, PVR and PVF, and increased MAP and SVP; (2) markedly increased the vascular compliance and reduced the zero-stress of the portal vein; (3) markedly decreased the amount of NO and cGMP and activity of NOS; and (4) improved the pathological status of the liver tissue and reduced the expression of COL Ⅰ, COL Ⅲ and TGF-β1. CONCLUSION: Ntau inhibited the LC-induced PHT by improving hyperdynamic circulation, morphology of liver and biomechanical properties of the portal vein in experimentally-induced LC rats.

  14. Dysregulation of vascular contractile signaling in liver cirrhosis : Rho-kinase as molecular basis for portal hypertension

    NARCIS (Netherlands)

    Hennenberg, Martin

    2007-01-01

    Cirrhosis of the liver is associated with the development of portal hypertension. The increase in portal pressure results from hernodynamic and vascular abnormalities ccurlng during cirrhosis (1-6). These are an increased splanchnic flaw due to persistent mesenteric vasodilation, and an impaired por

  15. Portal hypertensive gastropathy: A systematic review of thepathophysiology, clinical presentation, natural history andtherapy

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    AIM To describe the pathophysiology, clinical presentation,natural history, and therapy of portal hypertensivegastropathy (PHG) based on a systematic literaturereview.METHODS: Computerized search of the literature wasperformed via PubMed using the following medicalsubject headings or keywords: "portal" and "gastropathy";or "portal" and "hypertensive"; or "congestive"and "gastropathy"; or "congestive" and "gastroenteropathy".The following criteria were applied for studyinclusion: Publication in peer-reviewed journals, andpublication since 1980. Articles were independentlyevaluated by each author and selected for inclusionby consensus after discussion based on the followingcriteria: Well-designed, prospective trials; recent studies;large study populations; and study emphasis on PHG.RESULTS: PHG is diagnosed by characteristic endoscopicfindings of small polygonal areas of variableerythema surrounded by a pale, reticular border in amosaic pattern in the gastric fundus/body in a patientwith cirrhotic or non-cirrhotic portal hypertension. Histologicfindings include capillary and venule dilatation,congestion, and tortuosity, without vascular fibrinthrombi or inflammatory cells in gastric submucosa.PHG is differentiated from gastric antral vascular ectasiaby a different endoscopic appearance. The etiology ofPHG is inadequately understood. Portal hypertensionis necessary but insufficient to develop PHG becausemany patients have portal hypertension without PHG.PHG increases in frequency with more severe portalhypertension, advanced liver disease, longer liver diseaseduration, presence of esophageal varices, and endoscopicvariceal obliteration. PHG pathogenesis is related to ahyperdynamic circulation, induced by portal hypertension,characterized by increased intrahepatic resistance toflow, increased splanchnic flow, increased total gastricflow, and most likely decreased gastric mucosal flow.Gastric mucosa in PHG shows increased

  16. Antioxidant role of heme oxygenase-1 in prehepatic portal hypertensive rats

    Institute of Scientific and Technical Information of China (English)

    Soledad Gonzales; María Julia Pérez; Juan C Perazzo; María Luján Tomaro

    2006-01-01

    AIM: To study the effect of bilirubin on the oxidative liver status and the activity and expression of heme oxygenase-1 (HO-1) in rat liver injury induced by prehepatic portal hypertension.METHODS: Wistar male rats, weighing 200-250 g, were divided at random into two groups: one group with prehepatic portal hypertension (PH) induced by regulated prehepatic portal vein ligation (PPVL) and the other group corresponded to sham operated rats. Portal pressure, oxidative stress parameters, antioxidant enzymes,HO-1 activity and expression and hepatic sinusoidal vasodilatation were measured.RESULTS: In PPVL rats oxidative stress was evidenced by a marked increase in thiobarbituric acid reactive substances (TBARS) content and a decrease in reduced glutathione (GSH) levels. The activities of liver antioxidant enzymes, superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) were also diminished while activity and expression of HO-1 were enhanced. Administration of bilirubin (5 μmol/kg body weight) 24 h before the end of the experiment entirely prevented ali these effects. Pretreatment with Sn-protoporphyrin Ⅸ (Sn-PPIX) (100 μg/kg body weight, i.p.),a potent inhibitor of HO, completely abolished the oxidative stress and provoked a slight decrease in liver GSH levels as well as an increase in lipid peroxidation. Besides,carbon monoxide, another heme catabolic product, induced a significant increase in sinusoidal hepatic areas in PPVL group. Pretreatment of PPVL rats with Sn-PPIX totally prevented this effect.CONCLUSION: These results suggest a beneficial role of HO-1 overexpression in prehepatic portal hypertensive rats.

  17. Partial portacaval shunt with H-grafts to treat portal hypertension

    Institute of Scientific and Technical Information of China (English)

    XU Geliang; HU Hejie; LI Jiansheng; YANG Shugao; CHAI Zhongpei; XU Rongnan

    2007-01-01

    Partial portosystemic shunts have been popularized because of a reported low rate of mortality and morbidity (especially encephalopathy,liver failure and occlusion).The results of partial portacaval shunts[small-diameter expanded polytetrafluoroethylene(ePTFE)H-graft portacaval shunt]were retrospectively reviewed to evaluate the clinical efficacy in the treatment of portal hypertension.Forty-three patients with portal hypertension were treated by small-diameter H-graft of ePTFE portacaval shunt from May 1995 to April 2006.Thirty-three had externally ringed grafts and ten had non-ringed ones.Ten had grafts of 10mm in diameter and 33 had grafts of 8 mm.The left gastric artery and coronary vein were ligated in all the cases.Six had pericardial devascularization and splenectomy was performed in 42.An average decrease of flee portal pressure(FPP)from(33.24±4.78)cm H2O before shunting and(13.65±5.65)cmH2O after shunting was observed.The portal blood flow was reduced by one-third of that before shunt.Thirty-eight patients survived and no upper gastro-intestinal rebleeding occurred in the follow-up period(50.5 months in average).Two were out of contact.Color Doppler ultrasonography and/or portography revealed the shunts were Patent in 38 cases and were occluded in three cases(3/41,7.3%).Encephalopathy developed in five cases(5/41,12.2%).Partial(small-diameter ePTFE H-graft)portacaval shunting Can reduce the portal pressure effectively.Majority of the hepatic flow from the portal vein can be maintained adequately.The shunts with reinforced grafts can keep a higher rate of patency.The morbidity of encephalopathy was lower than those with total shunt.The partial portacaval shunt is effective in preventing recurrent variceal bleeding.

  18. Nodular Regenerative Hyperplasia and Portal Hypertension in a Patient with Coeliac Disease

    Directory of Open Access Journals (Sweden)

    Erwin Biecker

    2011-01-01

    Full Text Available Nodular regenerative hyperplasia (NRH of the liver is often associated with rheumatologic or lymphoproliferative disorders and a cause of portal hypertension in some patients. We report the case of a 71-year-old patient with celiac disease and unexplained portal hypertension. Biopsy of the liver revealed NRH as the underlying cause. The patient did not suffer from an autoimmune, rheumatologic or lymphoproliferative disease. A thrombophilic disorder that might cause NRH was ruled out. Celiac disease is often associated with mild elevation of liver enzymes and steatosis of the liver, but the association with NRH was described in only a few patients. We discuss the possible relationship of celiac disease and NRH.

  19. Pulmonary vascular complications in portal hypertension and liver disease: A concise review

    Directory of Open Access Journals (Sweden)

    M. Porres-Aguilar

    2013-01-01

    Full Text Available Chronic liver disease and/or portal hypertension may be associated with one of the two pulmonary vascular complications: portopulmonary hypertension and hepatopulmonary syndrome. These pulmonary vascular disorders are notoriously underdiagnosed; however, they have a substantial negative impact on survival and require special attention in order to understand their diagnostic approach and to select the best therapeutic options. Portopulmonary hypertension results from excessive vasoconstriction, vascular remodeling, and proliferative and thrombotic events within the pulmonary circulation that lead to progressive right ventricular failure and ultimately to death. On the other hand, abnormal intrapulmonary vascular dilations, profound hypoxemia, and a wide alveolar-arterial gradient are the hallmarks of the hepatopulmonary syndrome, resulting in difficult-to-treat hypoxemia. The aim of this review is to summarize the latest pathophysiologic concepts, diagnostic approach, therapy, and prognosis of portopulmonary hypertension and hepatopulmonary syndrome, as well as to discuss the role of liver transplantation as a definitive therapy in selected patients with these conditions.

  20. Idiopathic portal hypertension in renal transplant recipients: report of two cases.

    Science.gov (United States)

    Yoshimura, N; Oka, T; Ohmori, Y; Yasumura, T; Kohnosu, H; Kobashi, T

    1994-01-01

    We present herein the cases of two patients who developed idiopathic portal hypertension (IPH) following renal transplantation. Both patients had been treated with azathioprine and prednisolone for 6 years and 4 months and for 4 years and 7 months, respectively, and presented with splenomegaly and thrombocytopenia suggesting hypersplenism. Celiac angiography showed a dilated splenic artery and vein in both patients. When the splenic artery was obliterated with a balloon catheter in case 1, the portal venous pressure decreased from 51 cmH2O to 36 cmH2O, and the direction of the superiomesenteric venous blood flow became hepatopetal rather than hepatofugal. These results suggested that the spleen might have played an important role in the development of IPH in these two patients. A splenectomy was therefore performed, immediately following which the portal venous pressure decreased remarkably, and the esophageal varices disappeared during the postoperative follow-up period. Microscopic examination of liver biopsies taken at the operation revealed lymphoplasmacytic infiltration with bile duct hyperplasia but no evidence of periportal fibrosis, and electron microscopy demonstrated very mild perisinusoidal fibrosis. Thus, the histological changes seen in the livers of these patients seemed not to have caused the portal hypertension. In conclusion, although few patients develop IPH after renal transplantation, we should be aware of its possibility and consider splenectomy as the treatment of choice.

  1. Protective effect of omeprazole on gastric mucosal of cirrhotic portal hypertension rats

    Institute of Scientific and Technical Information of China (English)

    Wei Gao; Hai-Ying Li; Li-Xin Wang; Li-Jun Hao; Jian-Li Gao; Rong-Juan Zheng; Chun-Jiang Cai; Yan-Ling Si

    2014-01-01

    Objective:To observe the protective effect of omeprazole on gastric mucosal of cirrhotic portal hypertension rats.Methods:All rats were randomly divided into normal control group, cirrhosis and treatment group.Thioacetamide was used to establish rat model of cirrhotic portal hypertension.The necrotic tissue of gastric mucosa ulcer focus, degree of neutrophils infiltration at the ulcer margin, portal pressure, portal venous flow, abdominal aortic pressure, abdominal aortic blood flow at front end, gastric mucosal blood flow(GMBF), glycoprotein(GP) of gastric mucosa,basal acid secretion,H+ back -diffusion, gastric mucosal damage index,NO, prostaglandinE2(PGE2) and tumor necrosis factor-α(TNF-α) were determined respectively, and the pathological changes of gastric mucosa were also observed by microscope.Results:Compared with cirrhosis group and the control group, the ulcer bottom necrotic material, gastric neutrophil infiltration andUI of the treatment group were all decreased significantly(P<0.01), GMBF value,GP values, serumNO,PGE2,TNF-α were all significantly increased.Conclusions:Omeprazole has an important protective effect on gastric mucosal and it can increase gastric mucosal blood flow and related to many factors.

  2. Central and systemic haemodynamic effects of terlipressin in portal hypertensive patients

    DEFF Research Database (Denmark)

    Møller, S; Hansen, E F; Becker, U

    2000-01-01

    the acute effects of terlipressin on central and systemic haemodynamics. METHODS: Sixteen patients with alcoholic cirrhosis and portal hypertension had their systemic, central, and splanchnic haemodynamics determined at baseline and after a blind randomised bolus infusion (2 mg) of terlipressin...... increased by 36% (pportal pressure and hepatic blood flow decreased (17% and 29%, both pportal pressure after terlipressin was significantly related to the increase in systemic...... vascular resistance (r=-0.52, pportal hypertensive patients without a further contraction of the central and arterial blood volume. The systemic haemodynamic...

  3. PUMA mediates ER stress-induced apoptosis in portal hypertensive gastropathy

    OpenAIRE

    Tan, S; X Wei; Song, M.; Tao, J.; Yang, Y.; Khatoon, S.; Liu, H; Jiang, J.; Wu, B.

    2014-01-01

    Mucosal apoptosis has been demonstrated to be an essential pathological feature in portal hypertensive gastropathy (PHG). p53-upregulated modulator of apoptosis (PUMA) was identified as a BH3-only Bcl-2 family protein that has an essential role in apoptosis induced by a variety of stimuli, including endoplasmic reticulum (ER) stress. However, whether PUMA is involved in mucosal apoptosis in PHG remains unclear, and whether PUMA induces PHG by mediating ER stress remains unknown. The aim of th...

  4. Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

    Institute of Scientific and Technical Information of China (English)

    ZHOU Guang-wen; LI Hong-wei

    2009-01-01

    @@ Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.

  5. IgA Myeloma, Portal Hypertension and Normal Skeletal Survey—A Triad

    Directory of Open Access Journals (Sweden)

    Waseem Raja Dar

    2015-01-01

    Full Text Available Multiple myeloma is a neoplastic plasma cell dyscrasia. Patients usually present with bone pain, anemia, hypercalcemia and renal failure. Unusual presentations include progressive bilateral carpal tunnel syndrome, polyarthritis, amyloidosis of the tongue, and involvement of pulmonary parenchyma. Early diagnosis is important for timely therapy. We present the case of a patient with clinical features of portal hypertension that ultimately proved to be multiple myeloma.

  6. [Endoscopic sclerotherapy in the combined treatment of portal hypertension in children].

    Science.gov (United States)

    Ul'rikh, E V; Korolev, M P; Kupatadze, F D; Sevriugov, B L; Nabokov, V V

    1992-01-01

    The authors have performed 28 sessions of endoscopic sclerotherapy of dilated esophagus veins in children. The 70% ethyl alcohol was used. Six sessions were carried out in patients with gastroesophageal hemorrhage. In 22 patients the sclerotherapy was carried on according to plan. The fiber gastroscope with a standard injector was used. A conclusion is made of expediency of using endoscopic sclerotherapy in complex treatment of portal hypertension in children.

  7. Splenic Marginal Zone Lymphoma in the Setting of Noncirrhotic Portal Hypertension.

    Science.gov (United States)

    Ratnayake, Saman; Ammar, Ali; Rezvani, Rodd; Petersen, Greti

    2015-01-01

    We present a case of a 65-year-old Hispanic man with a history of disseminated cutaneous coccidioidomycosis who presented to the emergency room for progressively worsening abdominal pain associated with shortness of breath. The patient was found to have pleural effusion and moderate ascites on physical examination. Abdominal ultrasound and computed tomography scan were consistent with moderate ascites and portal hypertension but negative for both liver cirrhosis and for venous or arterial thrombosis. Cytology of ascitic fluid was suggestive of portal hypertension and was negative for infection. Subsequent, thoracentesis was suggestive of exudative effusion and also negative for infection. Liver biopsy confirmed the absence of cirrhosis. Complete blood count indicated pancytopenia, whereas bone marrow biopsy and flow cytometry were suggestive of marginal zone lymphoma (MZL). Clinically, the patient's shortness of breath was resolved by thoracentesis and paracentesis; however, his abdominal pain persisted. A diagnosis of idiopathic noncirrhotic portal hypertension in the setting of splenic MZL was made. The patient was transferred to a higher level of care for splenectomy; however, he missed multiple appointments. Since discharge, the patient has been seen in the outpatient setting and states that he is controlling his disease with diet and exercise; however, he continues to complain of intermittent shortness of breath with exertion.

  8. Peripheral blood cell variations in cirrhotic portal hypertension patients with hypersplenism

    Institute of Scientific and Technical Information of China (English)

    Yun-Fu Lu; Xin-Qiu Li; Xiao-Yu Han; Xiao-Guang Gong; Shun-Wu Chang

    2013-01-01

    Objective:To explore peripheral blood cell variations in hepatic cirrhosis portal hypertension patients with hypersplenism. Methods: Clinical data of 322 hypersplenism patients with decreased peripheral blood cells, admitted with cirrhotic portal hypertension, was retrospectively studied over the last 17 years. Results:In 64% (206/322) of patients, more than 2 kinds of blood cell were decreased, including 89 cases of pancytopenia (43.2%), 52 cases of WBC+PLT decrease (25.2%), 29 cases of RBC + PLT decrease (14.1%), and 36 cases of WBC + RBC decrease (17.5%);in 36% (116/322) of patients, single type blood cell decrease occurred, including 31 cases of PLT decrease (26.7%), 29 cases of WBC decrease (25%) and 56 cases of RBC decrease (48.3%). Of 227 routine bone marrow examinations, bone marrow hyperplasia was observed in 118 cases (52.0%), the remainder showed no hyperplasia. For the distinct scope and extent of peripheralblood cell decreases, preoperative blood component transfusions were carried out, then treated by surgery, after whole group splenectomy, the peripheral blood cell count was significantly higher (P<0.05). Conclusions: Of portal hypertensive patients with splenomegaly and hypersplenism, 64%have simultaneous decrease in various blood cells, 36%have decrease in single type blood cells, 52%of patients have bone marrow hyperplasia. A splenectomy can significantly increase the reduction of peripheral blood cells.

  9. Splenic Marginal Zone Lymphoma in the Setting of Noncirrhotic Portal Hypertension

    Directory of Open Access Journals (Sweden)

    Saman Ratnayake MD

    2015-09-01

    Full Text Available We present a case of a 65-year-old Hispanic man with a history of disseminated cutaneous coccidioidomycosis who presented to the emergency room for progressively worsening abdominal pain associated with shortness of breath. The patient was found to have pleural effusion and moderate ascites on physical examination. Abdominal ultrasound and computed tomography scan were consistent with moderate ascites and portal hypertension but negative for both liver cirrhosis and for venous or arterial thrombosis. Cytology of ascitic fluid was suggestive of portal hypertension and was negative for infection. Subsequent, thoracentesis was suggestive of exudative effusion and also negative for infection. Liver biopsy confirmed the absence of cirrhosis. Complete blood count indicated pancytopenia, whereas bone marrow biopsy and flow cytometry were suggestive of marginal zone lymphoma (MZL. Clinically, the patient’s shortness of breath was resolved by thoracentesis and paracentesis; however, his abdominal pain persisted. A diagnosis of idiopathic noncirrhotic portal hypertension in the setting of splenic MZL was made. The patient was transferred to a higher level of care for splenectomy; however, he missed multiple appointments. Since discharge, the patient has been seen in the outpatient setting and states that he is controlling his disease with diet and exercise; however, he continues to complain of intermittent shortness of breath with exertion.

  10. [Intramural nervous apparatus of jejunum and rectum in experimental portal hypertension].

    Science.gov (United States)

    Gaĭvoronskiĭ, I V; Tikhonova, L P; Chepur, S V; Nichiporuk, G I

    2004-01-01

    Using histological and electron microscopical methods, the state of intramural nervous structures of jejunum and rectum was studied in 92 dogs with experimental portal hypertension. Three phases of changes of portal pressure were detected and its influence upon the intramural nervous apparatus was observed. In phase 1 (first 4-5 days after the surgery) the reactive changes of the nervous apparatus were shown that were more pronounced in jejunum. In phase 2 (day 5 to 2.5 months) the portal pressure was shown to drop; this was accompanied by some signs of regeneration in jejunum and by an aggravation of destructive processes in rectum. In phase 3 of the repeated rise of portal pressure (2.5 to 6.5 months after the surgery), destructive changes in the nervous apparatus were demonstrated that were similar to those found in phase 1. However, the differences in the reaction of nervous structures in different layers of intestinal tube and the heterogeneity of the changes of the nervous apparatus in jejunum and rectum were absent. The association of time of appearance and of severity of structural changes with the elevation of portal pressure suggests the significant role of vascular factor in the morphogenesis of alterations observed in phase 3 of hemodynamic changes.

  11. A pharmacodynamic model of portal hypertension in isolated perfused rat liver

    Institute of Scientific and Technical Information of China (English)

    Tao Zhang; Peng-Tao Li; Xue-Yan Xu; Hang Zhou; Xin Zhao; Da-Yong Cai; Meng Song; Tao-Tao Zhang; He Yin; Ting Li

    2012-01-01

    AIM: To develop a pharmacodynamic model of portal hypertension from chronic hepatitis. METHODS: Pathological changes and collagen depositions were analyzed using morphometry to confirm CCl4-induced chronic hepatitis. At d0, d28, d56 and d84 of the process, the portal perfused velocities (μL/min) in isolated rat livers were exactly controlled with a quantified pump. The pressure (mmHg) was monitored with a Physiological System. The geometric concentrations of phenylephrine or acetylcholine were added to a fixed volume (300 mL) of the circulating perfusate. The equation, the median effective concentration and its 95% confidence intervals of phenylephrine or acetylcholine were regressed with Prism-4 software in nonlinear fit and various slopes. In the isolated perfused rat livers with chronic hepatitis, both median effective concentrations were defined as the pharmacodynamic model of portal hypertension. RESULTS: At d0, d28, d56 and d84, the equations of portal pressure potency from the concentrations of phenylephrine used to constrict the portal vein in isolated perfused rat livers were Y = 0.1732 + 0.3970/[1 + 10(-4.3061-0.4407 X)], Y = -0.004934 + 0.12113/[1 + 10(-3. 1247-0.3262X)], Y = 0.0104 + 0.2643/[1 + 10(-8.8462-0.9579X)], and Y = 0.01603 + 0.12107/[1 + 10(-5.1134-0.563X)]; the median effective concentrations were 1.69 × 10-10 mol/L, 2.64 × 10-10 mol/L, 5.82 × 10-10 mol/L, and 8.24 × 10-10 mol/L, respectively. The equations from the concentrations of acetylcholine used to relax the portal vein were Y = -0.4548 + 0.3274/[1 + 10(6.1538 + 0.5554X)], Y = -0.05391 + 0.06424/[1 + 10(3.8541+0.3469X)], Y = -0.2733 + 0.22978/[1 + 10(3.0472 + 0.3008X)], and Y = -0.0559 + 0.053178/[1 + 10(5.6336 + 0.5883 X)]; the median effective concentrations were 8.40 × 10-10 mol/L, 7.73 × 10-12 mol/L, 5.98 × 10-11 mol/L, and 2.66 × 10-10 mol/L, respectively. CONCLUSION: A pharmacodynamic model of portal hypertension in isolated perfused rat livers with chronic hepatitis was

  12. Effects of hepatotrophic factors on the liver after portacaval shunt in rats with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhong-tao; JIANG Peng; WANG Yu; LI Jian-she; XUE Jian-guo; ZHOU Yan-zhong; YUAN Zhu

    2006-01-01

    Background Portacaval shunt (PCS) prevent hepatotrophic factors from flowing into the liver, but they enter directly the systemic circulation and worsen liver injury. This study was designed to investigate the effects of hepatotrophic factors through the portal vein on the liver in rats with portal hypertension after portacaval shunt.Methods Intrahepatic portal hypertension (IHPH) was induced by intragastric administration of carbon tetrachloride, and end-to-side PCS was performed. Eight normal rats served as controls, and eight rats with IHPH served as IHPH model (IHPH group). Another 32 rats with IHPH-PCS were randomly subdivided into 4 groups:normal saline (NS) given to 8 rats, hepatocyte growth factor (HGF) 8, insulin (INS) 8, hepatocyte growth factor and insulin (HGF+INS) 8. Hepatotrophic factors were infused into the portal vein through an intravenous catheter.Portal venous pressure (PVP) was measured. The levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were tested biochemically and those of hyaluronic acid (HA) and laminin (LN) were measured by radioimmunoassay. Hepatic fibrosis was assessed histologically and the expression of collagens type Ⅰ and Ⅲ were detected immunohistochemically. Ultrastructural change of hepatocytes and the number of mitochondria were observed under an electron microscope. The data were compared between groups and subgroups by Student-Newman-Keuls procedure with SPSS 10.0.Results PVP was significantly higher in the IHPH rats than in the control rats (P<0.05). The levels of serum ALT, AST, HA, and LN, hepatic fibrosis score, the amount of collagen deposition, collagens type Ⅰ and Ⅲ increased more significantly in the IHPH group than in the control rats (P<0.05). The number of mitochondria decreased more significantly in the IHPH rats than in the control rats (P<0.05). The levels of serum ALT, AST,HA and LN as well as hepatic fibrosis score, the amount of collagen deposition, and the

  13. Endoscopic band ligation of internal haemorrhoids versus stapled haemorrhoidopexy in patients with portal hypertension.

    Science.gov (United States)

    Zaher, Tarik; Ibrahim, Islam; Ibrahim, Amany

    2011-03-01

    Portal hypertension is common in Egypt as a sequela to the high prevalence of hepatitis C virus and bilharziasis. In portal hypertension internal haemorrhoids are frequently found. The aim of this work was to compare the outcome of endoscopic band ligation (EBL) of symptomatic internal haemorrhoids with that of stapled haemorrhoidopexy (SH) in Egyptian patients with portal hypertension. In this study, 26 portal hypertensive patients (with oesophageal and/or fundal varices) with a grade 2-4 internal haemorrhoids who had no coagulation disorders were randomised to treatment by EBL (13 patients) or SH (13 patients) after doing colonoscopy. Symptom scores of bleeding and prolapse were assessed before and after the intervention. Complications were recorded. Patients were followed up for 12months. Goligher's grades of internal haemorrhoids improved significantly (p=0.018) 12weeks after SH (from 2.9±0.8 to 0.4±0.5; p=0.001) and after EBL (from 2.8±0.8 to 1.1±0.8; p=0.001). Symptom (bleeding and prolapse) scores significantly improved 4weeks after both EBL (from 1.6±0.8 to 0.6±0.8; pEBL and SH were not significant (p=0.168 and p=0.225). Pain requiring analgesics occurred in five patients (38.5%) after EBL, compared with six (46.2%) after SH (p=0.691). Minimal bleeding occurred in two patients (15.4%) after EBL but not with SH; urinary retention was observed in one patient after EBL compared with two after SH; and anal fissures were observed in one patient after EBL. During 1-year follow-up, increased frequency of stool occurred in one patient after EBL. Recurrence of symptoms was observed in three patients after EBL and in one after SH. For portal hypertensive patients with internal haemorrhoids and without coagulation disorders SH seems to be superior to EBL. However further studies are needed to evaluate EBL in different grades of cirrhosis. Copyright © 2011 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.

  14. Complications after surgical attenuation of congenital extrahepatic portosystemic shunts in dogs can be prevented by intraoperative Doppler ultrasonographic assessment of portal hemodynamics

    NARCIS (Netherlands)

    Szatmári, Viktor

    2005-01-01

    Under normal circumstances the blood from the gastrointestinal tract flows via the portal vein to the liver. The detoxified blood leaves the liver via the hepatic veins to the caudal vena cava, which latter enters the heart. Portosystemic shunting occurs when an anomalous vein allows the portal bloo

  15. Portal Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hakan Demirci

    2016-01-01

    Full Text Available Portal vein thrombosis is an important cause of presinusoidal portal hypertension. Portal vein thrombosis commonly occurs in patient with cirrhosis, malignancy and prothrombotic states. Patients with acute portal vein thrombosis have immediate onset. Patients with chronic portal vein thrombosis have developed portal hypertension and cavernous portal transformation. Portal vein thrombosis is diagnosed with doppler ultrasound, computed tomography and magnetic resonance imaging. Therapy with low molecular weight heparin achieves recanalization in more than half of acute cases.

  16. Difference in gene expression of macrophage between normal spleen and portal hypertensive spleen idendified by cDNA microarray

    Institute of Scientific and Technical Information of China (English)

    Feng Yan; Xiao-Min Wang

    2007-01-01

    AIM: To identify the difference in gene expression of microphage (Mφ) between normal spleen and portal hypertensive spleen using cDNA microarrays and find new gene functions associated with hypersplenism in portal hypertension.METHODS: The Biostar-H140s chip containing 14112 spots of cDNAs were used to investigate the difference of the expression. The total RNA extracted from macrophages isolated from both normal spleen and portal hypertensive spleen was reversely transcribed to cDNA with the incorporation of fluorescent (cy3 and cy5) labeled dCTP to prepare the hybridization probes.After hybridization, the gene chip was scanned for the fluorescent intensity. The differentially expressed genes were screened. That was repeated three times,and only the genes which had differential expression in all three chips were considered to be associated with hypersplenism in portal hypertension.RESULTS: Eight hundred and ninety-six, 1330 and 898 genes were identified to be differentially expressed in three chips, respectively. One hundred and twenty-one genes (0.86%) were identified to be differentially expressed in all three chips, including 21 up-regulated genes and 73 down-regulated genes. The differentially expressed genes were related to ionic channel and transport protein, cyclin, cytoskeleton, cell receptor, cell signal conduct, metabolism, immune, and so on. These genes might be related to the hypersplenism in portal hypertension.CONCLUSION: The investigations based on cDNA microarray can screen differentially expressed genes of macrophages between normal spleen and portal hypertensive spleen, thus may provide a new idea in studying the pathogenesis of hypersplenism in portal hypertension.

  17. Dihydroartemisinin counteracts fibrotic portal hypertension via farnesoid X receptor-dependent inhibition of hepatic stellate cell contraction.

    Science.gov (United States)

    Xu, Wenxuan; Lu, Chunfeng; Zhang, Feng; Shao, Jiangjuan; Yao, Shunyu; Zheng, Shizhong

    2017-01-01

    Portal hypertension is a frequent pathological symptom occurring especially in hepatic fibrosis and cirrhosis. Current paradigms indicate that inhibition of hepatic stellate cell (HSC) activation and contraction is anticipated to be an attractive therapeutic strategy, because activated HSC dominantly facilitates an increase in intrahepatic vein pressure through secreting extracellular matrix and contracting. Our previous in vitro study indicated that dihydroartemisinin (DHA) inhibited contractility of cultured HSC by activating intracellular farnesoid X receptor (FXR). However, the effect of DHA on fibrosis-related portal hypertension still requires clarification. In this study, gain- and loss-of-function models of FXR in HSC were established to investigate the mechanisms underlying DHA protection against chronic CCl4 -caused hepatic fibrosis and portal hypertension. Immunofluorescence staining visually showed a decrease in FXR expression in CCl4 -administrated rat HSC but an increase in that in DHA-treated rat HSC. Serum diagnostics and morphological analyses consistently indicated that DHA exhibited hepatoprotective effects on CCl4 -induced liver injury. DHA also reduced CCl4 -caused inflammatory mediator expression and inflammatory cell infiltration. These improvements were further enhanced by INT-747 but weakened by Z-guggulsterone. Noteworthily, DHA, analogous to INT-747, significantly lowered portal vein pressure and suppressed fibrogenesis. Experiments on mice using FXR shRNA lentivirus consolidated the results above. Mechanistically, inhibition of HSC activation and contraction was found as a cellular basis for DHA to relieve portal hypertension. These findings demonstrated that DHA attenuated portal hypertension in fibrotic rodents possibly by targeting HSC contraction via a FXR activation-dependent mechanism. FXR could be a target molecule for reducing portal hypertension during hepatic fibrosis.

  18. Kupffer cells are activated in cirrhotic portal hypertension and not normalised by TIPS

    DEFF Research Database (Denmark)

    Holland-Fischer, Peter; Grønbæk, Henning; Sandahl, Thomas Damgaard

    2011-01-01

    INTRODUCTION: Hepatic macrophages (Kupffer cells) undergo inflammatory activation during the development of portal hypertension in experimental cirrhosis; this activation may play a pathogenic role or be an epiphenomenon. Our objective was to study serum soluble CD163 (sCD163), a sensitive marker...... of macrophage activation, before and after reduction of portal venous pressure gradient by insertion of a transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhosis. METHODS: sCD163 was measured in 11 controls and 36 patients before and 1, 4 and 26 weeks after TIPS. We used...... in the controls (median 5.22 mg/l vs 1.45 mg/l, pportal venous pressure gradient (r(2)=0.24, pportal vein (p

  19. Effect of Gingko Injection on the Expression of NF-κB in Pulmonary Vessels of Rats with Portal Hypertension

    Institute of Scientific and Technical Information of China (English)

    Chao WANG; Juan HAN; Zhong Yan LIU; Zhen YANG

    2005-01-01

    @@ 1 Introduction Domestic scholars have originated the conception of"portal hypertensive vasculopathy ( PHV)", which concerns multiple organ vasculopathies in portal hypertensive patients. Portal hypertensive pulmonary vasculopathy is also a kind of internal organ vasculopathy. The transcription factor nuclear factor κB (NF-κB) regulates the expressions of genes that contribute to acute inflammatory reactions in endothelium. Few have reported about the expression of NF-κB in pulmonary vessels of rats related with portal hypertension (PH). Firstly we detected the expression of NF-κB in pulmonary vessels of rats with PH induced by biliary cirrhosis. Then through injecting of gingko (GI) into abdominal cavity, we found that NF-κB's expression was inhibited. We propose that NF-κB may play an important role in the pathogenesis of PHV and GI can hinder the improvement of PHV through inhibiting the expression of NF-κB. This outcome may provide certain theoretic basis for a novel therapy of portal hypertension.

  20. Cholecystolithotomy Combined Armillarisin A versus Cholecystectomy in Cirrhotic Portal Hypertension Patients with Symptomatic Cholelithiasis.

    Science.gov (United States)

    Fei, Yang; Li, Wei-Qin; Zong, Guang-Quan; Chen, Jian; Wang, Wei

    2017-01-01

    To discover whether cirrhotic portal hypertension patients with symptomatic cholelithiasis would benefit from cholecystolithotomy combined with Armillarisin A in the authors hospital. Methods: Sixty-one patients with cirrhotic portal hypertension and symptomatic gallstone disease who underwent either cholecystolithotomy combined with Armillarisin A (group A) or cholecystectomy (group B) for cholelithiasis from Feb 2007 to March 2011 were retrospectively reviewed. These patients were undergoing simultaneous procedure for esophageal varices. The operation-relevant information, change of laboratory examination data, postoperative complications and symptoms were analyzed. Results: There were no significant differences between group A and group B in mean operative time, intraoperative blood loss, time to resume diet postoperatively and length of hospital stay (P 0.05). The hepatic function biochemical profile and Child-Pugh'™s score at 2 weeks and 1 month after operations were both altered significantly less in group A than in group B (ALT, 0.008, 0.011; AST, 0.006, 0.003; Child-Pugh'™s score, 0.010, 0.016, respectively). However, at 6 months postoperatively, the changes were not significant (P 0.05). Except for gallstone recurrence and wound infection, occurrences or development of postoperative complications including biliary fistula, liver failure and subphrenic infection showed significant differences between the two groups (P = 0.037, P = 0.041, P = 0.019, respectively). After a mean follow-up of 4.2 years, all patients remain alive. Twenty-seven patients in group A (93%) are free of biliary symptoms. Cholecystolithotomy combined with using Armillarisin A is a useful treatment for symptomatic gallstones in patients with cirrhotic portal hypertension who are at high risk for cholecystectomy. It preserves gallbladder function and reduces the possibility of liver failure; moreover the rate of recurrent gallstones are relatively low. Celsius.

  1. Role of dissection of secondary branches of splenic pedicle in portal hypertension cases undergoing splenectomy

    Institute of Scientific and Technical Information of China (English)

    LIU Ying-bin; ZHANG Zhi-ping; WU Xiang-song; FEI Xiao-zhou; QUAN Zhi-wei; Li Song-gang; LI Ji-yu; CAO Li-ping; PENG Shu-you; KONG Ying; WANG Xuan; WANG Jian-wei; LI Jiang-tao; WANG Yong; CHEN Yan; CHEN De-qing; WENG Wei-hong

    2008-01-01

    Background It is well known that conventional splenectomy,which requires careful handling and ligation of tissue of the splenic hilum,can easily cause complications such as splenic fever and pancreatic fistula.Here,we use the technique of dissection of the secondary branches of the splenic pedicle to handle the hilum in the portal hypertension patients who are subjected to splenectomy.Methods We retrospectively compared and analyzed the complications,postoperative hospital stay,operative time,and occurrence of hemorrhage in 121 patients with portal hypertension undergoing splenectomy and devascularization of the gastric cardia from January 1999 to December 2007.The selected cases consisted of 51 patients undergoing conventional splenectomy and 70 patients undergoing dissection of secondary branches of the splenic pedicle.In addition,we analyzed the relationship between size of the spleen and occurrence of complications.Results The incidence of pancreatic fistula and splenic fever (0/70 and 9/70) was lower in patients undergoing dissection of secondary branches of the splenic pedicle as compared with that of the conventional group (5/51 and 18/51 respectively).In addition,there was no significant difference in operative time and volume of blood loss between two groups.The spleen thickness of those patients who had pancreatic fistula and splenic fever was significantly greater than those without complications.Conclusions These results indicate that dissection of secondary branches of the splenic pedicle in portal hypertension patients undergoing splenectomy can decrease the incidence of splenic fever and pancreatic fistula,and shorten the postoperative hospital stay,especially in the patients with a large spleen.So dissection of secondary branches of the splenic pedicle is a valuable technique for splenectomy.

  2. Predictive value of D-dimer for portal vein thrombosis after portal hypertension surgery in hepatitis B virus-related cirrhosis

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the predictive value of D-dimer as a predictive indicator of portal vein thrombosis (PVT) after portal hypertension surgery in hepatitis B virus-related cirrhosis.METHODS: A prospective study was carried out in 52 patients who had undergone surgery for portal hypertension in hepatitis B virus-related cirrhosis.Changes in perioperative dynamic D-dimer were observed. The sensitivity, specificity, positive predictive values and negative predictive values of D-dimer were calculated, and ROC curves were analyzed.RESULTS: The D-dimer levels in the group developing postoperative PVT was significantly higher than those in the group not developing PVT (P = 0.001), and the ROC semi-quantitative and qualitative analysis of D-dimer showed a moderate predictive value in PVT (semiquantitative value Az = 0.794, P = 0.000; qualitative analysis: Az = 0.739, P = 0.001).CONCLUSION: Dynamic monitoring of D-dimer levels in patients with portal hypertension after surgery can help early diagnosis of PVT, as in cases where the D-dimer levels steadily increase and exceed 16 μg/mL, the possibility of PVT is very high.

  3. New insights on an old medical emergency: non-portal hypertension related upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Tiago Cúrdia-Gonçalves

    Full Text Available Upper gastrointestinal bleeding (UGIB is a potentially life-threatening condition and the most common medical emergency managed by gastroenterologists. Despite being one of the most antique medical problems, recent studies have been slowly changing the management of these patients, which should nowadays include not only initial resuscitation, but also risk stratification, pre-endoscopic therapy, endoscopy treatment, and post-procedure care. The aim of this paper is to review the extended approach to the patient with non-portal hypertension related UGIB.

  4. Portal hypertension in children: High-risk varices, primary prophylaxis and consequences of bleeding.

    Science.gov (United States)

    Duché, Mathieu; Ducot, Béatrice; Ackermann, Oanez; Guérin, Florent; Jacquemin, Emmanuel; Bernard, Olivier

    2017-02-01

    Primary prophylaxis of bleeding is debated for children with portal hypertension because of the limited number of studies on its safety and efficacy, the lack of a known endoscopic pattern carrying a high-risk of bleeding for all causes, and the assumption that the mortality of a first bleed is low. We report our experience with these issues. From 1989 to 2014, we managed 1300 children with portal hypertension. Endoscopic features were recorded; high-risk varices were defined as: grade 3 esophageal varices, grade 2 varices with red wale markings, or gastric varices. Two hundred forty-six children bled spontaneously and 182 underwent primary prophylaxis. The results of primary prophylaxis were reviewed as well as bleed-free survival, overall survival and life-threatening complications of bleeding. High-risk varices were found in 96% of children who bled spontaneously and in 11% of children who did not bleed without primary prophylaxis (phypertension. Life-threatening complications of bleeding were recorded in 19% of children with cirrhosis and high-risk varices who bled spontaneously. Ten-year probabilities of bleed-free survival after primary prophylaxis in children with high-risk varices were 96% and 72% for non-cirrhotic causes and cirrhosis respectively. Ten-year probabilities of overall survival after primary prophylaxis were 100% and 93% in children with non-cirrhotic causes and cirrhosis respectively. In children with portal hypertension, bleeding is linked to the high-risk endoscopic pattern reported here. Primary prophylaxis of bleeding based on this pattern is fairly effective and safe. In children with liver disease, the risk of bleeding from varices in the esophagus is linked to their large size, the presence of congestion on their surface and their expansion into the stomach but not to the child's age nor to the cause of portal hypertension. Prevention of the first bleed in children with high-risk varices can be achieved by surgery or endoscopic

  5. An Adolescent Case of Osteopetrosis with Portal Hypertension as well as Mandibula Osteomyelitis.

    Science.gov (United States)

    Leblebisatan, Goksel; Celik, Umit; Temiz, Fatih; Celik, Tamer; Aydin, Fahri; Istifli, Fatma Levent; Leblebisatan, Serife; Komur, Mustafa

    2015-06-01

    Osteopetrosis is a clinical syndrome characterized by the failure of osteoclasts to resorb bone. Excessive bone density can interfere with vital tissues and structures, causing serious problems of the body. Hematopoietic insufficiency, disturbed tooth eruption, nerve entrapment syndromes, and growth impairment may develop in a patient with osteopetrosis. Herein, we present an adolescent girl diagnosed with non-infantile type of osteopetrosis with rare complications of the disease like mandibular osteomyelitis and portal hypertension (PHT) without liver cirrhosis. To our knowledge, this is the first pediatric case with osteopetrosis related PHT.

  6. Role of HSP-90 for increased nNOS-mediated vasodilation in mesenteric arteries in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Lukas; Moleda; Lars; Jurzik; Matthias; Froh; Erwin; Gbele; Claus; Hellerbrand; Rainer; H; Straub; Jürgen; Schlmerich; Reiner; Wiest

    2010-01-01

    AIM:To explore the role of heat shock protein-90 (HSP-90) for nitrergic vasorelaxation in the splanchnic circulation in rats with and without portal hypertension. METHODS: Neuronal nitric oxide synthase (nNOS) and HSP-90 were analyzed by immunofluorescence, western blotting and co-immunoprecipitation in the mesenteric vasculature and isolated nerves of portal-vein-ligated (PVL) rats and sham operated rats. In vitro perfused de-endothelialized mesenteric arterial vasculature was preconstricted with norepinep...

  7. Assessment of contrast-enhanced ultrasonography of the hepatic vein for detection of hemodynamic changes associated with experimentally induced portal hypertension in dogs.

    Science.gov (United States)

    Morishita, Keitaro; Hiramoto, Akira; Michishita, Asuka; Takagi, Satoshi; Hoshino, Yuki; Itami, Takaharu; Lim, Sue Yee; Osuga, Tatsuyuki; Nakamura, Sayuri; Ochiai, Kenji; Nakamura, Kensuke; Ohta, Hiroshi; Yamasaki, Masahiro; Takiguchi, Mitsuyoshi

    2017-04-01

    OBJECTIVE To assess the use of contrast-enhanced ultrasonography (CEUS) of the hepatic vein for the detection of hemodynamic changes associated with experimentally induced portal hypertension in dogs. ANIMALS 6 healthy Beagles. PROCEDURES A prospective study was conducted. A catheter was surgically placed in the portal vein of each dog. Hypertension was induced by intraportal injection of microspheres (10 to 15 mg/kg) at 5-day intervals via the catheter. Microsphere injections were continued until multiple acquired portosystemic shunts were created. Portal vein pressure (PVP) was measured through the catheter. Contrast-enhanced ultrasonography was performed before and after establishment of hypertension. Time-intensity curves were generated from the region of interest in the hepatic vein. Perfusion variables measured for statistical analysis were hepatic vein arrival time, time to peak, time to peak phase (TTPP), and washout ratio. The correlation between CEUS variables and PVP was assessed by use of simple regression analysis. RESULTS Time to peak and TTPP were significantly less after induction of portal hypertension. Simple regression analysis revealed a significant negative correlation between TTPP and PVP. CONCLUSIONS AND CLINICAL RELEVANCE CEUS was useful for detecting hemodynamic changes associated with experimentally induced portal hypertension in dogs, which was characterized by a rapid increase in the intensity of the hepatic vein. Furthermore, TTPP, a time-dependent variable, provided useful complementary information for predicting portal hypertension. IMPACT FOR HUMAN MEDICINE Because the method described here induced presinusoidal portal hypertension, these results can be applied to idiopathic portal hypertension in humans.

  8. [Activity of oxidation-reduction enzymes in endotheliocytes of the intestinal hemomicrocirculatory bed under normal conditions and in portal hypertension].

    Science.gov (United States)

    Gaĭvoronskiĭ, I V; Tikhonova, L P; Chepur, S V; Nichiporuk, G I

    1997-01-01

    An original quantitative examination of oxidation-reduction enzymes activity in endotheliocytes of hemomicroclrculatory vessels of jejunum and rectum submucosal base in normal state and in portal hypertension was performed by the authors. Comparative analysis of the activity of the enzymes studied revealed different metabolic processes intensity in these organs, dependent on current hemodynamic conditions. Cytochemical changes in hemomicrocirculatory bed are consistent with structural reorganizations that arise in the wall of vessels studied, consist of several phases and may be used as an assessment criterion for defining the portal hypertension stage.

  9. Portal hypertension: an uncommon clinical manifestation of Takayasu arteritis in a 9-year-old child

    Science.gov (United States)

    Herrera, Cristina N; Tomala-Haz, Javier E

    2016-01-01

    Takayasu arteritis (TA) is the third most common childhood vasculitis and its clinical manifestations depend on the arteries involved. We report a case of a 9-year-old boy with multiple aneurysms in carotid and iliac arteries, subclavian and coronary arteries, and abdominal aorta. At the age of 7 years, he presented with recurrent fever and hepatosplenomegaly. An angio-computed tomography scan showed aneurysms in the left subclavian artery, abdominal aorta, and both proximal iliac arteries. He was diagnosed with TA and was treated with corticosteroids, aspirin, and enalapril. One year later, he was admitted to Dr Roberto Gilbert Children’s Hospital because of intracranial hemorrhage. Angiography revealed enlargement of aneurysms enlargement and new aneurysms. He also developed portal hypertension. Treatment with intravenous corticosteroids, azathioprine, and monthly intravenous cyclophosphamide was begun. After 6 months of no improvement, infliximab was begun. The aim of this article was to report the concurrence of coronary involvement and portal vein hypertension in pediatric TA because there were scarce reports on this matter. PMID:27895519

  10. Noncirrhotic portal hypertension in a human immunodeficiency virus (HIV infected adolescent

    Directory of Open Access Journals (Sweden)

    Aída de Fátima Thomé Barbosa Gouvêa

    2015-06-01

    Full Text Available OBJECTIVE: To alert the pediatrician who is following up HIV-infected patients about the possibility of non-cirrhotic portal hypertension (NCPH in this period of life, in order to avoid the catastrophic consequences of this disease as bleeding esophageal varices. CASE DESCRIPTION: A 13 years old HIV-infected patient by vertical route was receiving didanosine (ddI for 12 years. Although the HIV viral load had been undetectable for 12 years, this patient showed gradual decrease of CD4+ T cells, prolonged thrombocytopenia and high alkaline phosphatase. Physical examination detected splenomegaly, which triggered the investigation that led to the diagnosis of severe liver fibrosis by transient elastography, probably due to hepatic toxicity by prolonged use of ddI. COMMENTS: This is the first case of NCPH in HIV-infected adolescent described in Brazil. Although, the NCPH is a rare disease entity in seropositive patients in the pediatric age group, it should be investigated in patients on long-term ddI or presenting clinical and laboratories indicators of portal hypertension, as splenomegaly, thrombocytopenia and increased alkaline phosphatase.

  11. Right Porto-Ovarian H-Shunt for the Surgical Treatment of Symptomatic Portal Biliopathy: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Konstantinos Vasiliadis

    2009-01-01

    Full Text Available Portal hypertension, especially when it is caused by extrahepatic portal vein thrombosis, is commonly followed by the development of an abnormal periportal and pericholedochal variceal network, which form a portal cavernoma. This may exert extrinsic pressure on the adjacent biliary ducts and gallblader, causing morphologic abnormalities, termed portal biliopathy, which is usually leading to asymptomatic cholestasis, while less frequently it can be associated with obstructive jaundice, gallstone formation, and cholangitis. Endoscopic stone extraction can effectively treat portal biliopathy when cholangitis is associated with common bile duct stones. Portosystemic shunts are indicated in cases of disease recurrence as they can achieve regression of portal cavernoma and usually relieve symptomatic portal biliopathy. This case describes an alternative partial portosystemic shunt that utilizes the right ovarian vein as an autologous conduit for the surgical treatment of symptomatic portal biliopathy.

  12. Salvianolic Acid B Reducing Portal Hypertension Depends on Macrophages in Isolated Portal Perfused Rat Livers with Chronic Hepatitis

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    Xin Zhao

    2012-01-01

    , and d84 in the progression of chronic hepatitis. After constricting with phenylephrine, the portal veins were relaxed with Sal B. The EC50 of Sal B for relaxing portal veins was −2.04×10−9, 7.28×10−11, 1.52×10−11, and 8.44×10−11 mol/L at d0, d28, d56, and d84, respectively. More macrophages infiltrated in portal triads and expressed more iNOS or HO-1 as PH advanced. The areas under the curve (AUCs of Sal B for reducing PH were positively correlated with the levels of iNOS or HO-1 in portal triads, and so did with serum CD163 levels. Sal B reduces PH in IPPRL with chronic hepatitis, via promoting portal relaxation due to macrophage-originated NO or CO in portal triads, partly at least.

  13. Beneficial Effect of Ultra-Low-Dose Aspirin in Platelet Activity Alterations and Haemorrhage Observed in Experimental Portal Hypertension

    Directory of Open Access Journals (Sweden)

    F. X. Eizayaga

    2012-01-01

    Full Text Available Ultra-low-dose aspirin has shown a prothrombotic effect in the laser-induced thrombosis model. Several studies of our laboratory have shown a positive effect in rats with two different experimental models of portal hypertension: portal vein ligation, a model with an almost normal liver, and 30 days of bile duct ligation, a model with cirrhosis and presence of ascitis. In both models of portal hypertensive rats, bleeding time was prolonged and thrombi formation, in a laser-induced model of thrombi production, decreased. The hypotheses of the presented studies were that ultra-low-dose aspirin could decrease the bleeding complications in these models and that the mechanism for these effects could act thorough the COX pathway. In different studies, ultra-low dose of aspirin normalized the induced hemorrhage time, thrombi production, and platelet-endothelial cell interaction. The possible beneficial role of these doses of aspirin and mechanism of COX 2 inhibition are discussed.

  14. Soluble CD163, a marker of Kupffer cell activation, is related to portal hypertension in patients with liver cirrhosis

    DEFF Research Database (Denmark)

    Grønbaek, H; Sandahl, T D; Mortensen, C

    2012-01-01

    BACKGROUND: Activation of Kupffer cells may be involved in the pathogenesis of portal hypertension by release of vasoconstrictive substances and fibrosis due to co-activation of hepatic stellate cells. AIM: To study soluble plasma (s) CD163, a specific marker of activated macrophages, as a biomar......BACKGROUND: Activation of Kupffer cells may be involved in the pathogenesis of portal hypertension by release of vasoconstrictive substances and fibrosis due to co-activation of hepatic stellate cells. AIM: To study soluble plasma (s) CD163, a specific marker of activated macrophages......, as a biomarker for portal hypertension in patients with liver cirrhosis. METHODS: We measured sCD163 concentration and the hepatic venous pressure gradient (HVPG) by liver vein catheterisation in 81 cirrhosis patients (Child-Pugh CP-A: n = 26, CP-B: n = 29, CP-C: n = 26) and 22 healthy subjects. We also measured...... for HVPG. These findings support a primary role of macrophage activation in portal hypertension, and may indicate a target for biological intervention....

  15. Glutamine and recombinant human growth hormone protect intestinal barrier function following portal hypertension surgery

    Institute of Scientific and Technical Information of China (English)

    Zhao-Feng Tang; Yun-Biao Ling; Nan Lin; Zheng Hao; Rui-Yun Xu

    2007-01-01

    AIM: To evaluate the effects of combined treatment of glutamine (Gln) and recombinant human growth hormone(rhGH) on intestinal barrier function following portal hypertension surgery.METHODS: This study was designed as a prospective,randomized and controlled clinical trial. Forty two patients after portal hypertension surgery were randomly assigned into 2 groups: control group (n = 20) and supplemental group (adding Gin and rhGH, n = 22). Every patient received isocaloric and isonitrogenous standard total parenteral nutrition (TPN) starting 3 d after surgery for 7 d. Blood samples were obtained before surgery and at the 3rd and 10th day postoperatively. Host immunity was evaluated by measuring levels of CD4, CD8, CD4/CD8, IgG, IgM and IgA, and the inflammatory responses were determined by assessing IL-2, TNF-α and C-reactive protein (CRP) levels. Intestinal permeability and integrity was evaluated by L/M test and histological examination, respectively.RESULTS: On postoperative d 10, CD4, CD4/CD8, IgG and IL-2 levels in supplemental group were significantly higher than those in control group (33.7 ± 5.5 vs 31.0± 5.4, P < 0.05, (1.17 ± 0.32 vs 1.05 ± 0.15, P < 0.05,13.94 ± 1.09 vs 12.33±1.33, P < 0.05, and 368.12± 59.25 vs 318.12 ± 45.65, P < 0.05, respectively),whereas the increase in serum TNF-α concentration was significantly reduced (41.02 ± 27.56 vs 160.09 ± 35.17,P < 0.05). The increase in L/M ratio was significantly lower in the supplemental group than in the control group (0.0166 ± 0.0017 vs 0.0339 ± 0.0028, P < 0.05).Moreover, mucosal integrity in the supplemental group was better than in the control group.CONCLUSION: Postoperative administration of TPN supplemented with Gin and rhGH in patients after portal hypertension surgery improves immune function,modulates inflammatory response, prevents the intestinal mucous membrane from atrophy and preserves intestinal integrity.

  16. Splenectomy with endoscopic variceal ligation is superior to splenectomy with pericardial devascularization in treatment of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Nan Lin; Bo Liu; Rui-Yun Xu; He-Ping Fang; Mei-Hai Deng

    2006-01-01

    AIM: To investigate the therapeutic efficacy and complications of splenectomy with endoscopic variceal ligation (EVL) and splenectomy with pericardial devascularization (i.e. Hassab's operation) in patients with portal hypertension.METHODS: A total of 103 patients with liver cirrhosis and portal hypertension were randomly selected to receive either splenectomy with EVL (n = 53, group A) or Hassab's operation (n = 50, group B).RESULTS: The portal blood flow volume, the presence of portal vein thrombosis, gastric emptying time and free portal venous pressure (FPP) before and after the operation were determined. Patients were followed up for up to 64 mo with an average of 45 mo, and the Dagradi classification of variceal veins and the grading of portal hypertension gastropathy (PHG) were evaluated.It was found that all esophageal varices were occluded or decreased to grade Ⅱ or less in both groups. There was little difference in the recurrence rate of esophageal varices (11.9% vs13.2%) and the re-bleeding rate (7.1% vs 5.3%) between groups A and B. The incidence of complications and the percentage of patients with severe PHG after the operation were significantly higher in group B (60.0% and 52.0%) than in group A (32.1%and 20.8%, P < 0.05). No patients died of operationrelated complications. There was no significant difference in gastric emptying time, FPP and portal blood flow volume between the two groups.CONCLUSION: The results suggest that splenectomy with EVL achieves similar therapeutic efficacy to that of Hassab's operation interms of the recurrence rate of esophageal varices and the re-bleeding rate, but the former results in fewer and milder complications.

  17. Combination therapy using PSE and TIO ameliorates hepatic encephalopathy due to intrahepatic portosystemic venous shunt in idiopathic portal hypertension

    Directory of Open Access Journals (Sweden)

    Seiichiro Kojima

    2016-09-01

    Full Text Available A 64-year-old woman treated for anemia and ascites exhibited hepatic encephalopathy. Abdominal ultrasonography and computed tomography (CT showed communication between the portal vein and the middle hepatic vein, indicating an intrahepatic portosystemic venous shunt (PSS. Since hepatic encephalopathy of the patient was resistant to medical treatment, interventional radiology was performed for the treatment of shunt obliteration. Hepatic venography showed anastomosis between the hepatic vein branches, supporting the diagnosis of idiopathic portal hypertension (IPH. To minimize the increase in portal vein pressure after shunt obliteration, partial splenic artery embolization (PSE was first performed to reduce portal vein blood flow. Transileocolic venous obliteration (TIO was then performed, and intrahepatic PSS was successfully obliterated using coils with n-butyl-2-cyanoacrylate (NBCA. In the present case, hepatic encephalopathy due to intrahepatic PSS in the patient with IPH was successfully treated by combination therapy using PSE and TIO.

  18. PRO-C3-levels in patients with HIV/HCV-Co-infection reflect fibrosis stage and degree of portal hypertension

    DEFF Research Database (Denmark)

    Jansen, Christian; Leeming, Diana J; Mandorfer, Mattias

    2014-01-01

    BACKGROUND: Liver-related deaths represent the leading cause of mortality among patients with HIV/HCV-co-infection, and are mainly related to complications of fibrosis and portal hypertension. In this study, we aimed to evaluate the structural changes by the assessment of extracellular matrix (ECM......) derived degradation fragments in peripheral blood as biomarkers for fibrosis and portal hypertension in patients with HIV/HCV co-infection. METHODS: Fifty-eight patients (67% male, mean age: 36.5 years) with HIV/HCV-co-infection were included in the study. Hepatic venous pressure gradient (HVPG......4M and C5M levels were higher in patients with portal hypertension (HVPG>5 mmHg). CONCLUSION: PRO-C3 levels reflect liver injury, stage of liver fibrosis and degree of portal hypertension in HIV/HCV-co-infected patients. Furthermore, C4M and C5M were associated with increased portal pressure...

  19. Congenital extrahepatic portosystemic shunts

    Energy Technology Data Exchange (ETDEWEB)

    Murray, Conor P.; Yoo, Shi-Joon; Babyn, Paul S. [Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, Ontario (Canada)

    2003-09-01

    A congenital extrahepatic portosystemic shunt (CEPS) is uncommon. A type 1 CEPS exists where there is absence of intrahepatic portal venous supply and a type 2 CEPS where this supply is preserved. The diagnosis of congenital portosystemic shunt is important because it may cause hepatic encephalopathy. To describe the clinical and imaging features of three children with CEPS and to review the cases in the published literature. The diagnostic imaging and medical records for three children with CEPS were retrieved and evaluated. An extensive literature search was performed. Including our cases, there are 61 reported cases of CEPS, 39 type 1 and 22 type 2. Type 1 occurs predominantly in females, while type 2 shows no significant sexual preponderance. The age at diagnosis ranges from 31 weeks of intrauterine life to 76 years. Both types of CEPS have a number of associations, the most common being nodular lesions of the liver (n=25), cardiac anomalies (n=19), portosystemic encephalopathy (n=10), polysplenia (n=9), biliary atresia (n=7), skeletal anomalies (n=5), and renal tract anomalies (n=4). MRI is recommended as an important means of diagnosing and classifying cases of CEPS and examining the associated cardiovascular and hepatic abnormalities. Screening for CEPS in patients born with polysplenia is suggested. (orig.)

  20. Pathological mechanisms of alcohol-induced hepatic portal hypertension in early stage fibrosis rat model

    Institute of Scientific and Technical Information of China (English)

    Jian Li; Jian-Zhao Niu; Ji-Feng Wang; Yu Li; Xiao-Hua Tao

    2005-01-01

    AIM: To study the role of hepatic sinusoidal capillarization and perisinusoidal fibrosis in rats with alcohol-induced portal hypertension and to discuss the pathological mechanisms of alcohol-induced hepatic portal hypertension.METHODS: Fifty SD rats were divided into control group (n=20) and model group (n=30). Alcoholic liver fibrosis rat model was induced by intragastric infusion of a mixture containing alcohol, corn oil and pyrazole (1 000:250:3). Fifteen rats in each group were killed at wk 16. The diameter and pressure of portal vein were measured. Plasma hyaluronic acid (HA), type Ⅳ collagen (CoⅣ) and laminin (LN) were determined by radioimmunoassay. Liver tissue was fixed in formalin (10%) and 6-μm thick sectiors were routinely stained with Mallory and Sirius Red. Liver tissue was treated with rabbit polyclonal antibody against LN and ColⅣ. Hepatic non-parenchymal cells were isolated,total protein was extracted and separated by SDS-PAGE.MMP-2 and TIMP-1 protein expression was estimated by Western blotting.RESULTS: The diameter (2.207 ± 0.096 vs 1.528 ± 0.054 mm, P<0.01) and pressure (11.014±0.395 vs 8.533±0.274 mmHg, P<0.01) of portal vein were significantly higher in model group than those in the control group. Plasma HA (129.97±16.10 vs 73.09±2.38 ng/mL, P<0.01), ColⅣ (210.49±4.36 vs 89.65±4.42 ng/mL, P<0.01) and LN (105.00±7.29 vs 55.70±4.32 ng/mL, P<0.01) were upregulated in model group. Abundant collagen deposited around the central vein of lobules, hepatic sinusoids and hepatocytes in model group. ColⅠ and ColⅢ increased remarkably and perisinusoids were almost surrounded by ColⅢ.Immunohistochemical staining showed that ColⅣ protein level (0.130±0.007 vs 0.032±0.004, P<0.01) and LN protein level (0.152±0.005 vs 0.029±0.005, P<0.01)were up-regulated remarkably in model group. MMP-2 protein expression (2.306±1.089 vs 0.612±0.081,P<0.01) and TIMP-1 protein expression (3.015±1.364 vs 0.446±0.009, P<0

  1. Celecoxib ameliorates portal hypertension of the cirrhotic rats through the dual inhibitory effects on the intrahepatic fibrosis and angiogenesis.

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    Jin-Hang Gao

    Full Text Available BACKGROUND: Increased intra-hepatic resistance to portal blood flow is the primary factor leading to portal hypertension in cirrhosis. Up-regulated expression of cyclooxygenase-2 (COX-2 in the cirrhotic liver might be a potential target to ameliorate portal hypertension. OBJECTIVE: To verify the effect of celecoxib, a selective inhibitor of COX-2, on portal hypertension and the mechanisms behind it. METHODS: Cirrhotic liver model of rat was established by peritoneal injection of thiacetamide (TAA. 36 rats were randomly assigned to control, TAA and TAA+celecoxib groups. Portal pressures were measured by introduction of catheters into portal vein. Hepatic fibrosis was assessed by the visible hepatic fibrotic areas and mRNAs for collagen III and α-SMA. The neovasculature was determined by hepatic vascular areas, vascular casts and CD31 expression. Expressions of COX-2, vascular endothelial growth factor (VEGF, VEGF receptor-2 (VEGFR-2 and related signal molecules were quantitated. RESULTS: Compared with TAA group, the portal pressure in TAA+celecoxib group was significantly decreased by 17.8%, p<0.01. Celecoxib treatment greatly reduced the tortuous hepatic portal venules. The data of fibrotic areas, CD31expression, mRNA levels of α-SMA and collagen III in TAA+celecoxib group were much lower than those in TAA group, p<0.01. Furthermore, the up-regulation of hepatic mRNA and protein levels of VEGF, VEGFR-2 and COX-2 induced by TAA was significantly inhibited after celecoxib treatment. The expressions of prostaglandin E2 (PGE2, phosphorylated extracellular signal-regulated kinase (p-ERK, hypoxia-inducible factor-1α (HIF-1α, and c-fos were also down-regulated after celecoxib treatment. CONCLUSIONS: Long term administration of celecoxib can efficiently ameliorate portal hypertension in TAA rat model by its dual inhibitory effects on the intrahepatic fibrosis and angiogenesis. The anti-angiogenesis effect afforded by celecoxib may attribute to its

  2. Surgical indication in Schistosomiasis mansoni portal hypertension: follow-up from 1985 to 2001

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    Maria José Conceição

    2002-10-01

    Full Text Available The study had the objective to evaluate the benefits of surgical indication for portal hypertension in schistosomiasis patients followed from 1985 to 2001. Schistosoma mansoni eggs were confirmed by at least six stool examinations or rectal biopsy. Clinical examination, abdominal ultrasonography, and digestive endoscopy confirmed the diagnosis of esophageal varices. A hundred and two patients, 61.3% male (14-53 years old were studied. Digestive hemorrhage, hypersplenism, left hypochondrial pain, abdominal discomfort, and hypogonadism were, in a decreasing order, the major signs and symptoms determining surgical indication. Among the surgical techniques employed, either splenectomy associated to splenorenal anastomosis or azigoportal desvascularization, esophageal gastric descompression and esophageal sclerosis were used. Follow-up of patients revealed that, independent on the technique utilized, a 9.9% of death occurred, caused mainly by digestive hemorrhage due to the persistence of post-treatment varices. The authors emphasize the benefits of elective surgical indication allowing a normal active life.

  3. Arterial hypoxemia and intrapulmonary vasodilatation in rat models of portal hypertension.

    Science.gov (United States)

    Katsuta, Yasumi; Zhang, Xue-Jun; Ohsuga, Masaru; Akimoto, Toshio; Komeichi, Hirokazu; Shimizu, Shuji; Kato, Yoshihito; Miyamoto, Akiko; Satomura, Katsuaki; Takano, Teruo

    2005-08-01

    Rats with chronic bile duct ligation (CBDL) and portal vein ligation (PVL) are used as models of portal hypertension. CBDL rats show hypoxemia with intrapulmonary vasodilatation (IPVD), and are recognized as a model of hepatopulmonary syndrome (HPS), while PVL rats are normoxemic. We investigated the differences in arterial oxygenation between these models, and the key factors leading to HPS. Forty-eight Sprague-Dawley rats were prepared as CBDL or PVL models, or as Sham rats. Arterial oxygenation, hemodynamics (reference sample method), and IPVD were simultaneously evaluated in conscious and unrestrained animals, using (141)Ce- or (113)Sn-labeled microspheres (15 microm in diameter), respectively. Endothelin-1 (ET-1) and nitrate/nitrite (end products of nitric oxide; NOx) production by the lung tissue (increment across the lungs) was also determined. The extent of IPVD was similar in both models, but hypoxemia was only observed in CBDL rats. The ET-1 level and the increment in NOx were significantly increased in CBDL rats, and the increment was directly correlated with impairment of oxygenation. Blood flow through the bronchial arteries (anatomical shunting) was increased in CBDL rats, reaching more than three times the level in PVL rats or Sham rats. These results support the hypothesis that NO derived from the lung tissues contributes to hypoxemia, and IPVD appears to be a prerequisite for impaired oxygenation. The considerable increase of anatomical shunting may potentially contribute to impaired oxygenation in CBDL rats.

  4. Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Michael A. [University Hospital Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); Karolinska Institutet, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden); Brehmer, Katharina [Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden); Svensson, Anders; Aspelin, Peter; Brismar, Torkel B. [Karolinska Institutet, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden); Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden)

    2016-11-15

    To assess liver perfusion-CT (P-CT) parameters derived from peak-splenic (PSE) versus peak-renal enhancement (PRE) maximum slope-based modelling in different levels of portal-venous hypertension (PVH). Twenty-four patients (16 men; mean age 68 ± 10 years) who underwent dynamic P-CT for detection of hepatocellular carcinoma (HCC) were retrospectively divided into three groups: (1) without PVH (n = 8), (2) with PVH (n = 8), (3) with PVH and thrombosis (n = 8). Time to PSE and PRE and arterial liver perfusion (ALP), portal-venous liver perfusion (PLP) and hepatic perfusion-index (HPI) of the liver and HCC derived from PSE- versus PRE-based modelling were compared between the groups. Time to PSE was significantly longer in PVH groups 2 and 3 (P = 0.02), whereas PRE was similar in groups 1, 2 and 3 (P > 0.05). In group 1, liver and HCC perfusion parameters were similar for PSE- and PRE-based modelling (all P > 0.05), whereas significant differences were seen for PLP and HPI (liver only) in group 2 and ALP in group 3 (all P < 0.05). PSE is delayed in patients with PVH, resulting in a miscalculation of PSE-based P-CT parameters. Maximum slope-based P-CT might be improved by replacing PSE with PRE-modelling, whereas the difference between PSE and PRE might serve as a non-invasive biomarker of PVH. (orig.)

  5. Dynamic CT and MRA findings of a case of portopulmonary venous anastomosis (PPVA) in a patient with portal hypertension: a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Jeong Min; Ahn, Myeong Im; Han, Dae Hee; Jung, Jung Im; Park, Seog Hee (Dept. of Radiology, Seoul St Mary' s Hospital, College of Medicine, The Catholic Univ. of Korea, Seoul (Korea, Republic of)), email: ami@catholic.ac.kr

    2011-06-15

    Portopulmonary venous anastomosis (PPVA), which has been rarely reported in conventional CT and MR studies, is an unusual collateral pathway in patients with portal hypertension. It has clinical implications related to right-to-left shunt that are different from the clinical implications related to other more usual portosystemic shunts in portal hypertensive patients. Here, we report the dynamic CT and MRA findings of a case of PPVA in a patient with portal hypertension, directly demonstrating the shunt flow from the paraesophageal varix to the left atrium via the right inferior pulmonary vein

  6. 门静脉高压症少见成因及其诊断%Portal hypertension: rare causes and their diagnosis

    Institute of Scientific and Technical Information of China (English)

    孙立平; 童巧霞; 揭盛华

    2011-01-01

    Portal hypertension is defined as an increase in blood pressure in the veins of the portal system and extensive formation of portal-systemic communicating branches, which results from a blockage in the portal blood flow or abnormal blood increment. Generally, cirrhotic portal hypertension is common more than non-cirrhotic portal hypertension, but the latter is caused by a group of diseases, such as idiopathic portal hypertension(IPH), pancreatic sinistral portal hypertension (PSPH), cavernous transformation of the portal vein (CTPV), congenital hepatic fibrosis (CHF), Budd-Chiari syndrome (BCS), hepatic sinusoidal obstruction syndrome (SOS), portal vein thrombosis (PVT), myeloproliferative disease (MLD), hepatic amyloidosis, and hemochromatosis (HC). This paper reviews the rare causes of portal hypertension and their diagnosis.%门静脉高压症是指由不同原因引起的门静脉血流受阻或者血流异常增多而导致门静脉系统压力增高和广泛侧支循环形成的临床综合征,最常见于肝硬化.而非硬化性门脉高压常见于特发性门静脉高压(idiopathic portal hypertension,IPH)、胰源性门脉高压(pancreatic sinistral portal hypertension,PSPH)、门静脉海绵样变性(cavernous transformation of the portal vein,CTPV)、先天性肝纤维化(congenital hepatic fibrosis,CHF)、Budd-Chiari综合征(Budd-Chiari syndrome,BCS)、肝窦阻塞综合征(hepatic sinusoidal obstruction syndrome,SOS)、门静脉血栓形成(portal vein thrombosis,PVT)、骨髓增生性疾病(myeloproliferative disease,MLD)、肝淀粉样变(hepatic amyloidosis)、血色病(hemochromatosis,HC)等.本文就这几种门脉高压的少见成因及诊断作一综述.

  7. Extrahepatic manifestations of HCV.

    Science.gov (United States)

    Grignoli, R; Goossens, N; Negro, F

    2015-03-01

    The hepatic consequences of an infection with the hepatitis C virus (HCV) are well recognised, but extrahepatic manifestations of HCV may be just as severe. Here we have reviewed various extrahepatic manifestations of HCV such as mixed cryoglobulinemia, lymphoma, metabolic features and neurologic consequences and we discuss pathogenesis and management of these clinical problems. We concluded with important aspects of therapy with novel anti-HCV agents and its effects on extrahepatic manifestations.

  8. Antibody titers and response to vaccination against hepatitis A and B in pediatric patients with portal hypertension.

    Science.gov (United States)

    Rosa, Mariana Nogueira de Paula; Hessel, Gabriel; Alves De Tommaso, Adriana María

    2008-09-01

    In Brazil, approximately 130 new cases of hepatitis A per 100,000 inhabitants occur annually and 15% of the population has been in contact with hepatitis B virus. Portal hypertension causes hypersplenism and reduces T cell production, which may lead to less effective response to hepatitis vaccination. The objective of the study was to evaluate the response to hepatitis A and B vaccination in patients with portal hypertension secondary to chronic liver disease or portal vein thrombosis. Twenty-three patients (2 to 18 years) with portal hypertension seen at the Pediatric Hepatology Service of Hospital das Clínicas, Universidade Estadual de Campinas, between 1994 and 2006 were studied. Hepatitis A and B serology was tested in all patients. Patients who had not been vaccinated before their visits received the vaccines during the study period. Patients who had been vaccinated before but had negative anti-HB antibodies received a booster dose, and their serology was repeated Blood counts were performed in each patient to assess for immunosuppression. Eighteen patients received hepatitis A vaccine and all became positive for anti-HAV antibodies. All patients had received hepatitis B vaccine and 17 (73.9%) were anti-HBs positive at the time of the study The other 6 received a booster dose and became anti-HBs positive afterward. The anti-HBs-positive and -negative patients did not differ significantly in age, leukocytes, lymphocytes, or duration between the vaccination and positive serology. In this study, hepatitis A vaccines elicited a 100% response and hepatitis B vaccine conferred protection and induced an anamnestic response in pediatric patients with portal hypertension.

  9. Is portal vein cavernous transformation a component of congenital hepatic fibrosis?

    Institute of Scientific and Technical Information of China (English)

    Ozlem Yonem; Yusuf Bayraktar

    2007-01-01

    Congenital hepatic fibrosis (CHF) is an autosomal recessive disorder that belongs to the family of fibropolycystic liver diseases. This family includes a spectrum of disorders which are usually found in combination with each other and are usually inherited.Clinically fibropolycystic diseases have three effects being present in different proportions, those of a space occupying lesion, of portal hypertension and of cholangitis. In most patients, the first manifestations of CHF are signs and symptoms related to portal hypertension such as splenomegaly and varices. Portal hypertension in these patients has been attributed to the hypoplasia or compression of the portal vein radicles in the fibrous bands. Cavernous transformation of the portal vein (CTPV) is a relatively rare condition resulting from extrahepatic portal vein obstruction with recanalization or collateral vein formation to bypass the obstruction. It has been found that patients with CHF having an accompanying CTPV have relatively large splenomegaly and suffers more frequent episodes of bleeding from esophageal varices. We believe that CTPV is a congenital component of CHF and also one of the important causative factors of portal hypertension in these patients.

  10. 肝门静脉高压症猪肝门静脉的结构重建%Structure remodeling of swine portal vein in portal hypertension

    Institute of Scientific and Technical Information of China (English)

    贺细菊; 余明华; 李静; 黄铁柱

    2011-01-01

    目的:建立猪肝门静脉高压症模型,探讨肝门静脉高压症时肝门静脉的结构重建.方法:猪以四氯化碳、苯巴比妥、乙醇配合高脂、低蛋白、低胆碱饮食进行混合饲养.通过脾静脉插管测压,取门静脉常规石蜡包埋、切片,用H-E 染色法、Weigert法、Aniline blue法、Organge G法分别染组织结构、弹性纤维、胶原纤维和平滑肌,用计算机图像分析系统定量分析肝门静脉的几何形态及显微成分.结果:实验组肝门静脉压为(4.17±1.03)kPa,而正常组为(1.51±0.79)kPa,实验组门静脉的内膜与中膜增厚,管壁增厚,管径增粗,平滑肌、胶原纤维的百分含量增加,平滑肌细胞核的数密度和面密度也在增加,C/E值增加.结论:肝门静脉高压症时,与血液动力学改变相适应,肝门静脉的几何形态与显微结构成分均发生了改变.%Objective: To establish reliable swine portal hypertension model and explore the morphological properties of hepatic portal vein.Methods: Liver cirrhosis and portal hypertension was induced by carbon tetrachloride and fenobarbital (n = 8), 4 pigs served as the control, and the hepatic arteries were collected and serially sectioned.The tissue structure, elastic fiber, collagen fiber and smooth muscle were stained by H-E, Weigert, Aniline blue and Orange G respectively.The morphological data of hepatic arteries were obtained by the computer image analysis system.Results: The portal vein pressure of the experimental group was (4.17 ± 1.03) kpa, and that of normal group was (1.51 ± 0.79) kPa.The thickness of intima and media wall, diameter of the experimental group were significantly larger than those of the normal group (P <0.01).The relative content of collagenic fiber and smooth muscle, and C/E of the experimental group were also significantly larger than that of the normal group.Conclusion: In portal hypertension, the structure remodeling of the portal vein was significantly changed, and

  11. ASSOCIATION OF GENE POLYMORPHISMS OF THE RENIN-ANGIOTENSIN SYSTEM AND ENDOTHELIAL DYSFUNCTION WITH DEVELOPMENT AND SEVERITY OF PORTAL HYPERTENSION IN PATIENTS WITH CHRONIC HEPATITIS C

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    O. V. Taratina

    2016-01-01

    Full Text Available Background: At present, much attention is paid to genetic factors explaining the clinical course of chronic hepatitis C. Aim: To evaluate an association of the gene polymorphisms involved in the formation of endothelial dysfunction (NOS3 894G/T, CYBA 242C/T, MTHFR 677C/T and encoding components of the renin-angiotensin system (ATR1 1166A/C, AGT (-6G/T and 235M/T with development and severity of portal hypertension syndrome in patients with chronic hepatitis C. Materials and methods: 162 patients with chronic hepatitis C and HCV-related cirrhosis (114 women and 48 men were divided into the following groups: no portal hypertension (n = 98, "compensated" (n = 19 and "decompensated" (n = 45 portal hypertension. The gene polymorphisms were assessed by molecular genetic methods. Results: TT genotype of CYBA was more common in patients with portal hypertension than in those without (odds ratio (OR for TT = 3.59, p = 0.031. This difference becomes larger when comparing the decompensated portal hypertension group with the no portal hypertension group (OR TT = 5.46, p = 0.009. Other gene polymorphisms were not associated with development or decompensation of portal hypertension. Multivariate analysis of the impact of genetic, clinical and demographic factors showed that portal hypertension was associated primarily with patients age at the time of the study (Wald's х2 = 14.99 and with their body mass index (Wald's х2 = 4.35. After exclusion of these population-wide risk factors from the model, the development of portal hypertension correlated with the carriage of 235TT genotype of CYBA (Wald's х2 = 6.07, OR = 4.29 and (-6AA genotype AGT (Wald's х2 = 4.73, OR = 4.13, as well as with the lack of protective 235TT genotype AGT (Wald's х2 = 4.06, OR = 0.33. The combined effects of the studied gene polymorphisms on decompensation of the portal hypertension in patients with chronic HCV infection were similar. Conclusion: The development and increase in

  12. Uso de octreotida na hemorragia digestiva alta secundária à hipertensão portal em pacientes pediátricos: experiência de um serviço terciário Uso de octreotide en la hemorragia digestiva alta secundaria a hipertensión portal en pacientes pediátricos: experiencia de un servicio terciario Octreotide for acute gastrointestinal bleeding secondary to portal hypertension in pediatric patients: experience of a tertiary center

    Directory of Open Access Journals (Sweden)

    Daniela Gois Meneses

    2011-12-01

    classified according the Child-Pugh score. RESULTS: Portal hypertension etiology was extra-hepatic portal vein obstruction in 11/17 (65% patients and cirrhosis in 6/17 (35%. Bleeding was controlled in 14/17 (82% patients. Octreotide infusion requirement was similar in cirrhotic and non-cirrhotic patients, but the decline in hemoglobin levels and the requirement of blood transfusions were greater but not significant in cirrhotic patients. The patients' responses were similar regardless of drug infusion strategy. Whether it included a loading dose or not. Treatment failure was observed mainly among cirrhotic patients (33%. Hyperglycemia was the only side effect detected during octreotide infusion. CONCLUSIONS: Octreotide administration in children and adolescents with digestive bleeding due to portal hypertension was safe and effective in order to control the acute episode of bleeding, regardless of the etiology of portal hypertension and infusion strategy.

  13. Plasma ADAMTS-13 protein is not associated with portal hypertension or hemodynamic changes in patients with cirrhosis

    DEFF Research Database (Denmark)

    Wiese, Signe; Timm, Annette; Nielsen, Lars B

    2016-01-01

    BACKGROUND: Activated hepatic stellate cells synthesize the matrix metalloprotease ADAMTS13, which may be involved in the development of liver cirrhosis and portal hypertension. Plasma ADAMTS13 activity has been reported as both increased and decreased in cirrhosis, but ADAMTS13 protein has...... not previously been examined. AIM: To evaluate ADAMTS13 protein in the hepatic circulation and the relation to disease severity, portal pressure, and systemic hemodynamics in cirrhotic patients. METHODS: Sixty-one cirrhotic patients (Child class: A=22; B=21; C=18) and nine healthy controls underwent a liver vein......portal pressure, nor systemic vascular resistance or cardiac output. CONCLUSIONS: The increased concentration of ADAMTS13 protein in the hepatic circulation may reflect an increased number of active hepatic stellate cells...

  14. Expression of local renin and angiotensinogen mRNA in cirrhotic portal hypertensive patient

    Institute of Scientific and Technical Information of China (English)

    Li Zhang; Zhen Yang; Bao-Min Shi; Da-Peng Li; Chong-Yun Fang; Fa-Zu Qiu

    2003-01-01

    AIM: To investigate the expression of local renin and angiotensinogen mRNA in cirrhotic portal hypertensive patients.METHODS: The expression of local renin and angiotensinogen mRNA in the liver, splenic artery and vein of PH patients was detected by RT-PCR analysis.RESULTS: Expression of local renin mRNA in the liver of control group was (0.19±0.11), significantly lower than that in splenic artery(0.45±0.17)or splenic vein(0.39±0.12)respectively, (P<0.05). Expression of local angiotensinogen mRNA in the liver was (0.64±0.21), significantly higher than that in splenic artery(0.41±0.15) or in splenic vein (0.35±0.18)respectively, (P<0.05). Expression of local renin mRNA in the liver, splenic artery and vein of PH group was (0.78±0.28),(0.86±0.35) and (0.81±0.22) respectively, significantly higher than that in the control group, (P<0.05). Expression of local angiotensinogen mRNA in the liver, splenic artery and vein of PH group was (0.96±0.25), (0.83±0.18) and (0.79±0.23)respectively, significantly higher than that in the control group,(P<0.05). There was no significant difference between the liver, splenic artery and vein in the expression of local renin or local angiotensinogen mRNA in PH group, (P<0.05).CONCLUSION: In normal subjects the expression of local renin and angiotensinogen mRNA was organ specific, but with increase of the expression of LRAS, the organ-specificity became lost in cirrhotic patients. LRAS may contribute to increased resistance of portal vein with liver and formation of splanchnic vasculopathy.

  15. Life-Threatening Bleeding from Peristomal Varices after Cystoprostatectomy: Multimodal Approach in a Cirrhotic, Encephalopathic Patient with Severe Portal Hypertension

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    Sergej E. L. Staubli

    2015-01-01

    Full Text Available The bleeding of peristomal varices due to a portosystemic shunt is rare but potentially life-threatening in cirrhotic patients with portal hypertension. The scarce case reports in the literature recommend transjugular intrahepatic portosystemic shunt (TIPS to prevent further bleeding. We report on a 72-year-old man who was referred to our hospital because of life-threatening bleeding from peristomal varices, three years after radical cystoprostatectomy for invasive bladder cancer. CT imaging showed liver cirrhosis with a prominent portosystemic shunt leading to massively enlarged peristomal varices. TIPS was taken into consideration, but not possible due to hepatic encephalopathy (HE. Medical therapy with lactulose and the nonselective beta-blocker carvedilol was initiated to treat HE and portal hypertension. In a second step, the portosystemic shunt was percutaneously embolized. Here, we present a multimodal approach to treat intractable bleeding from peristomal varices in a patient with ileal conduit urinary diversion, not suitable for TIPS.

  16. Congenital extrahepatic portosystemic shunt associated with heterotaxy and polysplenia

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley [Lucile Packard Children' s Hospital, Department of Radiology, Stanford University School of Medicine, Stanford, CA (United States); Feinstein, Jeffrey A. [Stanford University School of Medicine, Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children' s Hospital, Stanford (United States); Cohen, Ronald A.; Patel, Hitendra [Children' s Hospital and Research Center, Department of Diagnostic Radiology, Oakland, CA (United States); Feingold, Brian; Kreutzer, Jacqueline [Children' s Hospital of Pittsburgh, Department of Pediatrics, Division of Pediatric Cardiology, Pittsburgh, PA (United States); Chan, Fandics P. [Stanford University School of Medicine, Cardiovascular Imaging Section, Department of Radiology, Lucile Packard Children' s Hospital, Stanford, CA (United States)

    2010-07-15

    Heterotaxy with polysplenia is associated with many cardiovascular anomalies including the occasional occurrence of congenital extrahepatic portosystemic shunts (CEPS). Missing this anomaly can lead to inappropriate and ineffective therapy. To emphasize the importance and associated anatomy of CEPS in conjunction with heterotaxy with polysplenia. Review of three young children who presented with cyanosis and pulmonary hypertension without a cardiac etiology. They were known (1) or discovered (2) to have heterotaxy with polysplenia. There was absence of the intrahepatic inferior vena cava (IVC) with azygos or hemiazygos continuation in all three cases. In spite of normal liver function, they were discovered to have large portosystemic shunts, splenorenal in location, along with diffuse peripheral pulmonary arterial dilatation suggestive of CEPS (Abernethy malformation) with hepatopulmonary or, more accurately, portopulmonary syndrome. All CEPS were ipsilateral to the spleens. Patency of the portal veins in these cases allowed for percutaneous shunt closure with resolution of cyanosis. CEPS is associated with heterotaxy with polysplenia and can be symptomatic because of pulmonary arteriovenous (AV) shunting. Portal and hepatic vein patency are critical for determining feasibility of CEPS closure. (orig.)

  17. Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding

    OpenAIRE

    Arruda,Severino Marcos Borba de; Barreto,Victorino Spinelli Toscano; Amaral,Fernando José do

    2008-01-01

    BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive pa...

  18. Analysis of risk factors for rebleeding after splenectomy and pericardial devascularization in treatment of portal hypertension due to liver cirrhosis

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    ZHANG Lei

    2015-03-01

    Full Text Available ObjectiveTo investigate the possible risk factors for rebleeding after splenectomy and pericardial devascularization in the treatment of portal hypertension due to liver cirrhosis, and to provide a certain basis for reducing the incidence of digestive tract re-hemorrhage for these patients. MethodsA retrospective analysis was performed on 238 cirrhotic patients with portal hypertension who underwent splenectomy and pericardial devascularization in the First Hospital of Lanzhou University from December 2003 to December 2013. These patients were divided into postoperative rebleeding group (n=32 and non-bleeding group (n=206. Univariate analysis (t test or chi-square test and multivariate logistic regression analysis were performed to investigate the risk factors for rebleeding after splenectomy and pericardial devascularization. ResultsOf the 32 patients with postoperative rebleeding, 17 had esophagogastric variceal bleeding, 11 had bleeding due to portal hypertensive gastropathy, and 4 had stress ulcer bleeding. The univariate analysis showed that there were significant differences between the two groups in the following factors: Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, pathological changes of the gastric mucosa, platelet count, prothrombin time (PT, activated partial thromboplastin time (APTT, and presence of diabetes (all P<0.05. The multivariate logistic regression analysis suggested that the significant independent influential factors for postoperative rebleeding were presence of diabetes, Child-Pugh classification of liver function, degree of liver cirrhosis evaluated intraoperatively, diffuse lesion of the gastric mucosa, PT, and APTT. ConclusionFor cirrhotic patients with portal hypertension, the appropriate methods for managing these risk factors are of great clinical significance for preventing rebleeding after splenectomy and pericardial devascularization.

  19. PARTIAL PORTOSYSTEMIC SHUNTING BY CARBON-COATED ePTFE GRAFTS FOR PORTAL HYPERTENSION IN CIRRHOTIC PATIENTS

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    I. A. Porshennikov

    2010-01-01

    Full Text Available We present our first experience gained in use of polytetrafluoroethylene carbon-coated grafts for partial portosystemic shunting in three cirrhotic patients. The results obtained indicate that these grafts in mesocaval position can function as a long-term «bridge» to hepatic transplantation in patients with uncontrolled gastroesophageal varices. The different options of portal hypertension treatment and the current role of shunting procedures in the era of liver transplantation are discussed in short literature review. 

  20. Experience in the treatment of some complications of portal hypertension in alcoholic liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Savić Željka

    2011-01-01

    Full Text Available Background/Aim. Portal hypertension (PH is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC: ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC. Methods. A total of 237 patients with ALC were observed in a 3-year period. Results. A total of 161 patients (68% were hospitalized because of PH elements: 86 (36.3% had upper gastrointestinal bleeding, 75 (31.7% were decompensated. Only 76 (32% of the patients had icterus. General mortality was 85 (36%. According to the source of bleeding, 61 (71% patients bled from varices, and 25 (29% from other sources with existing varices but non-incriminated for bleeding in 16 (64% of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73% cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78% patients, just octreotide in 32 (52.46%, and octreotid plus balloon tamponade in 9 (14.75%. According to Child-Pugh classification, 25 (29% of the bleeding patients were in class A, score 5.4; 43 (50% in class B, score 7.8; and 18 (21% in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L, ALT 37.74 U/L (normal to 40 U/L. Until this bleeding episode, 41 (47% of the patients already bled. In the decompensated patients 3 (4% were in Child Pugh class A, score 6; 42 (56% in class B, score 8.3; and 30 (40% in class C, score 10.6. Until this decompensation episode, 7 (9.3% patients already bled. Conclusion. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

  1. [Experience in the treatment of some complications of portal hypertension in alcoholic liver cirrhosis].

    Science.gov (United States)

    Savić, Zeljka; Vracarić, Vladimir; Hadnadjev, Ljiljana; Petrović, Zora; Damjanov, Dragomir

    2011-11-01

    Portal hypertension (PH) is hemodynamical abnormality associated with the most serious complications of alcoholic liver cirrhosis (ALC): ascites, varices and variceal bleeding. The aim of this study was to determine characteristics of portal hypertension, especially of upper gastrointestinal bleedings in patients with alcoholic liver cirrhosis (ALC). A total of 237 patients with ALC were observed in a 3-year period. A total of 161 patients (68%) were hospitalized because of PH elements: 86 (36.3%) had upper gastrointestinal bleeding, 75 (31.7%) were decompensated. Only 76 (32%) of the patients had icterus. General mortality was 85 (36%). According to the source of bleeding, 61 (71%) patients bled from varices, and 25 (29%) from other sources with existing varices but non-incriminated for bleeding in 16 (64%) of those patients. Active bleeding or stigmata of recent bleeding were found in 63 (73%) cases. Endoscopic treatment of variceal bleeding along with octreotide applied in 20 (32.78%) patients, just octreotide in 32 (52.46%), and octreotid plus balloon tamponade in 9 (14.75%). According to Child-Pugh classification, 25 (29%) of the bleeding patients were in class A, score 5.4; 43 (50%) in class B, score 7.8; and 18 (21%) in class C, score 10.9. Average hemoglobin level was 93 g/L, hematocrit 0.27, AST 71.52 U/L (normal to 37 U/L), ALT 37.74 U/L (normal to 40 U/L). Until this bleeding episode, 41 (47%) of the patients already bled. In the decompensated patients 3 (4%) were in Child Pugh class A, score 6; 42 (56%) in class B, score 8.3; and 30 (40%) in class C, score 10.6. Until this decompensation episode, 7 (9.3%) patients already bled. Patients with ALC need early detection of varices, primary and secondary profilaxis of variceal bleeding and adequate therapy of ascites. When bleeding occurs, patients need urgent upper endoscopy and intensive treatment.

  2. Hepatocellular carcinoma in cirrhotic patients with portal hypertension: Is liver resection always contraindicated?

    Institute of Scientific and Technical Information of China (English)

    Andrea Ruzzenente; Alessandro Valdegamberi; Tommaso Campagnaro; Simone Conci; Silvia Pachera; Calogero Iacono,; Alfredo Guglielmi

    2011-01-01

    AIM: To analyze the outcome of hepatocellular carcinoma (HCC) resection in cirrhosis patients, related to presence of portal hypertension (PH) and extent of hepatectomy. METHODS: A retrospective analysis of 135 patients with HCC on a background of cirrhosis was submitted to curative liver resection. RESULTS: PH was present in 44 (32.5%) patients. Overall mortality and morbidity were 2.2% and 33.7%, respectively. Median survival time in patients with or without PH was 31.6 and 65.1 mo, respectively (P = 0.047); in the subgroup with Child-Pugh class A cirrhosis, median survival was 65.1 mo and 60.5 mo, respectively (P = 0.257). Survival for patients submitted to limited liver resection was not significantly different in presence or absence of PH. Conversely, median survival for patients after resection of 2 or more segments with or without PH was 64.4 mo and 163.9 mo, respectively (P = 0.035). CONCLUSION: PH is not an absolute contraindication to liver resection in Child-Pugh class A cirrhotic patients, but resection of 2 or more segments should not be recommended in patients with PH.

  3. Portal hypertension secondary to myelofibrosis with myeloid metaplasia: A study of 13 cases

    Institute of Scientific and Technical Information of China (English)

    Mohannad Abu-Hilal; Jayant Tawaker

    2009-01-01

    AIM: To describe the clinical presentation and complications of portal hypertension (PH) secondary to myelofibrosis with myeloid metaplasia (MMM).METHODS: Medical records for 123 patients with MMM were reviewed.RESULTS: Thirteen patients with PH secondary to MMM were identified. Median ages at time of MMM and PH diagnosis were 61 and 66 years, respectively. The interval from MMM diagnosis to presentation with one of the PH features ranged from 1 to 11 years. Variceal bleeding and ascites were the most common presentations. Of the eight patients who presented with variceal bleeding, six patients underwent endoscopic variceal ligation (EVL) with no variceal recurrence or hematological worsening during a 12-mo follow up period.CONCLUSION: Patients with MMM might develop PH. Exact mechanisms leading to PH in MMM are still controversial. As in other etiologies, variceal bleeding and ascites are the most common presentations. Anemia may correlate with, and/or predict, the severity of the PH presentation in these patients. EVL can successfully control variceal bleeding in MMM. Further clinical studies are required.

  4. Multiple esophageal variceal ruptures with massive ascites due to myelofibrosis-induced portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Koichi Tokai; Hiroyuki Miyatani; Yukio Yoshida; Shigeki Yamada

    2012-01-01

    A 75-year old man had been diagnosed at 42 years of age as having polycythemia vera and had been monitored at another hospital.Progression of anemia had been recognized at about age 70,and the patient was thus referred to our center in 2008 where secondary myelofibrosis was diagnosed based on bone marrow biopsy findings.Hematemesis due to rupture of esophageal varices occurred in January and February of 2011.The bleeding was stopped by endoscopic variceal ligation.Furthermore,in March of the same year,hematemesis recurred and the patient was transported to our center.He was in irreversible hemorrhagic shock and died.The autopsy showed severe bone marrow fibrosis with mainly argyrophilic fibers,an observation consistent with myelofibrosis.The liver weighed 1856 g the spleen 1572 g,indicating marked hepatosplenomegaly.The liver and spleen both showed extramedullary hemopoiesis.Myelofibrosis is often complicated by portal hypertension and is occasionally associated with gastrointestinal hemorrhage due to esophageal varices.A patient diagnosed as having myelofibrosis needs to be screened for esophageal/gastric varices.Myelofibrosis has a poor prognosis.Therefore,it is necessary to carefully decide the therapeutic strategy in consideration of the patient's concomitant conditions,treatment invasiveness and quality of life.

  5. Value of color Doppler ultrasound in diagnosis of portal hypertension liver cirrhosis merged with esophageal variceal bleeding

    Institute of Scientific and Technical Information of China (English)

    Hai-Rong Yang

    2016-01-01

    Objective:To explore the value of color Doppler ultrasound in the diagnosis of portal hypertension liver cirrhosis merged with esophageal variceal bleeding.Methods:The clinical materials of 30 patients with portal hypertension liver cirrhosis merged with esophageal varices who were admitted in our hospital from August, 2014 to August, 2015 were retrospectively analyzed. According to whether there was a history of hematemesis and melena or not before and 3 months after ultrasound examination, and whether was esophageal variceal bleeding or not confirming by the electronic gastroscopy, the patients were divided into the bleeding group (17 cases) and non-bleeding group (13 cases). The color Doppler ultrasonic diagnosis apparatus was used to detect the inner diameter and blood flow rate of splenic vein, portal vein, and left gastric vein. The blood flow volume of splenic vein, portal vein, and left gastric vein was calculated.Results:The inner diameter and blood flow volume of splenic vein in the bleeding group were significantly higher than those in the non-bleeding group, but the blood flow rate was significantly lower than that in the non-bleeding group (P0.05). The inner diameter of left gastric vein in the bleeding group was significantly higher than that in the non-bleeding group, but the blood flow rate was significantly lower that that in the non-bleeding group (P0.05).Conclusions:Color Doppler ultrasound can detect the inner diameter of splenic vein, portal vein, and left gastric vein, and the related hemodynamic indicators, particularly, the inner diameter, blood flow rate, and blood flow volume of splenic vein are effective in predicting the risk of esophageal variceal bleeding.

  6. Increased transvascular escape rate of albumin during experimental portal and hepatic venous hypertension in the pig. Relation to findings in patients with cirrhosis of the liver

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Parving, H H; Christiansen, L

    1981-01-01

    and during regional venous congestion in the infradiaphragmatic area. Balloon catheters were placed in the portal vein (infrahepatic portal congestion) and in the inferior vena cava above (suprahepatic caval congestion) and below (infrahepatic caval congestion) the outlets of the hepatic veins. TERalb...... was on the average 13% IVMalb.h-1 under basal pressure conditions. TERalb rose significantly (p less than 0.01) during suprahepatic caval and infrahepatic portal congestion to an average of 29 and 19% IVMalb.h-1, respectively. TERalb was positively correlated to the portal pressure (r = 0.75, P less than 0...... the lining of the sinusoids and perisinusoidal space of the liver into the interstitial space around the portal vessels and further into the lymphatics, as the main mechanism of the previously demonstrated marked increase in TERalb in patients with portal venous hypertension due to cirrhosis of the liver....

  7. Distal splenorenal shunt with splenopancreatic disconnection for portal hypertension in biliary atresia.

    Science.gov (United States)

    Hasegawa, T; Tamada, H; Fukui, Y; Tanano, H; Okada, A

    1999-01-01

    This study evaluated the long-term effects of distal splenorenal shunt with splenopancreatic disconnection (DSRS-SPD) on portal hypertension (PH) in biliary atresia (BA) patients. Five patients with BA underwent DSRS-SPD at the age of 3.3 to 8.5 years. They had been free from jaundice after hepatic portoenterostomy (HPE); however, they gradually developed gastroesophageal varices and hypersplenism. Portal venous pressure after anastomosis was 37.2 +/- 6.1 cmH2O, as high as that before anastomosis (37.8 +/- 3.3 cmH2O). Postoperatively, liver function tests became worse within 2 weeks; however, they returned to preoperative levels within 1 month without any further treatment. No patient developed a significant encephalopathy throughout the observed period. During follow-up of 4 to 12 years, the shunt was patent in all patients. Spleen size decreased after operation. Abdominal-wall venous dilatation completely disappeared in two of four patients. The platelet counts gradually increased and were significantly higher 3 years (126.6 +/- 59.3 x 10(3)/mm3) after DSRS-SPD than preoperative values (66.0 +/- 24.2 x 10(3)/mm3). White blood cell counts showed no significant changes. No patient developed a gastrointestinal hemorrhage postoperatively, although three had had repeated hemorrhages before the operation. Two patients showed disappearance of varices endoscopically at 2 years and 7 months after DSRS-SPD, respectively, but had recurrent varices at 7 and 11 years, respectively. The endoscopic findings regarding varices 3 to 7 years after DSRS-SPD were as follows: decreased number (80%); decreased length (40%); improvement of form (20%); improvement of fundamental color (60%); disappearance of red-color sign (100%); disappearance of gastric varices (75%); and disappearance of acute gastric mucosal lesions (100%). Although one patient later underwent liver transplantation because of progression of liver cirrhosis, all five are doing well. From these results, DSRS-SPD may

  8. Prominent porto-systemic collateral pathways in patients with portal hypertension: demonstration by gadolinium-enhanced magnetic resonance angiography; Vias colaterais porto-sistemicas exuberantes em portadores de hipertensao portal: demonstracao pela angiografia por ressonancia magnetica com gadolinio

    Energy Technology Data Exchange (ETDEWEB)

    Caldana, Rogerio Pedreschi; Bezerra, Alexandre Araujo Sergio; Cecin, Alexnadre Oliveira; Souza, Luis Ronan Marques Ferreira de; Goldman, Susan Menasce; D' Ippolito, Giuseppe; Szejnfeld, Jacob [Universidade Federal de Sao Paulo (UNIFESP/EPM), Sao Paulo, SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: rogercal@uol.com.br

    2003-03-01

    To demonstrate the usefulness of gadolinium-enhanced magnetic resonance angiography in the evaluation of prominent porto-systemic collateral pathways. We reviewed the images from 40 patients with portal hypertension studied with gadolinium-enhanced magnetic resonance angiography and selected illustrative cases of prominent porto-systemic collateral pathways. The scans were performed using high field equipment (1.5 Tesla) and a 3 D volume technique. Image were obtained after intravenous injection of paramagnetic contrast media using a power injector. Magnetic resonance angiography demonstrated with precision the porto-systemic collateral pathways, particularly when investigating extensive territories or large vessels. The cases presented show the potential of this method in the investigation of patients with portal hypertension. Gadolinium-enhanced magnetic resonance angiography is a useful method for the evaluation of patients with portal hypertension and prominent collateral pathways. (author)

  9. The accuracy of ultrasonography for the evaluation of portal hypertension in patients with cirrhosis: A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gaeun; Cho, Youn Zoo; Baik, Soon Koo [College of Nursing, Research Institute for Nursing Science, Keimyung Univercity, Daegu (Korea, Republic of); Kim, Moon Young; Hong, Won Ki; Kwon, Sang Ok [Dept. of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2015-04-15

    Studies have presented conflicting results regarding the accuracy of ultrasonography (US) for diagnosing portal hypertension (PH). We sought to identify evidence in the literature regarding the accuracy of US for assessing PH in patients with liver cirrhosis. We conducted a systematic review by searching databases, including MEDLINE, EMBASE, and the Cochrane Library, for relevant studies. A total of 14 studies met our inclusion criteria. The US indices were obtained in the portal vein (n = 9), hepatic artery (n = 6), hepatic vein (HV) (n = 4) and other vessels. Using hepatic venous pressure gradient (HVPG) as the reference, the sensitivity (Se) and specificity (Sp) of the portal venous indices were 69-88% and 67-75%, respectively. The correlation coefficients between HVPG and the portal venous indices were approximately 0.296-0.8. No studies assess the Se and Sp of the hepatic arterial indices. The correlation between HVPG and the hepatic arterial indices ranged from 0.01 to 0.83. The Se and Sp of the hepatic venous indices were 75.9-77.8% and 81.8-100%, respectively. In particular, the Se and Sp of HV arrival time for clinically significant PH were 92.7% and 86.7%, respectively. A statistically significant correlation between HVPG and the hepatic venous indices was observed (0.545-0.649). Some US indices, such as HV, exhibited an increased accuracy for diagnosing PH. These indices may be useful in clinical practice for the detection of significant PH.

  10. Portal hypertension in patients with cirrhosis: indirect assessment of hepatic venous pressure gradient by measuring azygos flow with 2D-cine phase-contrast magnetic resonance imaging.

    Science.gov (United States)

    Gouya, Hervé; Grabar, Sophie; Vignaux, Olivier; Saade, Anastasia; Pol, Stanislas; Legmann, Paul; Sogni, Philippe

    2016-07-01

    To measure azygos, portal and aortic flow by two-dimensional cine phase-contrast magnetic resonance imaging (2D-cine PC MRI), and to compare the MRI values to hepatic venous pressure gradient (HVPG) measurements, in patients with cirrhosis. Sixty-nine patients with cirrhosis were prospectively included. All patients underwent HVPG measurements, upper gastrointestinal endoscopy and 2D-cine PC MRI measurements of azygos, portal and aortic blood flow. Univariate and multivariate regression analyses were used to evaluate the correlation between the blood flow and HVPG. The performance of 2D-cine PC MRI to diagnose severe portal hypertension (HVPG ≥ 16 mmHg) was determined by receiver operating characteristic curve (ROC) analysis, and area under the curves (AUC) were compared. Azygos and aortic flow values were associated with HVPG in univariate linear regression model. Azygos flow (p cine PC MRI is a promising technique to evaluate significant portal hypertension in patients with cirrhosis. • Noninvasive HVPG assessment can be performed with MRI azygos flow. • Azygos MRI flow is an easy-to-measure marker to detect significant portal hypertension. • MRI flow is more specific that varice grade to detect portal hypertension.

  11. Carvedilol for portal hypertension in cirrhosis: systematic review with meta-analysis.

    Science.gov (United States)

    Li, Tong; Ke, Wenbo; Sun, Ping; Chen, Xiang; Belgaumkar, Ajay; Huang, Yuanjian; Xian, Wenjing; Li, Jinjin; Zheng, Qichang

    2016-05-04

    To assess the clinical and haemodynamic effects of carvedilol for patients with cirrhosis and portal hypertension. A systematic review and meta-analysis. We searched PubMed, Cochrane library databases, EMBASE and the Science Citation Index Expanded through December 2015. Only randomised controlled trials (RCTs) were included. We calculated clinical outcomes (all-cause mortality, bleeding-related mortality, upper gastrointestinal bleeding) as well as haemodynamic outcomes (hepatic venous pressure (HVPG) reduction, haemodynamic response rate, post-treatment arterial blood pressure (mean arterial pressure; MAP) and adverse events). 12 RCTs were included. In 7 trials that looked at haemodynamic outcomes compared carvedilol versus propranolol, showing that carvedilol was associated with a greater reduction (%) of HVPG within 6 months (mean difference -8.49, 95% CI -12.36 to -4.63) without a greater reduction in MAP than propranolol. In 3 trials investigating differences in clinical outcomes between carvedilol versus endoscopic variceal band ligation (EVL), no significant differences in mortality or variceal bleeding were demonstrated. 1 trial compared clinical outcomes between carvedilol versus nadolol plus isosorbide-5-mononitrate (ISMN), and showed that no significant difference in mortality or bleeding had been found. 1 trial comparing carvedilol versus nebivolol showed a greater reduction in HVPG after 14 days follow-up in the carvedilol group. Carvedilol may be more effective in decreasing HVPG than propranolol or nebivolol and it may be as effective as EVL or nadolol plus ISMN in preventing variceal bleeding. However, the overall quality of evidence is low. Further large-scale randomised studies are required before we can make firm conclusions. CRD42015020542. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. PUMA mediates ER stress-induced apoptosis in portal hypertensive gastropathy.

    Science.gov (United States)

    Tan, S; Wei, X; Song, M; Tao, J; Yang, Y; Khatoon, S; Liu, H; Jiang, J; Wu, B

    2014-03-13

    Mucosal apoptosis has been demonstrated to be an essential pathological feature in portal hypertensive gastropathy (PHG). p53-upregulated modulator of apoptosis (PUMA) was identified as a BH3-only Bcl-2 family protein that has an essential role in apoptosis induced by a variety of stimuli, including endoplasmic reticulum (ER) stress. However, whether PUMA is involved in mucosal apoptosis in PHG remains unclear, and whether PUMA induces PHG by mediating ER stress remains unknown. The aim of the study is to investigate whether PUMA is involved in PHG by mediating ER stress apoptotic signaling. To identify whether PUMA is involved in PHG by mediating ER stress, gastric mucosal injury and apoptosis were studied in both PHG patients and PHG animal models using PUMA knockout (PUMA-KO) and PUMA wild-type (PUMA-WT) mice. The induction of PUMA expression and ER stress signaling were investigated, and the mechanisms of PUMA-mediated apoptosis were analyzed. GES-1 and SGC7901 cell lines were used to further identify whether PUMA-mediated apoptosis was induced by ER stress in vitro. Epithelial apoptosis and PUMA were markedly induced in the gastric mucosa of PHG patients and mouse PHG models. ER stress had a potent role in the induction of PUMA and apoptosis in PHG models, and the apoptosis was obviously attenuated in PUMA-KO mice. Although the targeted deletion of PUMA did not affect ER stress, mitochondrial apoptotic signaling was downregulated in mice. Meanwhile, PUMA knockdown significantly ameliorated ER stress-induced mitochondria-dependent apoptosis in vitro. These results indicate that PUMA mediates ER stress-induced mucosal epithelial apoptosis through the mitochondrial apoptotic pathway in PHG, and that PUMA is a potentially therapeutic target for PHG.

  13. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  14. [Effects of malnutrition on infective morbidity in the surgical treatment of portal hypertension (prospective evaluation)].

    Science.gov (United States)

    Herrera, M F; Hoyos, C; Prado, E; Orozco, H

    1991-01-01

    With the aim of investigating the preoperative frequency of undernutrition and its impact on the infectious morbidity in patients without malignant disease, we studied prospectively 41 patients operated because of portal hypertension between 1987 and 1989 at the Instituto Nacional de la Nutrición. All patients were evaluated through anthropometric analysis and biochemical markers one week before the surgical procedure. A standard scheme of antibiotic profilaxis was used during surgery and the preoperative complications were registered up to discharge from the hospital. Undernutrition was considered when the serum albumin was less than 3 mg/dL or the total lymphocyte count was under 900, associated with a 10% weight loss in six months and reduction of one or more anthropometric parameters below the 30th percentile of the normal value. The group consisted of 17 males and 24 females with a mean age of 48 +/- 14 years old. 35 were Child A, four Child B and two Child C. Ten patients had a distal splenorenal shunt, seven esophageal devascularization and 24 gastric desvascularization with splenectomy. Twenty eight patients were well nourished and 13 undernourished. The two groups were comparable in all parameters except for the nutritional status. In the first group seven patients developed 10 complications and in the undernourished group eight patients had 14 complications (p less than 0.05 chi 2). There was no significant difference in the mortality rate. Infections occurred more frequently in: urinary tract, surgical wound, lung and pleura, and esophageal fistulae was an additional complication. The univariate analysis of the anthropometric parameters did not show significant differences between both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Role of PGI2 in the formation and maintenance of hyperdynamic circulatory state of portal hypertensive rats

    Institute of Scientific and Technical Information of China (English)

    Zhi-Yong Wu; Xue-Song Chen; Jiang-Feng Qiu; Hui Cao

    2005-01-01

    AIM: To investigate the role of prostacyclin (PGI2) and nitric oxide (NO) in the development and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats.METHODS: Ninety male Sprague-Dawley rats were divided into three groups: intrahepatic portal hypertension (IHPH)group by injection of CCl4, prehepatic portal hypertension (PHPH) group by partial stenosis of the portal vein and sham-operation control (SO) group. One week after the models were made, animals in each group were subdivided into 4 groups: saline controlled group (n = 23), Nω-nitroL-arginine (L-NNA)group (n = 21) group, indomethacin (INDO)group (n = 22) and high-dose heparin group (n = 24). The for one week, then heparin (200 IU/Kg/min) was given to rats by intravenous injection for an hour. Splanchnic and systemic hemodynamics were measured using radioactive microsphere techniques. The serum nitrate/nitrite(NO2-/NO3-)levels as a marker of production of NO were assessed by a colorimetric method, and concentration of 6-keto-PGF1α,a stable hydrolytic product of PGI2, was determined by radioimmunoassay.RESULTS: The concentrations of plasma 6-keto-PGF1α(pg/mL) and serum NO2-/NO3- (μmol/L) in IHPH rats(1123.85±153.64, 73.34±4.31) and PHPH rats (891.88±83.11,75.21±6.89) were significantly higher than those in SO rats(725.53±105.54, 58.79±8.47) (P<0.05). Compared with SO rats, total peripheral vascular resistance (TPR) and spanchnic vascular resistance (SVR) decreased but cardiac index (CI) and portal venous inflow (PVI) increased obviously in IHPH and PHPH rats (P<0.05). L-NNA and indomethacin could decrease the concentrations of plasma 6-keto-PGF1α and serum NO2-/NO3-in IHPH and PHPH rats (P<0.05) .Meanwhile, CI, FPP and PVI lowered but MAP,TPR and SVR increased(P<0.05). After deduction of the action of NO, there was no significant correlation between plasma PGI2 level and hemodynamic parameters such as CI, TPR, PVI and SVR. However, after deduction of the action of

  16. Effects of phased joint intervention on IL-35 and IL-17 expression levels in patients with portal hypertension.

    Science.gov (United States)

    Wang, Yugang; Dong, Jinbin; Meng, Wenying; Ma, Jiali; Wang, Na; Wei, Jue; Shi, Min

    2014-05-01

    The aim of the present study was to investigate the clinical efficacy of phased joint intervention [percutaneous transhepatic variceal embolization (PTVE) + phased partial splenic embolization (PSE)] in patients with portal hypertension complicated by esophageal variceal bleeding and hypersplenism and the effect of this intervention on interleukin-35 (IL-35)/IL-17 expression. A review of 53 patients with portal hypertension caused by liver cirrhosis and complicated by esophageal variceal bleeding and hypersplenism treated with phased joint intervention was conducted, and portal hemodynamics, routine blood examinations and liver function were determined. Quantitative polymerase chain reaction (qPCR) was used to evaluate EBI3, FOXP3 and IL-17 mRNA expression levels in peripheral blood mononuclear cells (PBMC) before and after the phased joint intervention, while western blot analysis was used to determine their protein expression. All 53 patients required emergency hemostasis resulting in an emergency hemostatic rate of 100%. Varicose veins disappeared, portal hemodynamics and liver function improved subsequent to the intervention. The expression levels of EBI3, FOXP3 and IL-17 mRNA in the postoperative group were significantly lower than the preoperative levels (PIL-35, IL-6 and IL-17 in peripheral blood were significantly reduced after the phased joint intervention (PIL-35, IL-6 and IL-17 levels were positively correlated with total bilirubin and international normalized ratio, and negatively correlated with albumin. The phased joint intervention can effectively treat esophageal variceal bleeding and hypersplenism, and improve liver function. The efficacy of this intervention may be associated with the regulation of immune function.

  17. Indocyanine green retention test (ICG-r15) as a noninvasive predictor of portal hypertension in patients with different severity of cirrhosis

    DEFF Research Database (Denmark)

    Pind, Marie-Louise Lindberg; Bendtsen, Flemming; Kallemose, Thomas

    2016-01-01

    BACKGROUND AND AIMS: Portal hypertension is a severe consequence of chronic liver disease, responsible for the main clinical complications of cirrhosis. Measurement of the hepatic venous pressure gradient (HVPG) provides important clinical information, but the procedure is invasive and demands...... as a noninvasive predictor of portal hypertension. METHODS: A total of 325 patients were studied. During a hemodynamic investigation, the ICG clearance was determined using the constant infusion technique and ICG-r15 was calculated. RESULTS: Assessment of the diagnostic performance of ICG clearance and ICG-r15...... significant results in Child class B (AUROC=0.7448) and Child class C patients (AUROC=0.7392). Only six out of 102 patients in Child class C had HVPG of less than 12 mmHg. CONCLUSION: ICG-r15 can be used as an indirect assessment of significant portal hypertension in compensated cirrhotic patients. ICG-r15...

  18. The macrophage activation marker sCD163 combined with markers of the Enhanced Liver Fibrosis (ELF) score predicts clinically significant portal hypertension in patients with cirrhosis

    DEFF Research Database (Denmark)

    Sandahl, T D; McGrail, R; Møller, Holger Jon

    2016-01-01

    BACKGROUND: Noninvasive identification of significant portal hypertension in patients with cirrhosis is needed in hepatology practice. AIM: To investigate whether the combination of sCD163 as a hepatic inflammation marker and the fibrosis markers of the Enhanced Liver Fibrosis score (ELF) can...... predict portal hypertension in patients with cirrhosis. METHODS: We measured sCD163 and the ELF components (hyaluronic acid, tissue inhibitor of metalloproteinase-1 and procollagen-III aminopeptide) in two separate cohorts of cirrhosis patients that underwent hepatic vein catheterisation. To test...... the predictive accuracy we developed a CD163-fibrosis portal hypertension score in an estimation cohort (n = 80) and validated the score in an independent cohort (n = 80). A HVPG ≥10 mmHg was considered clinically significant. RESULTS: Both sCD163 and the ELF components increased in a stepwise manner...

  19. Evaluation on therapeutic effects of orthotopic liver transplantation by megnetic resonance imaging in patients with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Wang Jin; Liang Yingying; Yan Ronghua; Jiang Zaibo; Liu Jingjing; Hu Bing; He Bingjun

    2014-01-01

    Background Orthotopic liver transplantation (OLT) has become the therapeutic option of choice for end-stage liver disease.The aim of this study was to investigate the changes of splenic morphology,signal-to-noise ratio (SNR),contrastto-noise ratio (CNR),apparent diffusion coefficient (ADC) values and explore their value in evaluating the therapeutic effects of orthotopic liver transplantation (OLT) on portal hypertension at 1.5 Tesla MRI.Methods Twenty patients with portal hypertension undergoing OLT were included in this study.Conventional MRI and diffusion-weighted image (DWI) (b value=600 s/mm2) sequences were applied on each patient before and after OLT,and these patients were referred to as the preoperative and postoperative groups.Twenty healthy individuals were selected as the normal group.After image acquisition,the splenic width (W),thickness (T),length (L),the diameter of the portal vein (PD) and splenic vein (SD) were measured and the splenic volume (V) was calculated.The SNR and CNR were measured on T2WI.The ADC maps were calculated using the b600 in DWls and the ADC values were measured.Results Compared with the preoperative group,the splenic V,PD and SD decreased significantly in the postoperative group (P <0.05).All splenic morphological values were significantly different between preoperative and normal groups (P <0.05).The splenic L and V were significantly different (P <0.05) between postoperative and normal groups.The SNR and CNR values were 17.66±4.62 and 13.18±3.12,11.50±1.64 and 7.44±4.32,4.24±1.24 and 3.03±2.41 in the preoperative,postoperative and normal groups,respectively.Both SNR and CNR decreased after OLT,but they was still higher than the normal values.The SNR was significantly different between any two groups (P <0.05).The CNR was significantly different (P <0.05) between the preoperative and postoperative groups,preoperative and normal groups.The splenic ADC values were (1.339±0.482)×103 mm2/s,(1.120±0.254)x10-3 mm

  20. Colloid osmotic pressure in decompensated cirrhosis. A 'mirror image' of portal venous hypertension

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl

    1985-01-01

    was significantly below that of plasma (average, 25% of IIP; P less than 0.01). Portal pressure (transmural), determined as wedged hepatic venous minus inferior vena caval pressure (WHV--IVCP), was significantly increased (mean, 18 mm Hg, versus normal, 3 mm Hg; P less than 0.01) and inversely correlated to IIA...... in the interstitial space and ascitic fluid is related to and most likely secondary to the elevated portal pressure in decompensated cirrhosis. Effective colloid osmotic pressure may therefore be regarded as a 'mirror image' of transmural portal pressure. The role of colloid osmotic pressure in the genesis...

  1. Portal hypertensiv gastropati

    DEFF Research Database (Denmark)

    Brinch, K; Møller, S; Henriksen, Jens Henrik Sahl

    1995-01-01

    Portal hypertensive gastropathy (PHG) as defined by congestive changes in the gastric mucosa owing to increased portal pressure, was first described about ten years ago. Whereas definition and grading of severity are still under debate, there is general agreement that PHG is a new clinical entity....... PHG is present in 50-80% of patients with liver cirrhosis. PHG is a major cause of upper gastrointestinal bleeding in patients with portal hypertension (25-90% depending on severity). Presence of portal hypertension is a prerequisite for the development of PHG, and reduction of portal pressure...

  2. Efficacy of argon plasma coagulation in the management of portal hypertensive gastropathy

    Science.gov (United States)

    Hanafy, Amr Shaaban; El Hawary, Amr Talaat

    2016-01-01

    Objectives: Evaluation of the outcome and experience in 2 years of management of portal hypertensive gastropathy (PHG) by argon plasma coagulation (APC) in a cohort of Egyptian cirrhotic patients. Methods: This study was conducted over a 2-year period from January 2011 to February 2013. Upper gastrointestinal endoscopy was performed to evaluate the degree and site of PHG. APC was applied to areas with mucosal vascular lesions. Results: In total, 200 cirrhotic patients were enrolled; 12 patients were excluded due to death (n = 6) caused by hepatic encephalopathy (n = 3), hepatorenal syndrome (n = 2), or chronic lymphatic leukemia (n = 1), or did not complete the treatment sessions (n = 6), so 188 patients completed the study. PHG was mainly fundic in 73 patients (38.8 %), corporeal in 66 patients (35.1 %), and pangastric in 49 patients (26.1 %) (P = 0.026). Patients were exposed to APC and received proton pump inhibitors together with propranolol at a dose sufficient to reduce the heart rate by 25 % or down to 55 beats/min. The mean (± standard deviation) number of sessions was 1.65 ± 0.8; six patients needed four sessions (3.2 %), 19 patients needed three sessions (10.1 %), 74 patients needed two sessions (39.4 %), and 89 patients needed one session (47.3 %). Patients with fundic and corporeal PHG required the lowest number of sessions (P = 0.000). Patients were followed up every 2 months for up to 1 year; the end point was a complete response with improved anemia and blood transfusion requirement which was achieved after one session in 89 patients (75.4 %), two sessions in 24 patients (20.3 %) and three sessions in five patients (4.3 %). A complete response was more prevalent in patients with corporeal and fundic PHG (P = 0.04). Conclusions: After 2 years’ experience in managing PHG, we found that a combination of APC and non-selective beta blockers was highly efficacious and safe in controlling

  3. A randomized controlled trial of laparoscopic versus open cholecystectomy in patients with cirrhotic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Wu Ji; Ling-Tang Li; Zhi-Ming Wang; Zhu-Fu Quan; Xun-Ru Chen; Jie-Shou Li

    2005-01-01

    AIM: To evaluate the characters, risks and benefits of laparoscopic cholecystectomy (LC) in cirrhotic portal hypertension (CPH) patients.METHODS: Altogether 80 patients with symptomatic gallbladder disease and CPH, including 41 Child class A,32 Child class B and 7 Child class C, were randomly divided into open cholecystectomy (OC) group (38 patients) and LC group (42 patients). The cohorts were well-matched for number, age, sex, Child classification and types of disease.Data of the two groups were collected and analyzed.RESULTS: In LC group, LC was successfully performed in 36 cases, and 2 patients were converted to OC for difficulty in managing bleeding under laparoscope and dense adhesion of Calot's triangle. The rate of conversion was 5.3%. The surgical duration was 62.6±15.2 min. The operative blood loss was 75.5±15.5 mL. The time to resume diet was 18.3±6.5 h. Seven postoperative complications occurred in five patients (13.2%). All patients were dismissed after an average of 4.6±2.4 d. In OC group, the operation time was 60.5±17.5 min. The operative blood loss was 112.5±23.5 mL. The time to resume diet was 44.2±10.5 h.Fifteen postoperative complications occurred in 12patients (30.0%). All patients were dismissed after an average of 7.5±3.5 d. There was no significant difference in operation time between OC and LC group. But LC offered several advantages over OC, including fewer blood loss and lower postoperative complication rate, shorter time to resume diet and shorter length of hospitalization in patients with CPH.CONCLUSION: Though LC for patients with CPH is difficult, it is feasible, relatively safe, and superior to OC.It is important to know the technical characters of the operation, and pay more attention to the meticulous perioperative managements.

  4. Changes in count and function of splenic lymphocytes from patients with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Zong-Fang Li; Shu Zhang; Gao-Bo Lv; Ying Huang; Wei Zhang; Song Ren; Jun Yang; Shuang-Suo Dang

    2008-01-01

    AIM: To investigate changes in numbers and proliferative function of splenic lymphocytes in patients with hypersplenism due to portal hypertension (PH), to provide evidence for further study of immune status of the spleen during PH.METHODS: Twelve spleens from patients with hypersplenism due to PH served as the PH group, and four spleens from cases of traumatic spleen rupture were regarded as the control group. After weighing the spleen, lymphocytes were separated and counted using a cell counting plate to calculate the lymphocyte count per gram of spleen tissue (relative quantity) and total lymphocyte count in whole spleen (absolute quantity). The immunohistochemical SP method was used to observe the density and distribution of lymphocytes in the spleen. The MTT method was used to observe changes in lymphocyte proliferative function.RESULTS: As compared to the control group, the splenic lymphocytes in the PH group showed that: (1) There was no difference in distribution but a significant decrease in density; (2) the number of lymphocytes per gram of spleen (relative quantity) decreased significantly [(0.822±0.157) × 108 vs (1.174±0.254) × 108, P < 0.01];(3) with the significant increase in the weight of the PH spleen (832.6±278.2 g vs 211.7±85.6 g, P < 0.01),the total quantity of lymphocytes (absolute quantity)increased significantly [(0.685±0.072) × 1011 vs (0.366±0.057) × 1011, P < 0.01]; and (4) the proliferative function of lymphocytes was enhanced: T lymphocytes,(0.022±0.005 vs 0.015±0.003, P < 0.05), and B lymphocytes (0.034±0.006 vs 0.023±0.001, P < 0.01).CONCLUSION: Although lymphocyte density in the spleen decreased in patients with PH, the total quantity of lymphoytes increased because spleen weight increased greatly, along with the proliferating function. With respect to changes in lymphocytes, PH spleens may still have immune function, although it may be disordered. However,complete evaluation of the immune function of the spleenin PH

  5. Effect of transjugular intrahepatic portosystemic shunt on pulmonary gas exchange in patients with portal hypertension and hepatopulmonary syndrome

    Institute of Scientific and Technical Information of China (English)

    Graciela Martínez-Pallí; Britt B Drake; Joan-Carles García-Pagán; Joan-Albert Barberà; Miguel R Arguedas; Robert Rodriguez-Roisin; Jaume Bosch; Michael B Fallon

    2005-01-01

    AIM: To assess the impact of transjugular intrahepatic portosystemic shunt (TIPS) on pulmonary gas exchange and to evaluate the use of TIPS for the treatment of hepatopulmonary syndrome (HPS).METHODS: Seven patients, three of them with advanced HPS, in whom detailed pulmonary function tests were performed before and after TIPS placementat the University of Alabama Hospital and at the Hospital Clinic, Barcelona, were considered.RESULTS: TIPS patency was confirmed by hemodynamic evaluation. No changes in arterial blood gases were observed in the overall subset of patients. Transient arterial oxygenation improvement was observed in only one HPS patient, early after TIPS, but this was not sustained 4 mo later.CONCLUSION: TIPS neither improved nor worsened pulmonary gas exchange in patients with portal hypertension. This data does not support the use of TIPS as a specific treatment for HPS. However, it does reinforce the view that TIPS can be safely performed for the treatment of other complications of portal hypertension in patients with HPS.

  6. A 26-year clinical observation of splenic auto-transplantation and oesophageal transection anastomosis: a new treatment strategy in patients with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    ZHANG Lei; CHEN Ji-sheng; HUO Jin-shan; ZHANG Hong-wei; CHEN Ru-fu; ZHANG Jie; Obetien Mapudengo; FANG Tian-lin; CHEN Ya-jin; OU Qing-jia

    2007-01-01

    Background Surgical treatment options for patients with cirrhosis and portal hypertension are complicated. In this study,we evaluated the effectiveness of a new treatment strategy, splenic auto-transplantation and oesophageal transection anastomosis. We report results from clinical observations, splenic immune function and portal dynamics in 274 patients.Methods From 1979 to 2005, 274 cirrhosis patients with portal hypertension underwent the new treatment strategy, and were followed up to compare results with those patients who underwent traditional surgical treatment. From 1999 to 2002,a randomized controlled trial (RCT) was performed on 40 patients to compare their post-operative immune function. From 1994 to 2006, another RCT enrolled 28 patients to compare portal dynamics using three-dimensional dynamic contrast-enhanced magnetic resonance angiography (3D DEC MRA) investigation post operation.Results Among 274 patients (mean age 41.8 years), the emergency operative mortality (4.4%), selective operative mortality (2.2%), complication rate (17.9%), prevalence of hepatic encephalopathy (<1%), rate of portal hypertension gastritis (PHG) bleeding (9.1%), and morbidity of hepatic carcinoma (8%) were similar to those patients undergoing traditional operation; the spleen immunology function (Tuftsin, IgM) decreased in both groups 2 months post operation,but this decrease did not reach statistical significance. Through 3D DCE MRA, the cross sectional area and the velocity and volume of blood flow of the main portal vein decreased significantly after operation in both groups. The velocity and volume of blood flow in the auto-transplantation group was significantly lower than that in the control group.Conclusions Splenic auto-transplantation and esophageal transection anastomosis is a safe, effective, and reasonable treatment strategy for patients with portal hypertension with varicial bleeding. It not only can correct hypersplenism, but may also achieve complete

  7. Portal cavernoma cholangiopathy: diagnosis, imaging, and intervention.

    Science.gov (United States)

    Moomjian, Lauren N; Winks, Sarah G

    2017-01-01

    The term portal cavernoma cholangiopathy refers to the biliary tract abnormalities that accompany extrahepatic portal vein obstruction (EHPVO) and subsequent cavernous transformation of the portal vein. EHPVO is a primary vascular disorder of the portal vein in children and adults manifested by longstanding thrombosis of the main portal vein. Nearly all patients with EHPVO have manifestations of portal cavernoma cholangiopathy, such as extrinsic indentation on the bile duct and mild bile duct narrowing, but the majority are asymptomatic. However, progressive portal cavernoma cholangiopathy may lead to severe complications, including secondary biliary cirrhosis. A spectrum of changes is seen radiologically in the setting of portal cavernoma cholangiopathy, including extrinsic indentation of the bile ducts, bile duct stricturing, bile duct wall thickening, angulation and displacement of the extrahepatic bile duct, cholelithiasis, choledocholithiasis, and hepatolithiasis. Radiologists must be aware of this disorder in order to provide appropriate imaging evaluation and interpretation, to facilitate appropriate treatment and to distinguish this entity from its potential radiologic mimics.

  8. Sonographic Features of Extrahepatic Cholangio carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Kyoo Byung; Lee, Hwang Bok; Choi, Won Young; Jeon, Hae Jeoung; Suh, Won Hyuck [Korea University College of Medicine, Seoul (Korea, Republic of)

    1987-12-15

    The cholangio carcinoma of extrahepatic bile duct is one of the common cause of obstructive jaundice, and the sonography is now the most convenient initial examination of theses cases. The location of 25 proven cases of extrahepatic cholangio carcinoma were classified as Klatskin type(6 cases), common hepatic duct(CHD)(9 cases) and common bilduct(CBD)(10cases). And the sonographic findings were analysed. The characteristic sonographic finding of Klatskin tumor was tqpered narrowing of dilated intrahepatic ducts at portal hepatis without communication between both lobe bile ducts. The CHD, cancer showed communicating dilatation of the intrahepatic ducts, but CHD cancer showed ommunicating dilatation of the intrahepatic ducts, but there was no dilatation of gall bladder or CBD, and in case of CBD cancer, entire biliary trees were usually dilated. With the sonographic findings onle, 19 of 25 cases(76%)were diagnosed as cholangio carcinoma, and 13 of 25 cases (52%) were diagnosed correctly the involved site as well as the malignant nature. The sonographic accuracy of the extrahepatic cholangiocarcinoma was greater in Klatskin tumor than the CHD or CBD cancer. Sonogram is most valuable screening study for cholangio carcinoma, and the CT scan and direct cholangiography such as PTC or ERCP have compensatory roles in detecting hepatic metastasis, regional adenopathy and length of involved bile duct

  9. The effect of carvedilol and propranolol on portal hypertension in patients with cirrhosis: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Chen S

    2015-07-01

    . No considerable difference could be observed in the %MAP reduction through the poor overlapping CI boundaries.Conclusion: Carvedilol has a greater portal hypertensive effect than propranolol. Further comparative trials of the two drugs are required to identify the effect of MAP reduction. Keywords: carvedilol, propranolol, portal hypertension, randomized controlled clinical trials, meta-analysis

  10. Rapamycin ameliorates inflammation and fibrosis in the early phase of cirrhotic portal hypertension in rats through inhibition of mTORC1 but not mTORC2.

    Directory of Open Access Journals (Sweden)

    Weijie Wang

    Full Text Available OBJECTIVE: Hepatic stellate cells (HSCs transdifferentiation and subsequent inflammation are important pathological processes involved in the formation of cirrhotic portal hypertension. This study characterizes the pathogenetic mechanisms leading to cholestatic liver fibrosis and portal hypertension, and focuses on mammalian target of rapamycin (mTOR pathway as a potential modulator in the early phase of cirrhotic portal hypertension. METHODS: Early cirrhotic portal hypertension was induced by bile duct ligation (BDL for three weeks. One week after operation, sham-operated (SHAM and BDL rats received rapamycin (2 mg/kg/day by intraperitoneal injection for fourteen days. Vehicle-treated SHAM and BDL rats served as controls. Fibrosis, inflammation, and portal pressure were evaluated by histology, morphometry, and hemodynamics. Expressions of pro-fibrogenic and pro-inflammatory genes in liver were measured by RT-PCR; alpha smooth muscle actin (α-SMA and antigen Ki67 were detected by immunohistochemistry; expressions of AKT/mTOR signaling molecules, extracellular-signal-regulated kinase 1/2 (ERK1/2, p-ERK1/2, and interleukin-1 beta (IL-1β were assessed by western blot. RESULTS: The AKT/mTOR signaling pathway was markedly activated in the early phase of cirrhotic portal hypertension induced by BDL in rats. mTOR blockade by rapamycin profoundly improved liver function by limiting inflammation, fibrosis and portal pressure. Rapamycin significantly inhibited the expressions of phosphorylated 70KD ribosomal protein S6 kinase (p-P70S6K and phosphorylated ribosomal protein S6 (p-S6 but not p-AKT Ser473 relative to their total proteins in BDL-Ra rats. Those results suggested that mTOR Complex 1 (mTORC1 rather than mTORC2 was inhibited by rapamycin. Interestingly, we also found that the level of p-ERK1/2 to ERK1/2 was significantly increased in BDL rats, which was little affected by rapamycin. CONCLUSIONS: The AKT/mTOR signaling pathway played an important

  11. Active Peptic Ulcer Disease in Patients with Hepatitis C Virus-Related Cirrhosis: The Role of Helicobacter pylori Infection and Portal Hypertensive Gastropathy

    Directory of Open Access Journals (Sweden)

    Maria Dore

    2004-01-01

    Full Text Available BACKGROUND & AIM: The relationship between Helicobacter pylori infection and peptic ulcer disease in cirrhosis remains controversial. The purpose of the present study was to investigate the role of H pylori infection and portal hypertension gastropathy in the prevalence of active peptic ulcer among dyspeptic patients with compensated hepatitis C virus (HCV-related cirrhosis.

  12. Pro-C5, a marker of true type V collagen formation and fibrillation, correlates with portal hypertension in patients with alcoholic cirrhosis

    DEFF Research Database (Denmark)

    Leeming, Diana J; Veidal, Sanne S; Karsdal, Morten A

    2015-01-01

    Pro-C5 reflects liver hemodynamics, liver function, disease stage and clinically significant portal hypertension (PH). A multimarker model in combination with clinical scores predicted HVPG and separated clinical relevant HVPG thresholds. Plasma Pro-C5 may be suitable for the noninvasive evaluation...

  13. The incidence of portal hypertension in children with choledochal cyst and the correlation of nitric oxide levels in the peripheral blood with portal pressure and liver histology

    Science.gov (United States)

    Chand, Karunesh; Bhatnagar, Veereshwar; Agarwala, Sandeep; Srinivas, Maddur; Das, Nibhriti; Singh, Manoj Kumar; Sharma, Raju

    2015-01-01

    Background and Aims: Symptomatic portal hypertension (PHT) as a complication of the choledochal cyst (CDC) is well-known, but the actual incidence of PHT in CDC has not been studied. This study was undertaken to evaluate the incidence of PHT in patients of CDC and correlate portal pressure (PP) with liver histology and blood nitric oxide (NO) levels. Materials and Methods: In this cross-sectional study, PP was measured after surgical access but before any mobilization of the cyst by directly cannulating a tributary of portal vein (preoperative PP) and at completion of surgery before closure (postoperative PP). Blood sample for NO and liver function tests (LFTs) was taken before surgery and during subsequent follow-up at 1-month, 3 months, and 6 months. Liver histology was assessed under parenchymal, bile duct, and portal parameters. Results: Measurement of PP and blood levels of NO was done in 20 patients. Mean preoperative PP was 16.45 ± 7.85 mmHg, and the median pressure was 14 mmHg (range 9-43). Mean of the postoperative PP was 14 ± 6.87 mmHg, and median pressure was 11.5 mmHg (range 7-37). The mean level of NO in the preoperative period was 11.85 ± 4.33 μmol/l, and median was 11.605 (range 5.24-22.77) μmol/l. NO levels at the first follow-up (1-month postoperative) were 5.96 ± 4.56 μmol/l and median value of 4.9 (range 1.74-23.56) μmol/l. Likewise, the mean and median values of NO at 3 months were 5.59 ± 7.15 μmol/l and median value of 3.71 (range 1.49-34.74) μmol/l. The mean and median levels of NO at 6 months postoperative were 5.08 ± 2.22 μmol/l and median of 4.59 (range 2.32-12.46) μmol/l. The fall in PP immediately after surgery was consistent and statistically significant (P = 0.001). There was statistically significant fall in the NO levels in the postoperative period as compared to the preoperative levels (P = 0.002). Bile duct proliferation was significantly correlated with PP (P = 0.05). Blood levels of NO closely followed the PP in the

  14. Endoscopic Doppler ultrasound for measurement of azygos blood flow. Validation against thermodilution and assessment of pharmacological effects of terlipressin in portal hypertension

    DEFF Research Database (Denmark)

    Hansen, Erik Feldager; Bendtsen, Flemming; Brinch, K

    2001-01-01

    technique were compared in 20 patients with portal hypertension. The ability of EUS flowmetry to detect changes in the azygos and portal venous flow after an intravenous dose of 2 mg of terlipressin was evaluated in 13 of the patients in a double-blind, randomized, placebo-controlled, cross-over design...... administration of terlipressin, the azygos blood flow, as measured by EUS Doppler, decreased significantly by 23% from 915 to 704 ml/min (P = 0.014) and the portal venous flow decreased by 28% from 1170 to 789 ml/min (P = 0.03). No effects of placebo were detected. CONCLUSIONS: These results show that EUS...... measurement of the azygos blood flow correlate strongly to the measurements by the thermodilution technique, and EUS is moreover well tolerated by the patients. The method is applicable for monitoring pharmacological effects on the superior porto-systemic collateral circulation and portal venous flow...

  15. Bleed caused by varicose veins rupture in a rare site in portal hypertension. Differential diagnosis with causes of acute hypovolemic shock in emergency.

    Directory of Open Access Journals (Sweden)

    Rosarino Procopio

    2011-09-01

    Full Text Available Portal hypertension is the increase in the pressure of the venous portal system, which receives around 1,500 mL/m of blood from the intestinum tenue, colon, spleen, and pancreas. A blocking of the flux or an increase in the resistance at any level of the portal tree results in an increase in the pressure in the system and the appearance of lateral circles between the portal vein and the inferior and superior, thus allowing for varicose veins to spread in the whole system. The present paper reports the case of a woman with liver cirrhosis, great ascites and bleeding out of varicose veins’ rupture at the spleen axis level, which presented the problem of differential diagnosis with other causes of hypovolemic shock. This cases resulted in the patient’s exitus.

  16. Effects of tumor necrosis factor, endothelin and nitric oxide on hyperdynamic circulation of rats with acute and chronic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    Ji-Jian Wang; Gen-Wu Gao; Ren-Zhong Gao; Chang-An Liu; Xiong Ding; Zhen-Xiang Yao

    2004-01-01

    AIM: To evaluate the effect of tumor necrosis factor (TNF),endothelin (ET) and nitric oxide (NO) on hyperdynamic circulation (HC) of rats with acute and chronic portal hypertension(PHT).METHODS: Chronic portal hypertension was induced in Wistar rats by injection of carbon tetrachloride. After two weeks of cirrhosis formation, L-NMMA (25 mg/kg) was injected into one group of cirrhotic rats via femoral vein and the experiment was begun immediately. Another group of cirrhotic rats was injected with anti-rat TNFa(300 mg/kg)via abdominal cavity twice within 48 h and the experiment was performed 24 h after the second injection. The blood concentrations of TNFc, ET-1 and NO in portal vein and the nitric oxide synthase (NOS) activity in hepatic tissue were determined pre-and post-injection of anti-rat TNFa or LNMMA. Stroke volume (SV), cardiac output (CO), portal pressure (PP), superior mesenteric artery blood flow (SMA flow) and lilac artery blood flow (IAflow) were measured simultaneously. Acute portal hypertension was established in Wistar rats by partial portal-vein ligation (PVL). The parameters mentioned above were determined at 0.5 h,24 h, 48 h, 72 h and 120 h after PVL. After the formation of stable PHT, the PVL rats were injected with anti-rat TNFa or L-NMMA according to different groups, the parameters mentioned above were also determined.RESULTS: In cirrhotic rats, the blood levels of TNFa, NO in portal vein and the liver NOS activity were significantly increased (P<0.05) while the blood level of ET-1 was not statistically different (P>0.05) from the control animals (477.67±83.81 pg/mL vS48.87±32.79 pg/mL, 278.41±20.11 μmol/L vs 113.28±14.51 μmol/L, 1.81±0.06 u/mg.prot vs 0.87±0.03 u/mg.prot and 14.33±4.42 pg/mL vs 8.72±0.79 pg/mL, respectively). After injection of anti-rat TNFa,the blood level of TNFa was lower than that in controls (15.17±18.79 pg/mL vs48.87±32.79 pg/mL). The blood level of NO and the liver NOS activity were significantly

  17. Spironolactone lowers portal hypertension by inhibiting liver fibrosis, ROCK-2 activity and activating NO/PKG pathway in the bile-duct-ligated rat.

    Directory of Open Access Journals (Sweden)

    Wei Luo

    Full Text Available OBJECTIVE: Aldosterone, one of the main peptides in renin angiotensin aldosterone system (RAAS, has been suggested to mediate liver fibrosis and portal hypertension. Spironolactone, an aldosterone antagonist, has beneficial effect on hyperdynamic circulation in clinical practice. However, the mechanisms remain unclear. The present study aimed to investigate the role of spionolactone on liver cirrhosis and portal hypertension. METHODS: Liver cirrhosis was induced by bile duct ligation (BDL. Spironolactone was administered orally (20 mg/kg/d after bile duct ligation was performed. Liver fibrosis was assessed by histology, Masson's trichrome staining, and the measurement of hydroxyproline and type I collagen content. The activation of HSC was determined by analysis of alpha smooth muscle actin (α-SMA expression. Protein expressions and protein phosphorylation were determined by immunohistochemical staining and Western blot analysis, Messenger RNA levels by quantitative real time polymerase chain reaction (Q-PCR. Portal pressure and intrahepatic resistance were examined in vivo. RESULTS: Treatment with spironolactone significantly lowered portal pressure. This was associated with attenuation of liver fibrosis, intrahepatic resistance and inhibition of HSC activation. In BDL rat liver, spironolactone suppressed up-regulation of proinflammatory cytokines (TNFα and IL-6. Additionally, spironolactone significantly decreased ROCK-2 activity without affecting expression of RhoA and Ras. Moreover, spironolactone markedly increased the levels of endothelial nitric oxide synthase (eNOS, phosphorylated eNOS and the activity of NO effector-protein kinase G (PKG in the liver. CONCLUSION: Spironolactone lowers portal hypertension by improvement of liver fibrosis and inhibition of intrahepatic vasoconstriction via down-regulating ROCK-2 activity and activating NO/PKG pathway. Thus, early spironolactone therapy might be the optional therapy in cirrhosis and

  18. Diagnosis and treatment guidelines for aberrant portal hemodynamics: The Aberrant Portal Hemodynamics Study Group supported by the Ministry of Health, Labor and Welfare of Japan.

    Science.gov (United States)

    2017-01-06

    Idiopathic portal hypertension (IPH), causing aberrant portal hemodynamics, is a disease with an as yet unidentified cause and no established treatment protocol. The Japanese research group on IPH in Japan was set up in 1975 by the Ministry of Health, Labor and Welfare. Extrahepatic portal obstruction and Budd-Chiari syndrome (BCS) have since been added to the group's research subjects. The aims of the research group are to accurately evaluate the current status of the three diseases in Japan, elucidate their etiology and pathogenesis, and develop new treatments. Due to the long-term efforts of the Japanese research group, aberrant portal hemodynamics has been investigated in a variety of aspects, from epidemiological and pathological studies to molecular biology analyses. As a result, it has been shown that there are abnormal genes in the liver, specific for IPH. In addition, pathological findings of BCS were internationally compared and the difference in findings between Japan and Europe (or North America) has been clarified. Furthermore, it was found that complication rates of hepatocellular carcinoma in BCS were higher in Japan. Based on the research, "Diagnosis and treatment of aberrant portal hemodynamics (2001)", including diagnostic criteria for aberrant portal hemodynamics, was published in 2001. In 2013, it was revised to "Diagnosis and treatment guidelines for aberrant portal hemodynamics (2013)" after the incorporation of diagnosis and treatment in accordance with its current status.

  19. [Therapeutic options for portal hypertensive biliopathy: case series and literature review].

    Science.gov (United States)

    Aguilar-Olivos, Nancy Edith; de León-Monterroso, José Luis; Avila-Escobedo, Lourdes; López-Méndez, Eric

    2014-01-01

    Antecedentes: la biliopatía por hipertensión portal es poco diagnosticada debido a que sólo algunos pacientes experimentan síntomas. Las manifestaciones clínicas más importantes son la colestasis y la colangitis. Objetivo: comunicar una serie de casos evaluados, tratados y seguidos en una institución pública de tercer nivel. Casos clínicos: cuatro pacientes con biliopatía por hipertensión portal se expusieron a diferentes métodos para tratar la hipertensión portal y la descompresión de la vía biliar. Se realizó seguimiento durante casi cinco años. Tres casos mostraron adecuada evolución, con remisión de los síntomas; un paciente falleció al intentar dilatarle la vía biliar. Finalmente, se revisa la bibliografía en relación con la terapéutica de la biliopatía por hipertensión portal. Conclusiones: no existe consenso para el tratamiento óptimo de este padecimiento, aunque el objetivo es descomprimir la vía biliar; cada caso plantea particularidades que guían el tratamiento.

  20. Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Kiminori Uka; Kazuaki Chayama; Hiroshi Aikata; Shintaro Takaki; Hiroo Shirakawa; Soo Cheol Jeong; Keitaro Yamashina; Akira Hiramatsu; Hideaki Kodama; Shoichi Takahashi

    2007-01-01

    AIM: To assess the clinical features and prognosis of 151 patients with extrahepatic metastases from primary hepatocellular carcinoma (HCC), and describe the treatment strategy for such patients.METHODS: After the diagnosis of HCC, all 995consecutive HCC patients were followed up at regular intervals and 151 (15.2%) patients were found to have extrahepatic metastases at the initial diagnosis of primary HCC or developed such tumors during the follow-up period. We assessed their clinical features,prognosis, and treatment strategies.RESULTS: The most frequent site of extrahepatic metastases was the lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%).The cumulative survival rates after the initial diagnosis of extrahepatic metastases at 6, 12, 24, and 36 mo were 44.1%, 21.7%, 14.2%, 7.1%, respectively. The median survival time was 4.9 mo (range, 0-37 mo). Fourteen patients (11%) died of extrahepatic HCC, others died of primary HCC or liver failure.CONCLUSION: The prognosis of HCC patients with extrahepatic metastases is poor. With regard to the cause of death, many patients would die of intrahepatic HCC and few of extrahepatic metastases. Although most of HCC patients with extrahepatic metastases should undergo treatment for the primary HCC mainly,treatment of extrahepatic metastases in selected HCC patients who have good hepatic reserve, intrahepatic tumor stage (T0-T2), and are free of portal venous invasion may improve survival.

  1. Effect of esophagogastric devascularization with splenectomy on schistossomal portal hypertension patients' immunity Efeito da cirurgia de desconexão ázigo-portal com esplenectomia na imunidade de doentes com hipertensão portal esquistossomótica

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    Fabio Gonçalves Ferreira

    2007-03-01

    Full Text Available BACKGROUND: Surgical treatment of hemorrhagic complication in schistosomal portal hypertension in our hospital is an esophagogastric devascularization procedure with splenectomy. Infectious risks and immunological alterations imputed to splenectomy may have significant importance. To minimize the consequences of spleen absence, the use of subtotal splenectomy and spleen auto-transplantation were stimulated. AIM: To verify the immunologic alterations imposed by this procedure in our patients. METHOD: Twenty-eight patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophagogastric varices rupture underwent elective esophagogastric devascularization and splenectomy. They were prospectively studied before esophagogastric devascularization procedure with splenectomy, 15 and 30 days, 3 and 6 months after the procedure. T and B-lymphocytes, CD4 and CD8 subpopulations were determinated by monoclonal antibodies. Immunoglobulins A, M, G and C3, C4 components of the complement were determinated by radial immunodiffusion. RESULTS: We observed important reduction of all immune cells, increase of IgG and normal levels of IgM, IgA, C3 and C4 at preoperative. CD4/CD8 relation was normal. Six months after esophagogastric devascularization procedure with splenectomy, significant increase in T-lymphocytes, CD4, CD8 and B-lymphocytes were observed. CD4/CD8 relation remained normal. We noted significant increase in C3. IgA, IgM, IgG and C4 had increased, but without significant difference. CONCLUSION: Esophagogastric devascularization procedure with splenectomy determines an increase in T and B-lymphocytes, CD4 and CD8 subpopulations without compromising immunoglobulins and components of complement levels.RACIONAL: A cirurgia de desconexão ázigo-portal com esplenectomia é utilizada no tratamento da complicação hemorrágica varicosa dos esquistossomóticos hepatoesplênicos com hipertensão do sistema portal, no

  2. Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding Dopplerfluxometria portal na esquistossomose hepatoesplênica com e sem antecedentes de hemorragia por varizes esofágicas

    OpenAIRE

    Severino Marcos Borba de Arruda; Victorino Spinelli Toscano Barreto; Fernando José do Amaral

    2008-01-01

    BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive pa...

  3. Hagen-Poiseuille's law: The link between cirrhosis, liverstiffness, portal hypertension and hepatic decompensation

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    Gerond Lake-Bakaar; Muneeb Ahmed; Amy Evenson; Alan Bonder; Salomao Faintuch; Vinay Sundaram

    2015-01-01

    The onset of hepatic decompensation in cirrhosisheralds an accelerated downhill course with pooroutcome. The sole predictor of this decompensation in cirrhosis is increased hepatic vein to portal veingradient hepatic venous pressure gradient (HVPG).Surrogate markers of liver function or hepatic reserveappear to be less relevant. The hepatic sinusoidsbecome less elastic and more rigid as liver fibrosisand cirrhosis progress. We propose that the Hagen-Poiseuille's law, which applies to rigid, but not elasticvessels, determines the pressure-flow characteristicsin the sinusoids. In the rigid cirrhotic liver, HVPG risesdramatically with any change in net surface areaor radius, r4 of the vasculature that follows surgicalresection. This review relates liver stiffness to therisk of decompensation in patients with cirrhosis. Theliver has a unique dual blood supply comprising a lowpressure portal vein and high pressure hepatic artery.We compare the complexity of autoregulation in thenormal elastic liver with that in the rigid cirrhotic liver.Therapeutic modalities to reduce portal pressure mayreduce the risk of hepatic decompensation and improveoutcomes in cirrhosis.

  4. Oxidative stress in portal hypertension-induced rats with particular emphasis on nitric oxide and trace metals

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    Titiz Izzet; Genc Habibe; Aydin Seval; Simsek Gonul; Krand Osman; Unal Ethem; Yavuz Nihat; Kusaslan Ramazan; Dogan Mustafa; Uzun Hafize; Kiziler Ali Riza; Aydemir Birsen

    2005-01-01

    AIM: To investigate the oxidative-stress-related changes in rats with portal hypertension with particular emphasis on nitric oxide (NO) and trace metals. METHODS: Cirrhosis was induced by partial portal vein ligation (PVL) in Wistar rats. The lipid peroxidation marker (malondialdehyde, MDA), antioxidant defense enzymes including superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), and agents known to have antioxidant features including nitric oxide (NO), zinc (Zn), copper (Cu) were determined both in serum and in liver tissue at 4 wk after surgery in PVL and sham-operated rats. Portal pressure of all experimental animals was measured. MDA was detected by thiobarbituric acid reactivity assay.SOD activity was determined by inhibition of nitroblue tetrazolium reduction with xanthine/xanthine oxidase used asa superoxide generator. CAT activity was determined by the breakdown of hydrogen peroxide. GSH concentrations were measured by using metaphosphoric acid for protein precipitation and 5'-5'-dithio-bis-2-nitrobenzoic acid for color development. NO was detected by the Griess method after reduction of nitrate to nitrite with nitrate reductase, and the concentrations of Zn and Cu were measured by a Shimadzu 680 AA atomic absorption spectrometer. Histopathological confirmation was done under light microscope. Statistical analyses were done by Student's t-test, and significance of the difference was tested by the unpaired Mann-Whitney test. P<0.05 was considered statistically significant.RESULTS: Histopathological studies confirmed PVL induced cirrhotic changes. There was a statistically significant difference in portal pressure between PVL and control groups (P<0.001). The results showed significant increases in the levels of MDA and NO in both tissue and serum (P<0.05 and P<0.001, respectively in tissue; P<0.001 for each in serum), and Zn only in tissue (P<0.001)in rats with PVL compared with sham-operated rats. Besides, PVL rats exhibited reduced

  5. Diagnosis and treatment of portal hypertension in children (Part I: general issues Diagnóstico y tratamiento de la hipertensión portal en el niño (Parte I: Generalidades.

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    Luis Marcano Sanz

    Full Text Available The portal hypertension is the clinical syndrome characterized by the increase of pressure in portal system. Undoubtedly the gastrointestinal bleeding due to esopagheal and gastroesophageal varices, erosive gastritis and peptic ulcers constitute the most difficult and dangerous challenge for doctors and patients. Although most patients are treated by non-surgical methods, the surgical treatment correctly realized in chosen patients according to the current protocols is the most effective method to diminish the portal pressure definitively and can be carried out in more than 88% of patients smaller than 2 years old with a near elective mortality to 0% in some countries. We presented the First Part of Good Clinical Practices Guideline for Portal hypertension, approved by consensus in the 1st National Good Clinical Practices Workshop in Pediatric Surgery (Cienfuegos, Cuba, March 7 – 9, 2002.
    La hipertensión portal es el síndrome clínico caracterizado por el aumento de la presión en el sistema de drenaje venoso portal del aparato digestivo. Indudablemente las hemorragias digestivas altas debidas a várices esofagogástricas, gastritis erosivas y úlceras pépticas constituyen el reto más difícil y peligroso para médicos y pacientes. Aunque la mayoría de los pacientes son tratados de forma ";conservadora";, el tratamiento quirúrgico realizado correctamente en pacientes escogidos según los protocolos actuales de manejo de la enfermedad es el método más eficaz para disminuir la presión portal definitivamente y puede ser realizado en más del 88 % de los pacientes, incluso menores de 2 años, con una mortalidad electiva cercana a 0 % en algunos países. Se presenta la primera parte de la Guía de Buenas Prácticas Clínicas para Hipertensión Portal, aprobada por consenso en el 1er Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Cienfuegos, 7 al 9 de marzo del 2002.

  6. Assessing portal hypertension in post-operative biliary atresia patients using 2D magnetic resonance angiography

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    Hiki, Saori; Horikoshi, Kentarou; Kobayashi, Hiroyuki; Yamataka, Atsuyuki; Miyano, Takeshi; Kuwatsuru, Ryouhei; Katayama, Hitoshi [Juntendo Univ., Tokyo (Japan). School of Medicine

    2000-01-01

    2D magnetic resonance angiography (MRA) was performed in 38 post-operative biliary atresia (BA) patients. Collateral circulation other than esophageal varices that could not be observed with endoscopy was detected. By using contrast, the portal vasculature could be clearly delineated. MRA can be performed without using general anesthesia obviating the nead for hospitalization. At present, MRA alone is not sufficient for the complete assessment of varices in post-operative BA patients, and mucosal changes cannot be detected without endoscopy. However, combined with endoscopy, it provides valuable additional follow-up information without the need for general anesthesia or hospitalization. (author)

  7. Preliminary experiences of Rex shunt for extrahepatic portal vein obstruction via a conduit of internal jugular vein%颈内静脉搭桥Rex手术治疗小儿肝外门静脉梗阻的初步探讨

    Institute of Scientific and Technical Information of China (English)

    温哲; 王哲; 刘涛; 张向向; 王红英; 申刚; 张靖; 梁奇峰; 刘斐

    2016-01-01

    Objective To evaluate the outcomes of treating extrahepatic portal vein obstruction (EHPVO) by Rex shunt (superior mesenteric-left port vein bypass) with internal jugular vein graft.Methods From October 2014 to June 2015,8 patients of extrahepatic portal vein obstruction underwent Rex shunting with internal jugular vein as a venous graft.The surgical outcomes were evaluated over a follow-up period of 1-9 months.A median longitudinal abdominal incision was made.After peritoneal cavity was satisfactorily opened,round hepatic ligament was resected and lifted.For inflow vein,left portal vein in Rex recess was liberated for around 3 cm.Superior mesenteric vein was identified by tracking mid-colon vein and dissected around 3 crn for outflow.Through 2 small transverse incisions on left side of neck,7~9 cm of left internal jugular vein was harvested as a venous graft.Shunt was established by two end-to-side anastomoses at both ends of jugular vein graft between left portal and superior mesenteric veins.Results There were 5 boys and 3 girls with an average age of 4 (1.3~7) years.The manifestations included gastrointestinal hemorrhage (n =6),hypersplenism (n =6) and hemorrhage & splenomegaly (n =4).Preoperative liver function and blood coagulation were all normal while endoscopy revealed esophageal gastric varices (n =7).Portal vein cavernoma was identified by ultrasound and computed tomography (CT).Portal vein system retrograde angiography showed the presence of left portal vein bifurcation (n =7) and unidentifiable (n =1) (confirmed intraoperatively as atresia).Vascular patency of left portal vein in Rex recess was confirmed (n =7) during surgical exploration followed by Rex shunting.Warren shunt was performed for left portal vein atresia.After shunting,angiography through superior mesenteric vein demonstrated patency of vein graft,better development of intrahepatic portal system and regression of extrahepatic collateral varicose vessels.Portal vein pressure (PVP) was

  8. Detailed EFSUM recommendations on the scope of ultrasound assessment in patients with portal hypertension considering the diagnostic reference level

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    Andrzej Smereczyński

    2017-06-01

    Full Text Available An important paper describing the Standards of the Polish Ultrasound Society regarding the assessment of portal and hepatic vasculature was published in the Journal of Ultrasonography. Due to the multiplicity of morphological and hemodynamic data required, the time needed to obtain these data and the legal responsibility of doctors for the results, there seems to be a need to determine a clear range of the assessed parameters depending on the reference level of a given healthcare facility. Therefore, the aim of the paper was to present the EFSUMB recommendations on the range of the evaluated ultrasonographic parameters in portal hypertension depending on the reference level. European healthcare institutions are characterized by a clear three-level reference network. Due to the lack of a similar division in Poland, we propose our own classification of the competence of medical entities. The first reference level: ultrasound assessments in a primary health care setting (performed by GPs, emergency physicians, non-specialist private practice physicians, non-specialist practice physicians; at least one mid-class ultrasound scanner with pulsed and color Doppler options, equipped with convex 3–5 MHz and linear 7–12 MHz transducers should be available at physician’s disposal. The second reference level: ultrasound assessments in the hospital setting and specialist outpatient clinics, performed by specialist private practice physicians, radiologists, gastroenterologists and hepatologists; top class (premium digital ultrasound scanner should be available at physician’s disposal. Third reference level: ultrasound assessments performed in gastroenterology, hepatology and liver surgery departments as well as their specialist outpatient clinics; physicians should use top class digital ultrasound equipment. At every reference level, physicians performing abdominal ultrasound should have the appropriate certification to perform such an assessment or

  9. Spontaneous rupture of splenic hamartoma in a patient with hepatitis C virus-related cirrhosis and portal hypertension: A case report and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Yasuji Seyama; Nobutaka Tanaka; Yoshio Suzuki; Motoki Nagai; Takatoshi Furuya; Yukihiro Nomura; Jimpei Ishii; Masakazu Nobori

    2006-01-01

    Spontaneous rupture is a rare complication of splenic hamartoma. A review of the literature revealed only four such cases. To the best of our knowledge, this is the first report of spontaneous rupture of splenic hamartoma associated with liver cirrhosis and portal hypertension.A 53-year-old woman, who was followed up for aortic dissection and hepatitis C virus (HCV)-related liver cirrhosis, was referred with sudden left chest and shoulder pain. An abdominal ultrasound showed intraabdominalbleeding, and computed tomography indicated rupture of a splenic tumor. Emergent splenectomy was carried out. The postoperative course was uneventful, and the patient was discharged on the 13th postoperative day.Pathology revealed the tumor to be a ruptured splenic hamartoma. The non-tumorous splenic parenchyma revealed congestive changes. We consider that the presence of liver cirrhosis and portal hypertension are risk factors for spontaneous rupture of the splenic hamartoma.

  10. Fatal upper gastrointestinal bleed arising from duodenal varices secondary to undiagnosed portal hypertension.

    Science.gov (United States)

    Larson, John V; Steensma, Elizabeth A; Burke, Leandra H; Bartholomew, David M

    2013-08-16

    Duodenal varices are an unexpected source of upper gastrointestinal haemorrhage associated with high mortality. The prevalence of ectopic variceal bleeding accounts for 2-5% of all variceal bleeding; of this, only 17% occurs in the duodenum. Diagnosis is difficult, and insufficient evidence exists to demonstrate the best treatment option when haemorrhage occurs. We report the case of a 69-year-old man with a history of chronic alcoholism who presented to the emergency department (ED) with nausea, vomiting and several episodes of haematochezia. Diagnostic workup in the ED included CT with multiplanar reconstruction, which revealed a network of large tortuous blood vessels running near the second portion of the duodenum between the inferior vena cava and portal vein. The patient was emergently treated with endoscopic therapy and clipping of the vessel. This failed, and he was subsequently taken to the operating room for suture ligation of the bleeding duodenal varices.

  11. [Cholecystolithotomy with cholecystojejunostomy as surgical solution for cholelithiasis in portal hypertension caused by hepatic cirrhosis].

    Science.gov (United States)

    Confalonieri, F; Ballerini, A; Santangelo, A; Turra, G

    1995-03-01

    Cholecystolithotomy and cholecystojejunostomy has been carried out on 11 patients with severe hypertension from cirrhosis. The indications were frequently recurring attacks of biliary cholic or acute cholecystitis at onset. There was 1 postoperative death from cardiac infarction and only minor in-hospital morbidity. None of the remaining patients has to date developed post-cholecystojejunostomy sequelae. Except the case of extensive inflammation on gangrena, this procedure appears to be a safe and definitive operation, alternative to subtotal cholecystectomy.

  12. Hepatitis C: extrahepatic manifestations.

    Science.gov (United States)

    Metts, Julius; Carmichael, Lesley; Kokor, Winfred; Scharffenberg, Robert

    2014-12-01

    Chronic hepatitis C virus (HCV) infection is associated with multiple extrahepatic manifestations (EHM) affecting various organs in the body. Approximately 40% to 75% of patients with chronic HCV infection experience at least one clinical EHM during the course of the HCV infection. Mixed cryoglobulinemia (type 2) is the most documented EHM associated with chronic HCV infection. This has been documented in up to 50% of patients. Clinically, it presents as arthralgia, weakness, and cutaneous symptoms. Morphologically, immune complex depositions are identified in small vessels and glomerular capillary walls, leading to leukocytoclastic vasculitis in the skin and membranoproliferative glomerulonephritis in the kidney. In other EHMs of chronic HCV infection not related to cryoglobulinemia, such as Sjögren syndrome, lichen planus, and autoimmune thyroiditis, autoimmune processes resulting in chronic inflammatory infiltrates are thought to be the underlying mechanism.

  13. Influência da ascite na avaliação da função pulmonar em portadores de hipertensão portal Influence of ascites in the pulmonary function of patients with portal hypertension

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    Angela Maria Stiefano Nitrini

    2004-02-01

    Full Text Available INTRODUÇÃO: A oxigenação inadequada nos pacientes com hipertensão portal pode ser secundária a alterações na mecânica respiratória, determinadas pela presença da ascite. OBJETIVO: Avaliar a função pulmonar de doentes com hipertensão portal antes e após redução do volumeda ascite. Método: Quinze doentes com hipertensão portal e ascite foram submetidos a provas de função pulmonar, constituindo-se de espirometria e gasometria arterial, antes e após redução do volume da ascite. Os parâmetros analisados foram: capacidade vital forçada (CVF; volume expiratório no primeiro segundo (VEF1; fluxo expiratório entre 25 e 75% da CVF (FEF 25-75% ; volume de reserva expiratória (VRE; relação VEF1 / CVF; pressão arterial de oxigênio (PaO2, pressão arterial de dióxido de carbono (PaCO2 e saturação arterial de oxigênio (SaO2. RESULTADOS: Houve melhora significativa dos volumes pulmonares analisados após a diminuição da ascite com o tratamento diurético associado ou não à paracentese. CONCLUSÃO: Concluímos que nos doentes com hipertensão portal e ascite, há diminuição dos volumes pulmonares emrelação aos valores preditos, com melhora significativa após diminuição da ascite. Do mesmo modo, observamos aumento na PaO2 e na SaO2.BACKGROUND: Oxygen deficiency in patients with portal hypertension may be secondary to changes in respiratory mechanics due to ascites. OBJECTIVES: Evaluate pulmonary function in patients with portal hypertension before and after reduction of the ascites. METHOD: Fifteen patients with portal hypertension and ascites were submitted to pulmonary function tests, comprising spirometry and arterial blood gas determination, before and after reduction of ascites. The analysed parameters were: forced vital capacity (FVC; forced expiratory volume in one second (FEV1; forced expiratory flow between 25-75% of the forced vital capacity (FEF 25-75%; expiratory reserve volume (ERV; FEV1/CVF; arterial

  14. Management of digestive bleeding related to portal hypertension in cirrhotic patients: A French multicenter cross-sectional practice survey

    Institute of Scientific and Technical Information of China (English)

    Pierre Ingrand; Jean-Claude Barbare; Isabelle Ingrand; Michel Beauchant; Jér(o)me Gournay; Pierre Bernard; Frédéric Oberti; Brigitte Bernard-Chabert; Arnault Pauwels; Philippe Renard; Eric Bartoli; Jean-Fran(c)ois Cadranel

    2006-01-01

    AIM: To investigate the conformity of management practices of gastrointestinal hemorrhage in cirrhotic patients with relevant guidelines.METHODS: A questionnaire on the management of digestive bleeding was completed for all consecutive cirrhotic patients admitted to 31 French hospitals.RESULTS: One hundred and twenty-six bleeding events were recorded. It was the first bleeding episode in 79 patients (63%), of whom 40 (51%) had a prior diagnosis of cirrhosis and 25 (32%) had previously undergone an endoscopy. The bleeding episode was a recurrence in 46 patients (37%). The median time between onset and admission was 4 h, but exceeded 12 h in 42% of cases. There was an agreement between centers for early vasoactive drug administration (87% of cases),association with ligation (42%) more often than sclerosis (21%) at initial endoscopy, and antibiotic prophylaxis (64%). By contrast, prescription of beta-blockade alone or in combination (0 to 100%, P = 0.003) for secondary prophylaxis and lactulose (26% to 86%, P = 0.04),differed among centers.CONCLUSION: In French hospitals, management of bleeding related to portal hypertension in cirrhotic patients is generally in keeping with the consensus.Broad variability still remains concerning beta-blockade use for secondary prophylaxis. Screening for esophageal varices, the use of antibiotic prophylaxis and patients information need to be improved.

  15. Intravenous Bevacizumab Therapy in a Patient with Hereditary Hemorrhagic Telangiectasia, ENG E137K, Alcoholic Cirrhosis, and Portal Hypertension.

    Science.gov (United States)

    Bertoli, Luigi F; Lee, Pauline L; Lallone, Lauren; Barton, James C

    2017-01-01

    Intravenous bevacizumab decreased mucosal bleeding in some patients with hereditary hemorrhagic telangiectasia (HHT). We treated a 47-year-old male who had HHT, severe epistaxis, and gastrointestinal bleeding, alcoholic cirrhosis, and portal hypertension with intravenous bevacizumab 2.5 mg/kg every 2 weeks. We tabulated these measures weekly during weeks 1-33 (no bevacizumab); 34-57 (bevacizumab); and 58-97 (no bevacizumab): hemoglobin (Hb) levels; platelet counts; units of transfused packed erythrocytes (PRBC units); and quantities of iron infused as iron dextran to support erythropoiesis. We performed univariate and multivariable analyses. We sequenced his ENG and ACVRL1 genes. Epistaxis and melena decreased markedly during bevacizumab treatment. He reported no adverse effects due to bevacizumab. Mean weekly Hb levels were significantly higher and mean weekly PRBC units and quantities of intravenous iron were significantly lower during bevacizumab treatment. We performed a multiple regression on weekly Hb levels using these independent variables: bevacizumab treatment (dichotomous); weekly platelet counts; weekly PRBC units; and weekly quantities of intravenous iron. There was 1 positive association: (bevacizumab treatment; p = 0.0046) and 1 negative association (PRBC units; p = 0.0004). This patient had the novel ENG mutation E137K (exon 4; c.409G→A). Intravenous bevacizumab treatment 2.5 mg/kg every 2 weeks for 24 weeks was well-tolerated by a patient with HHT due to ENG E137K and was associated with higher weekly Hb levels and fewer weekly PRBC units.

  16. Inhibition of placental growth factor activity reduces the severity of fibrosis, inflammation, and portal hypertension in cirrhotic mice.

    Science.gov (United States)

    Van Steenkiste, Christophe; Ribera, Jordi; Geerts, Anja; Pauta, Montse; Tugues, Sònia; Casteleyn, Christophe; Libbrecht, Louis; Olievier, Kim; Schroyen, Ben; Reynaert, Hendrik; van Grunsven, Leo A; Blomme, Bram; Coulon, Stephanie; Heindryckx, Femke; De Vos, Martine; Stassen, Jean Marie; Vinckier, Stefan; Altamirano, Jose; Bataller, Ramón; Carmeliet, Peter; Van Vlierberghe, Hans; Colle, Isabelle; Morales-Ruiz, Manuel

    2011-05-01

    Placental growth factor (PlGF) is associated selectively with pathological angiogenesis, and PlGF blockade does not affect the healthy vasculature. Anti-PlGF is therefore currently being clinically evaluated for the treatment of cancer patients. In cirrhosis, hepatic fibrogenesis is accompanied by extensive angiogenesis. In this paper, we evaluated the pathophysiological role of PlGF and the therapeutic potential of anti-PlGF in liver cirrhosis. PlGF was significantly up-regulated in the CCl(4) -induced rodent model of liver cirrhosis as well as in cirrhotic patients. Compared with wild-type animals, cirrhotic PlGF(-/-) mice showed a significant reduction in angiogenesis, arteriogenesis, inflammation, fibrosis, and portal hypertension. Importantly, pharmacological inhibition with anti-PlGF antibodies yielded similar results as genetic loss of PlGF. Notably, PlGF treatment of activated hepatic stellate cells induced sustained extracellular signal-regulated kinase 1/2 phosphorylation, as well as chemotaxis and proliferation, indicating a previously unrecognized profibrogenic role of PlGF. PlGF is a disease-candidate gene in liver cirrhosis, and inhibition of PlGF offers a therapeutic alternative with an attractive safety profile. Copyright © 2011 American Association for the Study of Liver Diseases.

  17. The role of endotoxin in the pathogenesis of gastric mucosal damage in cirrhotic rats with portal hypertensive gastropathy

    Institute of Scientific and Technical Information of China (English)

    ChengLan; XiaoningSun; LiweiDong; BailiHuang; SuYuan; KeliWu

    2011-01-01

    Objective:To study the role and the mechanism of endotoxin in the pathogenesis of gastric mucosa during portal vein hypertension gastrography (PHG) in the rats with cirrhosis. Methods:Rat model for PHG was established by injection of tetrachloride. The animals were injected with endotoxin i.p. at 3 mg/kg and endotoxin antagonist BPI21 i.v. at 2.0 mg/kg. The plasma level of endotoxin as well as the gastric mucosal level of tumor necrosis factor alpha (TNF-α) was measured with azobenzene and ELISA respectively. Furthermore, the pathological changes of the gastric mucosa were studied with HE stainning. Results:In rats with PHG, increased endotoxin and TNF-αas well as the gastric pathological lesion were observed. Injection of endotoxin remarkably increased plasma level of endotoxin as well as the gastric mucosal level of tumor necrosis TNF-αand induced more serious gastric lesion. Animals injected with endotoxin antagonist BPI21 showed improved gastric mucosal lesion, accompanied by the declining TNF-αlevel. Conclusions:Our results suggestes that endotoxin may play a pathogenetic role in PHG by inducing the expression of TNF-α.

  18. Splenic Arterial Embolization in the Treatment of Severe Portal Hypertension Due to Pancreatic Diseases: The Primary Experience in 14 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Qi, E-mail: wqtjmu@gmail.com; Xiong, Bin, E-mail: herrxiong@126.com; Zheng, ChuanSheng, E-mail: hqzcsxh@sina.com; Liang, Ming, E-mail: whliangming@163.com; Han, Ping, E-mail: cjr.hanping@vip.163.com [Huazhong University of Science and Technology, Department of Radiology, Union Hospital, Tongji Medical College (China)

    2016-03-15

    ObjectiveThis retrospective study reports our experience using splenic arterial particle embolization and coil embolization for the treatment of sinistral portal hypertension (SPH) in patients with and without gastric bleeding.MethodsFrom August 2009 to May 2012, 14 patients with SPH due to pancreatic disease were diagnosed and treated with splenic arterial embolization. Two different embolization strategies were applied; either combined distal splenic bed particle embolization and proximal splenic artery coil embolization in the same procedure for acute hemorrhage (1-step) or interval staged distal embolization and proximal embolization in the stable patient (2-step). The patients were clinically followed.ResultsIn 14 patients, splenic arterial embolization was successful. The one-step method was performed in three patients suffering from massive gastric bleeding, and the bleeding was relieved after embolization. The two-step method was used in 11 patients, who had chronic gastric variceal bleeding or gastric varices only. The gastric varices disappeared in the enhanced CT scan and the patients had no gastric bleeding during follow-up.ConclusionsSplenic arterial embolization, particularly the two-step method, proved feasible and effective for the treatment of SPH patients with gastric varices or gastric variceal bleeding.

  19. Hipertensão portal por esquistossomose mansônica hepatoesplênica: efeito da desconexão ázigo-portal com esplenectomia no diâmetro e na velocidade média de fluxo do sistema portal (estudo ultra-sonográfico com Doppler Hepatosplenic schistosomotic portal hypertension: effect of esophagogastric devascularization with splenectomy on the diameter and mean flow velocity in the portal system (ultra-sonographic Doppler study

    Directory of Open Access Journals (Sweden)

    Azzo WIDMAN

    2001-01-01

    ção significativa do diâmetro e da velocidade média de fluxo sangüíneo no sistema portal, no pós-operatório tardio, em pacientes com esquistossomose mansônica hepatoesplênica, submetidos a desconexão ázigo-portal.Background - Esophagogastric devascularization with splenectomy has been used for the treatment of upper digestive bleeding due to esophagic varices in hepatoportal mansoni's schistosomic portal hypertension. Nevertheless, early portal thrombosis has hampered this surgical technique (13,3% and 53,2%, compromising the good results on the hemorrhagic side. Supposing that portal circulatory changes, due to the surgical treatment, may play an important role in this kind of complication, our objective was to identify the hemodynamic facilitating factors. Portal hemodynamic aspects, identified by ultra-sonographic Doppler study, from two groups of patients: non-operated upon and splenectomized with esophagogastric devascularization in late post-operatory phase (in excess of 6 moths, with portal hypertension due to mansoni hepatoesplenic portal hypertension and in similar clinical conditions, were compared. Method - Fifty eight ambulatorial patients were studied, all had portal hypertension caused by mansoni's hepatosplenic schistosomiasis and previous bouts of digestive bleeding. They were divided in two groups: A - 29 followed clinically/endoscopically, and group B - 29 previously submitted to esophagogastric devascularization with splenectomy. In all was measured the diameter and mean flow velocity in the portal vein and its right and left branches by ultra-sonographic Doppler study. The results were submitted to statistical analysis for inter- and intra-group comparison. Results - Group A (non-operated: the portal vein diameter was greater than the right and left branches (10.6 ± 2.9, 8.0 ± 1.8, 9.1 ± 2.6 cm, the mean flow velocities in the portal vein and its branches were similar (15.62 ± 6.17, 14.92 ± 5.33, 16.12 ±4.18 cm/seg. Group B (operated: the

  20. 门静脉高压症术后门静脉血栓形成的危险因素分析%Risk factors for portal venous thrombosis after operation of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    匡洁; 杨卫平; 陈皓; 彭承宏; 李宏为

    2012-01-01

    目的:分析肝硬化门静脉高压症术后出现门静脉血栓的危险因素.方法:回顾性分析2008年1月至2010年7月,因肝硬化门静脉高压导致脾功能亢进和消化道出血在我院行手术治疗的92例病人的临床资料.分为血栓组和非血栓组,对可能导致门静脉血栓形成的各种因素进行多因素分析.结果:92例病人中有40例(43.47%)出现门静脉血栓形成.病人的性别、年龄、病因、肝功能Child-Pugh分级、血清总胆红素、白蛋白、凝血酶原时间、门静脉流速及流量、手术方式、手术前后门静脉压力、手术前后血小板数量及术前D-二聚体均不是门静脉血栓形成的危险因素.门静脉直径和脾静脉直径是血栓形成的独立危险因素(P<0.01),当门静脉直径>11.65 mm或脾静脉直径>9.5 mm时,术后容易形成门静脉血栓.结论:肝硬化门静脉高压症行手术治疗的病人,术前门静脉直径及脾静脉直径是术后门静脉血栓形成的独立危险因素.%Objective To investigate the risk factors for portal vein thrombosis (PVT) after surgery in patients with cirrhosis and portal hypertension. Methods Patients underwent operation for portal hypersplenism and variceal bleeding in Ruijn Hospital between Jan 2008 and Jul 2010 were retrospectively analyzed. All the patients with postoperative PVT or without were divided into two groups. We analyzed the factors to relate with PVT. Results PVT developed in 40 (43.47%) of 92 patients after surgery. Portal vein diameter and splenic vein diameter were both independent risk factors for PVT(P< 0.01). However, sex, age, aetiology, Child-Pugh classification, serum total billirubin, serum albumin, prothrombin time, portal venous flow, portal venous velocity, type of operation, free portal pressure, platelet count, D-dimer were not independent risk factors. Postoperative PVT tended to occur when portal vein diameter over 11.65 mm or splenic vein diameter over 9.5 mm

  1. Avaliação intra-operatória da pressão portal e resultados imediatos do tratamento cirúrgico da hipertensão portal em pacientes esquistossomóticos submetidos a desconexão ázigo-portal e esplenectomia Intra-operative evaluation of portal pressure and immediate results of surgical treatment of portal hypertension in schistosomotic patients submitted to esophagogastric devascularization with splenectomy

    Directory of Open Access Journals (Sweden)

    Walter De Biase da Silva-Neto

    2004-09-01

    é-operatório. CONCLUSÃO: A desconexão ázigo-portal e esplenectomia promoveram queda imediata na pressão portal, com conseqüente diminuição do calibre das varizes esofágicas. Observou-se ainda que não é insignificante o risco de mortalidade e complicações graves relacionados a essa técnica.BACKGROUND: The main cause of portal hypertension in Brazil is the hepato-splenic form of mansonic schistosomiasis and the most employed technique for the surgical approach of this disease is the esophagogastric devascularization with splenectomy, generally associated to postoperative endoscopical esophageal varices sclerotherapy. The hemodynamic alterations after surgical treatment and its possible influence on the outcome are not well established. AIM: To evaluate the immediate impact of esophagogastric devascularization with splenectomy upon portal pressure as well as the results of the surgical treatment on digestive hemorrhage recurrence and on esophageal varices. METHODS: Nineteen patients with mean age of 37.9 years and portal hypertension and previous episodes of digestive hemorrhage caused by esophageal varices rupture due to hepato-splenic schistosomiasis were studied. None of the patients had received any treatment prior to the surgery and underwent to elective esophagogastric devascularization with splenectomy. Portal pressure was assessed at the beginning and at the end of esophagogastric devascularization with splenectomy through portal vein catheterization with a polyethylene catheter introduced through a jejunal branch vein. All patients were submitted to digestive endoscopy before and after the surgery, in order to classify the size of esophageal varices after esophagogastric devascularization with splenectomy according to Palmer’s classification. RESULTS: In all patients the portal pressure had diminished with a mean decrease of 31.3% after esophagogastric devascularization with splenectomy. In the postoperative endoscopic follow-up (1 month, the esophageal varices

  2. Avaliação crítica da cirurgia na hipertensão portal esquistossômica Critical evaluation of surgical treatment of schistosomotic portal hypertension

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    Salomão Kelner

    1992-01-01

    Full Text Available There are over 100.000 patients affected by schistosomotic portal hipertension, that may suffer rupture of the esophageal varices. Besides the portal hypertension, local factors must be emphazised as responsible for the three distal centimeters of the esophagus, called "zona vulnerável" (vulnerable zone. The beter liver functional reserve of these schistosomotic patients as compared to the cirrhotic, present two favorable condititions: (1 beter possibility of conservative treatment during acute hemorrhage; (2 elective surgical treatment may be undergo without a mandatory step of large portal descompression. The Author only indicate surgical treatment in patients with hemorrhage antecedence and his preference consist in splenectomy plus obliterative suture of the varices at the "vulnerable zone" and when possible, ligature of left gastric vein also; 358 patients were undergone surgery with operative mortality 3.07%, 347 were followed during 1 to 25 years; late mortality 8.38%; recurrence hemorrage 11.58%; none porto-sustemic encephalopaty was observed.

  3. Severe bleeding from esophageal varices resistant to endoscopic treatment in a non cirrhotic patient with portal hypertension

    Science.gov (United States)

    Caronna, Roberto; Bezzi, Mario; Schiratti, Monica; Cardi, Maurizio; Prezioso, Giampaolo; Benedetti, Michele; Papini, Federica; Mangioni, Simona; Martino, Gabriele; Chirletti, Piero

    2008-01-01

    A non cirrhotic patient with esophageal varices and portal vein thrombosis had recurrent variceal bleeding unsuccessfully controlled by endoscopy and esophageal transection. Emergency transhepatic portography confirmed the thrombosed right branch of the portal vein, while the left branch appeared angulated, shifted and stenotic. A stent was successfully implanted into the left branch and the collateral vessels along the epatoduodenal ligament disappeared. In patients with esophageal variceal hemorrhage and portal thrombosis if endoscopy fails, emergency esophageal transection or nonselective portocaval shunting are indicated. The rare patients with only partial portal thrombosis can be treated directly with stenting through an angioradiologic approach. PMID:18644135

  4. Severe bleeding from esophageal varices resistant to endoscopic treatment in a non cirrhotic patient with portal hypertension

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    Mangioni Simona

    2008-07-01

    Full Text Available Abstract A non cirrhotic patient with esophageal varices and portal vein thrombosis had recurrent variceal bleeding unsuccessfully controlled by endoscopy and esophageal transection. Emergency transhepatic portography confirmed the thrombosed right branch of the portal vein, while the left branch appeared angulated, shifted and stenotic. A stent was successfully implanted into the left branch and the collateral vessels along the epatoduodenal ligament disappeared. In patients with esophageal variceal hemorrhage and portal thrombosis if endoscopy fails, emergency esophageal transection or nonselective portocaval shunting are indicated. The rare patients with only partial portal thrombosis can be treated directly with stenting through an angioradiologic approach.

  5. Cross-sectional Multi-center Analysis of Portal Hypertension in 163 Children and Young Adults with Biliary Atresia

    Science.gov (United States)

    Shneider, Benjamin L.; Abel, Bob; Haber, Barbara; Karpen, Saul J.; Magee, John C.; Romero, Rene; Schwarz, Kathleen; Bass, Lee M.; Kerkar, Nanda; Miethke, Alexander G.; Rosenthal, Philip; Turmelle, Yumirle; Robuck, Patricia R.; Sokol, Ronald J.

    2012-01-01

    Objectives Biliary atresia (BA) frequently results in portal hypertension (PHT), complications of which lead to significant morbidity and mortality. The Childhood Liver Disease Research and Education Network (ChiLDREN) was utilized to perform a cross-sectional multi-centered analysis of PHT in children with BA. Methods BA subjects receiving medical management at a ChiLDREN site were enrolled. A priori, clinically evident PHT was defined as “definite” when there was either 1) history of a complication of PHT or 2) clinical findings consistent with PHT (both splenomegaly and thrombocytopenia). PHT was denoted as “possible” if one of the findings was present in the absence of a complication, while PHT was “absent” if none of the criteria were met. Results 163 subjects were enrolled between May 2006 and December 2009. At baseline, definite PHT was present in 49%, possible in 17% and absent in 34% of subjects. Demographics, growth and anthropometrics were similar amongst the 3 PHT categories. ALT, GGTP, and sodium levels were similar, while there were significant differences in AST, AST/ALT, albumin, total bilirubin, PT, WBC, platelet count and AST/platelet between definite and absent PHT. Thirty-four percent of those with definite PHT had either PT > 15s or albumin < 3 g/L. Conclusions Clinically definable PHT is present in two thirds of North American long-term BA survivors with their native livers. The presence of PHT is associated with measures of hepatic injury and dysfunction, although in this selected cohort the degree of hepatic dysfunction is relatively mild and growth is preserved. PMID:22903006

  6. Endoscopic Doppler ultrasound for measurement of azygos blood flow. Validation against thermodilution and assessment of pharmacological effects of terlipressin in portal hypertension

    DEFF Research Database (Denmark)

    Hansen, Erik Feldager; Bendtsen, Flemming; Brinch, K;

    2001-01-01

    BACKGROUND: Endoscopic ultrasound (EUS) is a new modality allowing real-time flow measurements by means of the Doppler technique. The aim of the study was to evaluate azygos blood flow measurements by endoscopic ultrasound. METHODS: Measurements of azygos blood flow by EUS and by the thermodilution...... technique were compared in 20 patients with portal hypertension. The ability of EUS flowmetry to detect changes in the azygos and portal venous flow after an intravenous dose of 2 mg of terlipressin was evaluated in 13 of the patients in a double-blind, randomized, placebo-controlled, cross-over design....... RESULTS: The EUS Doppler and thermodilution measurements correlated significantly (R=0.81, P blood flow was found to be 14% higher by the EUS method than by thermodilution. The coefficient of variation of the EUS Doppler measurements of the azygos blood flow was 14.8%. After...

  7. Duplex sonography study in schistosomiasis portal hypertension: characterization of patients with and without a history of variceal bleeding Dopplerfluxometria portal na esquistossomose hepatoesplênica com e sem antecedentes de hemorragia por varizes esofágicas

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    Severino Marcos Borba de Arruda

    2008-03-01

    Full Text Available BACKGROUND: Presinusoidal portal hypertension with frequent episodes of upper gastrointestinal variceal bleeding are hallmarks of hepatosplenic Manson’s schistosomiasis; a clinical form that affects about 5% of Brazilians who are infected by Schistosoma mansoni. AIMS: To evaluate duplex sonography findings in patients with hepatosplenic Manson’s schistosomiasis with and without upper gastrointestinal variceal hemorrhage. METHODS: A cross-sectional study was performed whereby 27 consecutive patients with hepatosplenic Manson’s schistosomiasis were divided into two groups: group I (six men and six women; mean age 48.7 years with a past history of bleeding and group II (four men and eight women; mean age 44.7 years without a past history of upper gastrointestinal bleeding, underwent duplex sonography examination. All patients underwent the same upper gastrointestinal endoscopy and laboratory examinations. Those with signs of mixed chronic liver disease or portal vein thrombosis (three cases were excluded. RESULTS: Group I showed significantly higher mean portal vein flow velocity than group II (26.36 cm/s vs 17.15 cm/sec. Although, as a whole it was not significant in all forms of collateral vessels (83% vs 100%, there was a significantly higher frequency of splenorenal collateral circulation type in group II compared with group I (17% vs 67%. The congestion index of the portal vein was significantly lower in group I than in group II (0.057 cm vs 0.073 cm/sec. CONCLUSION: Our duplex sonography findings in hepatosplenic Manson’s schistosomiasis support the idea that schistosomotic portal hypertension is strongly influenced by overflow status, and that collateral circulation seems to play an important role in hemodynamic behavior.RACIONAL: Hipertensão portal pré-sinusoidal com freqüentes episódios de hemorragia digestiva alta são aspectos característicos da esquistossomose hepatoesplênica, forma clínica que acomete cerca de 5% dos

  8. 门静脉高压症门静脉血栓形成的机制研究%Risk factors of portal venous thrombosis development in patients with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    吴婷婷; 陈炜; 吴志勇

    2012-01-01

    Objective To investigate the risk factors related with portal vein thrombosis (PVT) in patients with portal hypertension caused by liver cirrhosis. Methods From Jan to Dec 2011, 40 patients with portal hypertension and liver cirrhosis were analyzed of the risk factors of PVT. Results The velocity of portal vein was much lower in the pre-operative PVT group than that in non PVT group (P<0.05). No difference was observed in coagulation function between the patients with and without PVT. All patients with devascularization suffered splenic vein thrombosis, 9 of whom had thrombosis extended to the trunk of portal vein. In patients with both splenorenal shunt and devascularization, blood in superior mesenteric vein flowed into systemic circulation through splenorenal shunt except one patient with thrombosis in portal vein extended back to splenic vein. Two-thirds of these patients had partial thrombosis formed in portal trunk. There was no difference of platelet levels between the two groups. D-dimer higher than normal level, however did not differ between the two groups. Conclusions PVT may occur independent of operation approaches. It may correlate with the changes of portal hemodynamics.%目的:探讨肝硬化门静脉高压症病人术后门静脉系统血栓形成的原因.方法:回顾性分析2011年1月至12月间收治资料完整的40例肝硬化门静脉高压症病人术前术后的临床资料,分析术前术后门静脉系统血栓形成与凝血功能及血流动力学状况之间的关系.结果:术前在有无门静脉系统血栓形成的两组间各项凝血功能参数均无统计学差异,唯门静脉血流速度在血栓组较无血栓组显著减慢(P<0.05).断流术后脾静脉均有血栓形成,其中9例向门静脉主干蔓延.脾肾静脉分流加断流的联合手术后,除1例门静脉主干血栓逆向蔓延至脾静脉外,肠系膜上静脉血至脾静脉经脾肾分流口分流人体循环,约2/3的病人在门静脉左右支或主干

  9. Portal hypertensive enteropathy diagnosed by capsule endoscopy and demonstration of the ileal changes after transjugular intrahepatic portosystemic shunt placement: a case report

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    Carella Alessandra

    2011-03-01

    Full Text Available Abstract Introduction Recent data suggest that mucosal abnormalities can occur even in the duodenum, jejunum, and distal ileum of cirrhosis patients. We present a case of portal hypertensive enteropathy in a cirrhosis patient shown by capsule endoscopy and the effect of transjugular intrahepatic portosystemic shunt on the ileal pictures. Case presentation An 83-year-old Caucasian woman was admitted to our hospital for anemia and a positive fecal occult blood test. An upper gastrointestinal endoscopy revealed small varices without bleeding signs and hypertensive gastropathy. Colonoscopy was negative. To rule out any other cause of bleeding, capsule endoscopy was performed; capsule endoscopy revealed severe hyperemia of the jejunum-ileal mucosa with active bleeding. Because of the persistence of anemia and the frequent blood transfusions, not responding to β-blocker drugs or octreotide infusion, a transjugular intrahepatic portosystemic shunt was performed. Anemia improved quickly after the transjugular intrahepatic portosystemic shunt, and no further blood transfusion was necessary in the follow-up. The patient developed portal encephalopathy two months later and was readmitted to our department. We repeated the capsule endoscopy that showed a significant improvement of the gastric and ileal mucosa without any signs of bleeding. Conclusion Hypertensive enteropathy is a rare condition, but it seems more common with the introduction of capsule endoscopy in clinical practice. This case shows that the jejunum can be a source of bleeding in cirrhosis patients, and this is the first demonstration of its resolution after transjugular intrahepatic portosystemic shunt placement.

  10. Clinical, radiologic, and endoscopic characteristics upon diagnosis of patients with prehepatic portal hypertension at the Instituto Nacional de Pediatría from 2001 to 2011.

    Science.gov (United States)

    Zárate Mondragón, F; Romero Trujillo, J O; Cervantes Bustamante, R; Mora Tiscareño, M A; Montijo Barrios, E; Cadena León, J F; Cázares Méndez, M; Toro Monjaraz, E M; Ramírez Mayans, J

    2014-01-01

    Prehepatic portal hypertension in children can be asymptomatic for many years. Once diagnosed, the therapeutic measures (pharmacologic, endoscopic, and surgical) are conditioned by the specific characteristics of each patient. In Mexico, there are no recorded data on the incidence of the disease and patient characteristics. To determine the main clinical, radiologic, and endoscopic characteristics upon diagnosis of these patients at the Instituto Nacional de Pediatría within the time frame of January 2001 and December 2011. A cross-sectional, retrolective, descriptive, and observational study was conducted in which all the medical records of the patients with portal hypertension diagnosis were reviewed. There was a greater prevalence of prehepatic etiology (32/52) (61.5%) in the portal hypertension cases reviewed. Males (62.5%) predominated and 11 of the 32 patients were under 4 years of age. The primary reason for medical consultation was upper digestive tract bleeding with anemia (71.9%) and the main pathology was cavernomatous degeneration of the portal vein (65.6%). Splenoportography was carried out on 17 of the 32 patients. A total of 65.5% of the patients received the combination therapy of propranolol and a proton pump inhibitor. Initial endoscopy revealed esophageal varices in 96.9% of the patients, 12 of whom presented with gastroesophageal varices. Congestive gastropathy was found in 75% of the patients. The varices were ligated in 8 cases, sclerotherapy for esophageal varices was carried out in 5 cases (15.6%), and sclerotherapy for gastric varices was performed in 2 patients. Seventeen patients (53.1%) underwent portosystemic diversion: 10 of the procedures employed a mesocaval shunt and 7 a splenorenal shunt. Nine patients (28.1%) underwent total splenectomy. The primary cause of the disease was cavernomatous degeneration of the portal vein; it was predominant in males and the first symptom was variceal bleeding. Copyright © 2014 Asociación Mexicana

  11. A meta-analysis study of laparoscopic versus open splenectomy with or without esophagogastric devascularization in the management of liver cirrhosis and portal hypertension.

    Science.gov (United States)

    Zheng, Xin; Dou, Changwei; Yao, Yingmin; Liu, Qingguang

    2015-02-01

    The aim of this meta-analysis was to determine whether laparoscopic splenectomy (LS) and LS with esophagogastric devascularization (LSED) were the minimally invasive alternative for portal hypertension. A meta-analysis of comparative clinical trials was performed to assess our questions noted above. The databases PubMed, ScienceDirect, and Springerlink were searched. In total, 725 patients with liver cirrhosis and/or portal hypertension from eight published comparative trials were included. The operation time in the laparoscopic group was more than that in the open group [weighted mean difference (WMD) 35.24 (16.74, 53.74); P<.001]. However, there were less intraoperative blood loss [WMD -194.84 (-321.34, -68.34); P=.003] and a shorter postoperative hospital stay [WMD -4.33 (-5.30, -3.36); P<.001] in the laparoscopic group. The incidence of complications was similar in the two groups. In the subgroup studies about LS versus open splenectomy, no significant differences were found in operation time, intraoperative blood loss, and complication rates. The postoperative hospital stay in the LS group was apparently decreased [WMD -4.07 (-4.93, -3.21); P<.001]. Although the operation time of LSED was longer [WMD 43.23 (17.13, 69.32); P=.001], LSED was associated with less intraoperative blood loss [WMD -189.26 (-295.71, -82.81); P<.001] and a shorter postoperative hospital stay [WMD -5.41 (-7.84, -2.98); P<.001]. Meta-analysis did not favor either LSED or open splenectomy with esophagogastric devascularization in term of complication rates. The results of this meta-analysis were in favor of LS and LSED for being a safe, minimally invasion alternative for patients with liver cirrhosis and portal hypertension.

  12. Portal Hypertensive Duodenopathy Manifesting as “Kissing” Duodenal Ulcers in a Nigerian with Alcoholic Cirrhosis: A Case Report and Brief Review of the Literature

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    Aderemi Oluyemi

    2012-01-01

    Full Text Available Multiple duodenal ulcers are an uncommon finding in portal hypertensive duodenopathy (PHD. They represent a potential source of clinically significant bleeding from the upper gastrointestinal system in patients with cirrhosis. As this particular ulcer entity in relation to PHD has no distinguishing symptoms aside from those relating to the consequent bleeding, most of them are found either on routine endoscopic screening for cirrhotics or on endoscopic examination for cause(s of bleeding in this patient population. The case documented below highlights many of the aspects of pathogenesis, associations, and consequences of this unique endoscopic finding in cirrhotic patients.

  13. Risk factors for portal venous thrombosis under anticoagulation therapy after operation of portal hypertension%门脉高压症术后抗凝治疗下门静脉血栓形成的因素分析

    Institute of Scientific and Technical Information of China (English)

    张本厚; 王桂芳; 池萍

    2015-01-01

    目的:分析门静脉高压症术后抗凝治疗下门静脉血栓形成的危险因素。方法回顾性分析我院门静脉高压症手术治疗的96例患者的临床资料。分为血栓组和非血栓组,对可能预测门静脉血栓形成的各种因素进行分析。结果96例患者中有41例(40.08%)出现门静脉血栓。患者性别、年龄、Child-Pugh 分级、手术方式、手术前后门静脉压力及压力差、凝血酶原时间、术前血小板计数、脾脏指数、门静脉内径等均不是预测门静脉血栓形成的危险因素;脾静脉直径是门静脉血栓形成的独立危险因素(P =0.036),当脾静脉直径>11 mm 时,术后容易形成门静脉血栓。结论术前彩色多普勒检测脾静脉直径可以预测门静脉高压症患者手术治疗后门静脉血栓形成。%Objective To investigate the risk factors for portal vein thrombosis (PVT)under anticoagulation therapy after surgery in patients with portal hypertension.Methods We made a retrospective analysis of clinical data of 96 portal hypertension patients for surgical treatment at our hospital.All the patients with postoperative PVT or without were divided into two groups.Risk factors that may predict PVT were analyzed.Results PVT developed in 41 (40.08%)of 96 patients after surgery.Risk factors such as sex,age,Child-Pugh classification,type of operation,portal pressure and the pressure difference before and after surgery,preoperative prothrombin time, preoperative platelet count,spleen index,and portal vein diameter were not predictors of PVT.However,splenic vein diameter was an independent risk factor for PVT (P = 0.036);postoperative PVT tended to develop when the splenic vein diameter was larger than 1 1 mm.Conclusion Preoperative color Doppler testing of splenic vein diameter can predict PVT after surgery in patients with portal hypertension.

  14. Esquistossomose pulmonar. I. Forma crônica extensa sem hipertensão pulmonar e na ausência de hipertensão portal Pulmonary Schistosomiasis. I. Extensive chronic form without pulmonary hypertension and portal hypertension syndrome

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    Jayme Neves

    1980-12-01

    right; cardiac area was apparently normal. Microthoracotomy showed dominant pleural lesion enclosing the right superior lobe, affecting widely the parenchyma. Decortication of medium and right inferior lobes, partial reexpansion of their parenchyma, and pulmonary biopsy were performed. Histopathological study disclosed a predomiantly focal, but relatively extensive, and severe case of pulmonary arteritis without cor pulmonale. This pulmonary involvement occured isolated, not related to a hepato-splenic symptomatology, and consequently there was no syndrome of portal hypertension to indicate the preferentiai way of migration of the eggs, and eventually of the worms to the lungs.

  15. Analysis of the reasons of portal vein thrombosis after splenectomy for portal hypertension due to hepatic cirrhosis%肝硬化脾切除术后门静脉系统血栓形成的原因分析

    Institute of Scientific and Technical Information of China (English)

    朱柯磊; 陆才德; 李定耀; 陈明良; 蒋存兵

    2012-01-01

    To explore the contributory reasons leading to portal vein thrombosis (PVT) after splenectomy and perieardial devascularization for portal hypertension due to hepatic cirrhosis. Methods The cl inieal data of 204 patients with portal hypertension due to hepatic cirrhosis inour hospital from January 2004 to January 2010 were retrospectively analyzed. Results One hundredand fiftypatients underwent splenectomy and perieardial devascularization, whi le54patientsunderwentpartial spleneetamyandperieardialdevascularization.PVT occurred in 30 patients (14. 7%). There was significant difference in the diameter of portal veins and splenic veins,the blood flow of portal veins in two groups of patients with or without PVT (P<0. 05). The incidence of PVT in patients undergone spl eneetomy and perieardial devasculari zation or suffered from postoperative eompl ieat ions were muchhigher than that in the other group (P<0. 05). Conclusion The risk factors of PVT after splenectomy and pericardial devaseularizationforportalhypertensionduetohepaticcirrhosisare: diameterofportalveins, diameterofsplenicveins,blood flow of portal veins and complications. And partial splenectomy can decrease the incidence of PVT.%目的 探讨肝硬化门静脉高压患者行脾脏切除+贲门周围血管离断术后门静脉系统血栓(portal vein thrombosis,PVT)形成的原因.方法 回顾性分析我院2004年1月至2010年1月204例肝炎后肝硬化门静脉高压症行手术治疗患者的临床资料.结果 其中150例行脾切除+贲门周围血管离断术,54例行脾脏部分切除术+贲门周围血管离断术.术后发生PVT30例,未发生PVT174例;发生PVT患者的门静脉和脾静脉直径、术后门静脉血液流速及术后并发症与未发生PVT患者有显著性差异(P<0.05),脾脏部分切除术后患者PVT的发生率明显比脾脏切除患者低,有显著性差异(P<0.05).结论 门静脉和脾静脉直径、门静脉血液流速及术后并发症是肝硬化门脉高压

  16. Extrahepatic manifestations of hepatitis C.

    Science.gov (United States)

    Palekar, Nicole A; Harrison, Stephen A

    2005-10-01

    Hepatitis C affects approximately 170 million people worldwide. Extrahepatic manifestations of chronic hepatitis C infection are clinically evident in nearly 40% of patients. Much research has been done over the last decade to better understand their incidence, clinical presentation, mechanism of disease, and the role of antiviral therapy in their treatment. Of the commonly reported manifestations, cryoglobulinemia, membranoproliferative glomerulonephritis, and porphyria cutanea tarda remain the best understood manifestations. More recently, the association of insulin resistance and diabetes mellitus with chronic hepatitis C has been demonstrated. This paper serves to review the growing body of literature detailing the extrahepatic manifestations of chronic hepatitis C.

  17. Splenic arteriovenous fistula and sudden onset of portal hypertension as complications of a ruptured splenic artery aneurysm: Successful treatment with transcatheter arterial embolization. A case study and review of the literature

    Institute of Scientific and Technical Information of China (English)

    Dimitrios Siablis; Zafiria G Papathanassiou; Dimitrios Karnabatidis; Nikolaos Christeas; Konstantinos Katsanos; Constantine Vagianos

    2006-01-01

    Splenic arteriovenous fistula (SAVF) accounts for an unusual but well-documented treatable cause of portal hypertension[1-4]. A case of a 50-year-old multiparous female who developed suddenly portal hypertension due to SAVF formation is presented. The patient suffered from repeated episodes of haematemesis and melaena during the past twelve days and thus was emergently admitted to hospital for management. Clinical and laboratory investigations established the diagnosis of portal hypertension in the absence of liver parenchymal disease. Endoscopy revealed multiple esophageal bleeding varices. Abdominal computed tomography (CT)and transfemoral celiac arteriography documented the presence of a tortuous and aneurysmatic splenic artery and premature filling of an enlarged splenic vein, findings highly suggestive of an SAVF. The aforementioned vascular abnormality was successfully treated with percutaneous transcatheter embolization. Neither recurrence nor other complications were observed.

  18. Hypertension

    Science.gov (United States)

    ... Hypertension Triglycerides Featured Resource Find an Endocrinologist Search Hypertension March 2010 Download PDFs English Espanol Editors Robert ... Additional Resources MedlinePlus (NIH) Mayo Clinic What is hypertension? Hypertension, or chronic (long-term) high blood pressure, ...

  19. An Unusual Case of Gastrointestinal Bleeding from Isolated Gallbladder Varices in a Patient with Pancreatic Cancer Complicated by Portal Biliopathy

    Directory of Open Access Journals (Sweden)

    Mahir Gachabayov

    2016-01-01

    Full Text Available Portal biliopathy is the complex of abnormalities of extrahepatic and intrahepatic bile ducts, cystic duct, and gallbladder, arising as a result of extrahepatic portal vein obstruction and noncirrhotic portal fibrosis, which can be caused by coagulopathies, tumors, inflammation, postoperative complications, dehydration, and neonatal umbilical vein catheterization. We report a case of a 55-year-old male patient with the history of pancreatic cancer and cholecystoenteric anastomosis presenting with gastrointestinal bleeding from gallbladder varices via the anastomosis.

  20. 肝硬化门静脉高压症不同手术方式与血栓形成%Different operative patterns for cirrhotic portal hypertensive patients and development of portal vein thrombosis

    Institute of Scientific and Technical Information of China (English)

    吴婷婷; 吴志勇; 罗蒙

    2014-01-01

    relationship between different operation patterns for patients with portal hypertension caused by hepatic cirrhosis and examine the incidence,position and risk fac-tors of portal vein thrombosis (PVT).Methods From January 201 1 to December 2012,72 patients with portal hypertension in liver cirrhosis were analyzed.There were devascularization (n =25 ),se-lective devascularization (n = 1 5 )and splenorenal shunt associated with devascularization (n = 32). Platelet,prothrombin time,hemodynamics of portal vein and the incidence of PVT were analyzed be-fore and after operation.Results Pre-operative blood velocity of portal vein decreased remarkably in patients with PVT while both groups showed no difference in factors of coagulation function.No re-markable inter-group difference existed in platelet levels,but D-dimer levels were higher than nor-mal though the inter-group difference was insignificant.At 2 weeks and 2 months post-devascular-ization,splenic vein thrombosis extended to trunk and branch(es)of portal vein in 12(48%)patients. After selective devascularization,some of them had thrombosis extended to trunk of portal vein or branch(es)and blocked gastric coronary vein and paraesophageal vein.While another few patients on-ly showed superior mesenteric vein,gastric coronary vein and paraesophageal vein,with splenic vein and portal vein completely blocked.After splenorenal shunt associated with devascularization,the rate of PVT was 75% at 2 months post-operation and decreased to 41 % at 6 months.And it was the lowest among 3 groups.Most patients suffered partial thrombosis in portal trunk and(or)branches while only 1 case had the partially blocked shunt.Conclusion Occurring at different sites in trunk or branch(es)of portal vein after splenorenal shunt associated with devascularization,PVT may be cor-related with the changes of portal hemodynamics.

  1. The transjugular portosystemic stent shunt (TIPSS) as an intervention in clinical complication of portal hypertension; Der transjugulaere portosystemische Stentshunt (TIPSS) als Intervention bei klinischen Komplikationen der portalen Hypertonie

    Energy Technology Data Exchange (ETDEWEB)

    Thalhammer, A.; Jacobi, V.; Schwarz, W.; Balzer, J.; Abolmaali, N.; Vogl, T.J. [Frankfurt Univ. (Germany). Zentrum der Radiologie

    2001-10-01

    Most frequent complications in patients with liver cirrhosis are due to portal hypertension. Beside ascites circumvent vessles formate with vasodilatation. Due to counterregulation a secondary hyperaldosteronism develops with release of vasocontrictive agents. If conservative and endoscopic methods fail, indication for building a portosystemic shunt is given. The TIPSS procedure is less invasive than the surgical method of Warren-Shunt, so the radiological intervention has replaced surgery. Reducing the portal pressure by the shunt, the clinical complications change for the better. Still problems are defined as hepatic encephalopathy and right ventricular heart failure. Regular follow up investigations have to be performed to detect complications in the shunt. Using regular clinical and radiological check up TIPSS is of clinical benefit with good long term results. (orig.) [German] Die haeufigsten Komplikationen bei Patienten mit einer Leberzirrhose lassen sich auf das Vorliegen einer portalen Hypertension zurueckfuehren. Neben einer Aszitesbildung kommt es zur Vasodilatation mit Ausbildung portaler Umgehungskreislaeufe, gegenregulatorisch zu einem sekundaeren Hyperaldosteronismus und Ausschuettung vasokonstriktiver Substanzen. Sind mittels konservativer und endoskopischer Methoden die Komplikationen nicht mehr zu beherrschen, ist die Indikation zur Shuntanlage gegeben. Wegen der geringeren Invasivitaet einer TIPSS-Anlage gegenueber der operativen Methode eines Warren-Shunts hat sich die interventionell radiologische Methodik in den letzten Jahren immer mehr durchgesetzt. Durch den mittels Shuntanlage reduzierten Pfortaderdruck kommt es zu einer deutlichen klinischen Besserung der unterschiedlichen Komplikationen. Als klinisch problematische Symptome bei der Shuntanlage sind die hepatische Enzephalopathie und eine Zunahme der Rechtsherzbelastung zu werten. Um Komplikationen im Bereich des Shunts frueh zu erkennen, muss dieser engmaschig kontrolliert werden. Unter

  2. Successful Treatment of Bleeding Gastric Varices with Splenectomy in a Patient with Splenic, Portal, and Mesenteric Thromboses

    Directory of Open Access Journals (Sweden)

    Lior Menasherian-Yaccobe

    2013-01-01

    Full Text Available A 59-year-old female with a history of multiple splanchnic and portal thromboses treated with warfarin underwent an esophagogastroduodenoscopy for cancer screening, and a polypoid mass was biopsied. One week later, she was admitted with upper gastrointestinal hemorrhage. Her therapeutic coagulopathy was reversed with fresh frozen plasma, and she was transfused with packed red blood cells. An esophagogastroduodenoscopy demonstrated an erosion of a gastric varix without evidence of recent bleeding. Conservative measures failed, and she continued to bleed during her stay. She was not considered a candidate for a shunt procedure; therefore, a splenectomy was performed. Postoperative esophagogastroduodenoscopy demonstrated near complete resolution of gastric varices. One year after discharge on warfarin, there has been no recurrence of hemorrhage. Gastric varices often arise from either portal hypertension or splenic vein thrombosis. Treatment of gastric variceal hemorrhage can be challenging. Transjugular intrahepatic portosystemic shunt is often effective for emergency control in varices secondary to portal hypertension. Splenectomy is the treatment for varices that arise from splenic vein thrombosis. However, treatment of gastric variceal hemorrhage in the context of multiple splanchnic and portal vein thromboses is more complicated. We report splenectomy as a successful treatment of gastric varices in a patient with multiple extrahepatic thromboses.

  3. [Extrahepatic manifestations in hepatitis C].

    Science.gov (United States)

    Risum, Malene

    2011-05-09

    Hepatitis C does not only affect the liver, but also manifests outside the liver. The skin, kidneys and nervous system are often involved due to mixed cryoglobulinaemia. Porphyria cutanea tarda, lymphoma and thyroid diseases among others can also attend a chronic infection, but the exact pathogenesis behind these manifestations is not clearly mapped. Antiviral treatment is reported to induce sustained virological response in more than half of the treated patients with a variable clinical response in the extrahepatic manifestations.

  4. Expression of vasoactive proteins in gastric antral mucosa reflects vascular dysfunction in patients with cirrhosis and portal hypertension

    DEFF Research Database (Denmark)

    Trebicka, Jonel; Wix, Cyrus; von Heydebrand, Matthias

    2015-01-01

    . Portal pressure gradient was measured in 49 patients with TIPS and in 16 patients without TIPS. Biopsies from the antrum were conserved in formaldehyde for immunohistochemistry or shock-frozen for PCR and Western blot. RESULTS: The mucosal transcription of vascular markers (αSMA, CD31) was higher...

  5. Soluble TNF-Alpha-Receptors I Are Prognostic Markers in TIPS-Treated Patients with Cirrhosis and Portal Hypertension

    DEFF Research Database (Denmark)

    Trebicka, Jonel; Krag, Aleksander; Gansweid, Stefan

    2013-01-01

    TNFα levels are increased in liver cirrhosis even in the absence of infection, most likely owing to a continuous endotoxin influx into the portal blood. Soluble TNFα receptors (sTNFR type I and II) reflect release of the short-lived TNFα, because they are cleaved from the cells after binding...

  6. Extrahepatic Manifestations of Primary Biliary Cholangitis.

    Science.gov (United States)

    Chalifoux, Sara L; Konyn, Peter G; Choi, Gina; Saab, Sammy

    2017-03-16

    Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by progressive destruction of the intrahepatic bile ducts, leading to cholestasis. PBC is known to have both hepatic and extrahepatic manifestations. Extrahepatic manifestations are seen in up to 73% of patients with PBC, with the most common being Sjogren's syndrome, thyroid dysfunction and systemic sclerosis. It is thought that patients with PBC are at increased risk of developing these extrahepatic manifestations, almost all of which are autoimmune, because patients with autoimmune disease are at higher risk of developing another autoimmune condition. Due to the high prevalence of extrahepatic diseases in patients with PBC, it is important to complete a thorough medical history at the time of diagnosis. Prompt recognition of extrahepatic disease can lead to improved patient outcomes and quality of life. The following review summarizes the most common extrahepatic conditions associated with PBC.

  7. "Hiperesplenismo" em hipertensão porta por esquistossomose mansônica "Hiperesplenism" in portal hypertension provoked by Manson's schistosomiasis

    Directory of Open Access Journals (Sweden)

    Andy Petroianu

    2004-01-01

    Full Text Available INTRODUÇÃO: Durante anos, as alterações hematológicas que ocorrem na esquistossomose mansônica hepatoesplênica vêm sendo definidas como hiperesplenismo. Inicialmente, acreditava-se que apenas a remoção do baço normalizava os valores hematológicos, entretanto, em cirurgias para o tratamento da hipertensão porta nas quais o baço era preservado, observou-se normalização dos valores hematimétricos. Cabe correlacionar o quadro clínico e laboratorial para definir a real existência de hiperesplenismo. MÉTODO: Foram estudados 51 doentes portadores de hipertensão porta por esquistossomose mansônica distribuídos em cinco grupos: Grupo 1- pacientes não operados e em controle clínico, Grupo 2- pacientes submetidos a anastomose esplenorrenal distal, Grupo 3 - pacientes com esplenectomia subtotal e anastomose esplenorrenal proximal, Grupo 4 - pacientes com esplenectomia total e anastomose esplenorrenal proximal e Grupo 5 - pacientes com esplenectomia total e desconexão porta-varizes. Sinais clínicos de hiperesplenismo foram pesquisados em todos os doentes. Os valores hematológicos e as contagens das imunoglobulinas do pré e do pós-operatório foram comparados pelos testes de Friedman e t para amostras emparelhadas. Os grupos foram comparados pelo teste de Kruskal-Wallis, com significância pFor many years, the hematologic changes occurring in hepatosplenic Manson's schistosomiasis have been defined as hypersplenism. Initially, the belief was that removal of the spleen would normalize the hematologic values. However, hematimetric normalization was observed in surgeries for the treatment of portal hypertension in which the spleen was preserved. In view of these findings, it is necessary to verify the clinical and laboratory profile of these patients in order to define the real presence of hypersplenism. This study was conducted on 51 patients with Manson's schistosomatic portal hypertension divided into five groups: Group 1, non

  8. 胰源性门静脉高压症的诊断与治疗%Diagnosis and management of pancreatic regional portal hypertension

    Institute of Scientific and Technical Information of China (English)

    王正峰; 周光文

    2012-01-01

    Objective To summarize clinical experience on the diagnosis and management of pancreatic regional portal hypertension. Methods The clinical manifestations,diagnostic methods and therapeutic modalities of 40 cases of pancreatic regional portal hypertension were analyzed retrospectively.Results Male:female =26: 14.The average age was (40 ± 10)yrs.Among these patients,16 patients (40%) were accompanied by upper gastrointestinal bleeding and 20 patients (50%) by hypersplenism.There were 16 patients (40%) suffering from benign lesions and 6 patients (15%) from malignancy at pancreatic body and tail respectively,and 8 patients(20% ) from severe necrotic pancreatitis accompanying pseudocyst and 10 patients (25%) from chronic pancreatitis. The average splenic venous pressure was (28.4±4.2) cm H2O(P <0.01 ).The average diameter and speed of splenic vein bloodflow by Doppler examination was ( 1.3 ± 0.2 ) cm ( P < 0.01 ) and ( 9.3 ± 0.5 ) cm/s ( P < 0.05 ).The follow-up rate was 100%.Splenectomy was effective for controlling gastrointestinal bleeding. Conclusions It is not difficult to diagnose pancreatic regional portal hypertension based on findings of US,CT and endoscopic examination,together with its clinical features. Therapy should be aimed at both regional portal hypertension and underlying diseases.%目的 总结胰源性门静脉高压症的诊断与治疗经验.方法 回顾性分析40例胰源性门静脉高压症患者的临床表现、诊治和疗效.结果 本组40例患者中男26例,女14例,平均年龄(40±10)岁;16例合并上消化道出血,20例合并脾功能亢进;胰体尾良性肿瘤16例,恶性肿瘤6例,重症胰腺炎合并胰腺假性囊肿8例,慢性胰腺炎10例.胰源性门静脉高压组脾静脉压力为(28.4 ±4.2)cm H2O,与对照组相比差异有统计学意义,P<0.01.Doppler超声测定脾静脉直径和流速分别为(1.3±0.2) cm和(9.3±0.5)cm/s,与对照组相比差异有统计学意义,分别P<0.01

  9. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Zhi-yu LI; Bin LI; Yu-lian WU; Qiu-ping XIE

    2013-01-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic.In cases where gastrointestinal (GI) bleeding is present,however,the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment.A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article.The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography.After embolization,the bleeding stopped and stabilized for the entire follow-up period without any severe complications.In conclusion,embolization of the splenic artery is a simple,safe,and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  10. Acute pancreatitis associated left-sided portal hypertension with severe gastrointestinal bleeding treated by transcatheter splenic artery embolization: a case report and literature review.

    Science.gov (United States)

    Li, Zhi-yu; Li, Bin; Wu, Yu-lian; Xie, Qiu-ping

    2013-06-01

    Left-sided portal hypertension (LSPH) followed by acute pancreatitis is a rare condition with most patients being asymptomatic. In cases where gastrointestinal (GI) bleeding is present, however, the condition is more complicated and the mortality is very high because of the difficulty in diagnosing and selecting optimal treatment. A successfully treated case with severe GI bleeding by transcatheter splenic artery embolization is reported in this article. The patient exhibited severe uncontrollable GI bleeding and was confirmed as gastric varices secondary to LSPH by enhanced computed tomography (CT) scan and CT-angiography. After embolization, the bleeding stopped and stabilized for the entire follow-up period without any severe complications. In conclusion, embolization of the splenic artery is a simple, safe, and effective method of controlling gastric variceal bleeding caused by LSPH in acute pancreatitis.

  11. 肝前型门静脉高压症动物(犬)模型制作体会%Experiences in making canine models of pre-hepatic portal hypertension

    Institute of Scientific and Technical Information of China (English)

    赵莉; 李振东; 于增文; 孙静生; 仲智勇

    2001-01-01

    Objective To insure the reliability of animal models ofpre-hepatic portal hypertension.Methods The size of spleen, diameter and pressure of portal vein of 29 canine models were measured. A partial ligation of portal vein was performed narrowing at 95% of its original cross section, or making the portal vein pressure more than three times to its original pressure and the gastrointestinal venous stasis could not be seen. The features of gastrointestinal venous stasis and collateral circulation were observed during reoperation on the 2nd, 4th, 8th, 12th and 16th weeks postoperatively.Results Four dogs died from abdominal infection, anesthesia and acute enteric necrosis respectively. The higher pressure of portal vein, retroperitoneal edema, hypertrophy of the intestinal wall were noted. Following the formation of collaterals between portal and systemic circulation , the portal vein pressure decreased gradually from 2nd to 8th weeks. From 12th to 16th weeks postoperatively, the portal vein pressure was stabilized but still higher than that of the normal, retropertioneal edema disappeared and collateral vessels could be clearly seen. The pressure of portal vein in the 12th, 16th weeks was lower than that in 2nd, 4th weeks (P0.05。结论 采用部分结扎门静脉的方法制作肝前型门脉高压症动物模型,缩窄门脉后12~16周为成功;更接近其临床表现,有一定的侧支循环的门脉高压症,此时做肝前型门脉高压症的实验数据最可靠。

  12. Trombose de veia porta em crianças e adolescentes Portal vein thrombosis in children and adolescents

    Directory of Open Access Journals (Sweden)

    Graziela C. M. Schettino

    2006-06-01

    Full Text Available OBJETIVO: Apresentar uma revisão atualizada de trombose de veia porta na infância e adolescência, enfatizando o diagnóstico, suas complicações e tratamento. FONTE DOS DADOS: Foi realizada revisão da literatura, dos últimos 10 anos, através de pesquisa bibliográfica na Internet nos principais sites de busca médica, como o PubMed e MEDLINE, com enfoque na doença trombose de veia porta e suas repercussões clínicas. As principais palavras-chave e expressões pesquisadas foram: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Além disso, foram consultados os artigos citados nas referências dos trabalhos selecionados na pesquisa inicial e dos livros textos. SÍNTESE DOS DADOS: A trombose de veia porta é uma das causas mais comuns de hipertensão porta na infância. A apresentação clínica inicial pode ser através de episódios de hemorragia digestiva ou da presença de esplenomegalia em exame clínico de rotina. As principais complicações são a hemorragia digestiva, hiperesplenismo secundário à esplenomegalia, retardo de crescimento e biliopatia portal. O diagnóstico é realizado através da ultra-sonografia abdominal com Doppler. O tratamento é direcionado para as complicações, incluindo profilaxia primária e secundária de hemorragia digestiva, conseqüente à ruptura de varizes esofágicas, e derivações porto-sistêmicas, em casos selecionados. CONCLUSÕES:A trombose de veia porta é uma das causas mais importantes de hemorragia digestiva em crianças. Esses episódios acarretam impacto importante na qualidade de vida dos pacientes acometidos. Dessa forma, uma abordagem diagnóstica e terapêutica adequada é desejável na tentativa de se reduzir a morbimortalidade.OBJECTIVE: To review the literature on portal vein thrombosis in children and adolescents, focusing on its diagnosis, complications and treatment. SOURCE OF DATA: The medical

  13. The influence of periportal (pipestem fibrosis on long term results of surgical treatment for schistosomotic portal hypertension

    Directory of Open Access Journals (Sweden)

    Ferraz Álvaro Antônio Bandeira

    2003-01-01

    Full Text Available AIM: To evaluate the degree of influence that periportal fibrosis has on clinical development and the long term results of surgical treatment on patients with hepatic-splenic schistosomiasis with previous gastrointestinal hemorrhages. METHODS: During the period of 1992-1998, 111 patients underwent surgical treatment for the treatment of hepatic-splenic schistosomiasis with previous gastrointestinal hemorrhages. The degree of fibrosis was classified as: degree I - the portal spaces show a rich increase of young connective cells, a slight collagen production and a varying presence of inflammatory infiltrate. The periportal blade unchangeable (29/111; degree II - there is an expansion of the connective tissue with the emission of radial collagen septa, producing a star shaped aspect (38/111; degree III - the connective septa form bridges with other portal spaces or with the vein, with evident angiomatoid neo-formation (44/111. CONCLUSION: The patients with periportal fibrosis degree I present recurrent hemorrhages statistically less than patients with periportal fibrosis degrees II and III, and that the intensity of the periportal fibrosis is not the only pathophysiological factor of the esophageal varices, gastric varices, prevalence of post-operative portal vein thrombosis and hematological and biochemical alterations of the patients with pure mansoni schistosomiasis.

  14. Indications for portal pressure measurement in chronic liver disease

    DEFF Research Database (Denmark)

    Hobolth, Lise; Bendtsen, Flemming; Møller, Søren

    2012-01-01

    Portal hypertension leads to development of serious complications such as esophageal varices, ascites, renal and cardiovascular dysfunction. The importance of the degree of portal hypertension has been substantiated within recent years. Measurement of the portal pressure is simple and safe...... of HVPG should therefore be considered as a part of the general characterization of patients with portal hypertension in departments assessing and treating this condition....

  15. Structure remodeling of swine hepatic artery in portal hypertension%门静脉高压症猪肝动脉的结构重建

    Institute of Scientific and Technical Information of China (English)

    贺细菊; 于明华; 李文春; 张兴华; 黄铁柱

    2011-01-01

    Objective To establish a reliable swine portal hypertension model and explore the morphological properties of hepatic arteries. Methods Liver cirrhosis and portal hypertension were induced by carbon tetrachlorideand fenobarbital ( n = 8), 4 pigs served as the control, the hepatic arteries were collected and serially sectioned. The tissue structure, elastic fiber, collagen fiber and smooth muscle were stained by HE, Weigert, Aniline blue and Orange G respectively. The morphological data of hepatic arteries were obtained by the computer image analysis system. Results The portal vein pressure of experimental group was (4. 17 ± 1.03 ) kPa, that of the control group was ( 1.51 ± 0. 79 ) kPa. The intima and media thickness of hepatic artery was obviously larger than that of the control ( P <0. 05 ). The wall thickness and the diameter of hepatic artery were obviously larger than that of the control ( P < 0. 0l ), the relative percentage of collagen fibers(C) was significantly larger than that of the control (P < 0. 0l ), the relative percentage of elastic fibers ( E ) decreased significantly ( P < 0. 05 ), the ratio of C and E increased significanfiy. Conclusion The hepatic artery has suffered extensive morphological remodeling while portal hypertension, and in return affected the hepatic artery buffer response.%目的 建立猪门静脉高压症模型,探讨门静脉高压症时肝动脉的结构重建.方法猪以四氯化碳、苯巴比妥、乙醇配合高脂、低蛋白、低胆碱饮食进行混合饲养.通过脾静脉插管测压,取肝动脉常规石蜡包埋、切片,用HE 法、Weigert 法、Aniline blue法,Organge G法分别染组织结构、弹性纤维、胶原纤维和平滑肌,用计算机图像分析系统定量分析肝动脉的几何形态及显微成分.结果实验组门静脉压为(4.17±1.03)kPa,明显大于对照组(1.51±0.79)kPa;实验组肝动脉的内膜与中膜增厚,管壁增厚,管径增粗,胶原纤维的百分含量显著增

  16. Dignostic value of splenoportoscintigraphy,gastroscopy and B-mode ultrasonography for liver cirrhotics with portal hypertension.%经皮脾门静脉核素显像、B超及胃镜对肝硬化 门脉高压诊断价值的对比研究

    Institute of Scientific and Technical Information of China (English)

    赵幼安; 高丽; 任长征; 栗华

    2001-01-01

    To investigate and evaluate the methods for the dignosis ofcirrhotics with portal hypertension. Spleno-portal vein shape and portosystemic shunt index(PSSI)were determined through portal circulation imaging by using intrasplenic injection of 99m Tc-Phytate.Comparision was also made with gastroscopy and ultrasonography.Results showed that the liver cirrhostics with portal hypertension were separated into four type,namely nonshunt,shunt,with collateral vein and full-extrahepatic shunt type by splenoportoscintigraphy. The PSSI for controls was 0.192±0.068,chronic hepatitis was 0.246±0.057,cirrhosis was 0.541±0.082,cirrhosis Child-pugh A 0.384±0.052,B 0.523±0.07,C 0.680±0.081.If the threshold for cirrhosis was set at PSSI>0.36,the sensitivity was 91.7%,superior to the above other methods.It suggests that splenoportoscintigraphy is capable showing splenoportal circulation shape and helpful in dignosing cirrhosis at its early stage and evaluating prognosis.%为探讨经脾门静脉核素显像、胃镜及B超检查在肝硬化门脉高压诊断中的价值及其相关性,采用99m锝-植酸钠(99mTc-Phytate)经脾细针穿刺给药法对58例肝病与非肝病患者进行了经脾门静脉单光子发射计算机断层(SPECT)显像,以观察及门脉循环情况,计算门体分流指数(PSSI),并与胃镜、B超进行比较。结果显示,经脾门静脉核素显像可将肝硬化门脉高压分为四型,即无分流型、有分流型(包括肝内、外分流)、有侧支循环型、完全肝外分流型。PSSI值非肝病对照组为0.192±0.068,慢性肝病组为0.246±0.057,肝硬化门脉高压组为0.541±0.082。按肝硬化ChildA、B、C分级,三组分别为0.384±0.052、0.523±0.072、0.680±0.081。若以PSSI>0.36为判别阈,肝硬化组总阳性率为91.7%,其诊断价值明显优于B超及胃镜。提示经脾门静脉核素显像既能显示脾门静脉形态及

  17. Establishment and evaluation of esophagogastic varices in dogs with portal hypertension%犬门静脉高压症食管胃底静脉曲张模型的建立及评价

    Institute of Scientific and Technical Information of China (English)

    王启志; 唐军; 李同芬; 徐卓东; 王广川; 张春清

    2013-01-01

    Objective To establish and evaluate the dog model of portal hypertension with embolization of hepatic vein. Methods 10 healthy adult Beagle dogs were enrolled in the study. Portal hypertension was established by partly complete embolization hepatic vein, the degree of postoperative portal hypertension was evaluated by liver function, ultrasound and imaging examination. Results 8 of 10 cases were developed to portal hypertension, the liver function was abnormalities and hepatic portal pressure was elevated compared with preoperative, and it was statistic significance between pre and postoperation ( P <0. 01), esophagogastic varice veins had been shown in 6 cases by multislice CT and hepatic portal vein angiography. Conclusion The model establised is simple and reliable, the time of establishing model needs shorter, it is useful for research in esophagogastric varices and could provid a model on the esophagogastic varices bleeding for hepatic portal hypertension.%目的 介入栓塞肝静脉建立犬肝后型门静脉高压模型并加以评价,为临床治疗提供可靠、稳定的模型动物.方法 10条健康成年比格犬为研究对象,介入栓塞部分肝静脉建立犬肝后型门静脉高压模型,术后根据肝功能、超声和影像学检查等指标进行评估.结果 10条比格犬8只造模成功,形成门静脉高压模型,与术前相比,肝功能显著异常,门静脉压力明显升高(P<0.01).经CT强化及门静脉血管成像,6只形成曲张静脉.结论 本组所采用的方法简单易行,制备周期明显缩短.模型质量可靠,可形成稳定的食管静脉曲张模型,以用于门脉高压症食管胃底静脉曲张出血的相关研究.

  18. Congenital Extrahepatic Portosystemic Shunts: Spectrum of Findings on Ultrasound, Computed Tomography, and Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Pankaj Gupta

    2015-01-01

    Full Text Available Congenital extrahepatic portosystemic shunt (CEPS is a rare disorder characterised by partial or complete diversion of portomesenteric blood into systemic veins via congenital shunts. Type I is characterised by complete lack of intrahepatic portal venous blood flow due to an end to side fistula between main portal vein and the inferior vena cava. Type II on the other hand is characterised by partial preservation of portal blood supply to liver and side to side fistula between main portal vein or its branches and mesenteric, splenic, gastric, and systemic veins. The presentation of these patients is variable. Focal liver lesions, most commonly nodular regenerative hyperplasia, are an important clue to the underlying condition. This pictorial essay covers imaging characteristics in abdominopelvic region.

  19. Extrahepatic manifestations of hepatitis C virus infection.

    Science.gov (United States)

    Zignego, Anna Linda; Craxì, Antonio

    2008-08-01

    Hepatitis C virus may cause hepatic and extrahepatic diseases. Extrahepatic manifestations range from disorders for which a significant association with viral infection is supported by epidemiologic and pathogenetic data, to anecdotal observations without clear proof of causality. This article describes the diagnosis and treatment of these diseases.

  20. Portal cavernoma cholangiopathy: consensus statement of a working party of the Indian national association for study of the liver.

    Science.gov (United States)

    Dhiman, Radha K; Saraswat, Vivek A; Valla, Dominique C; Chawla, Yogesh; Behera, Arunanshu; Varma, Vibha; Agarwal, Swastik; Duseja, Ajay; Puri, Pankaj; Kalra, Naveen; Rameshbabu, Chittapuram S; Bhatia, Vikram; Sharma, Malay; Kumar, Manoj; Gupta, Subhash; Taneja, Sunil; Kaman, Leileshwar; Zargar, Showkat A; Nundy, Samiran; Singh, Shivaram P; Acharya, Subrat K; Dilawari, Jang B

    2014-02-01

    Portal cavernoma cholangiopathy (PCC) is defined as abnormalities in the extrahepatic biliary system including the cystic duct and gallbladder with or without abnormalities in the 1st and 2nd generation biliary ducts in a patient with portal cavernoma. Presence of a portal cavernoma, typical cholangiographic changes on endoscopic or magnetic resonance cholangiography and the absence of other causes of these biliary changes like bile duct injury, primary sclerosing cholangitis, cholangiocarcinoma etc are mandatory to arrive a diagnosis. Compression by porto-portal collateral veins involving the paracholedochal and epicholedochal venous plexuses and cholecystic veins and ischemic insult due to deficient portal blood supply or prolonged compression by collaterals bring about biliary changes. While the former are reversible after porto-systemic shunt surgery, the latter are not. Majority of the patients with PCC are asymptomatic and approximately 21% are symptomatic. Symptoms in PCC could be in the form of long standing jaundice due to chronic cholestasis, or biliary pain with or without cholangitis due to biliary stones. Endoscopic retrograde cholangiography has no diagnostic role because it is invasive and is associated with risk of complications, hence it is reserved for therapeutic procedures. Magnetic resonance cholangiography and portovenography is a noninvasive and comprehensive imaging technique, and is the modality of choice for mapping of the biliary and vascular abnormalities in these patients. PCC is a progressive condition and symptoms develop late in the course of portal hypertension only in patients with severe or advanced changes of cholangiopathy. Asymptomatic patients with PCC do not require any treatment. Treatment of symptomatic PCC can be approached in a phased manner, coping first with biliary clearance by nasobiliary or biliary stent placement for acute cholangitis and endoscopic biliary sphincterotomy for biliary stone removal; second, with

  1. 特发性门静脉高压症CT、MR检查与临床价值%Idiopathic portal hypertension CT and MR images and clinical valu e

    Institute of Scientific and Technical Information of China (English)

    谢辉; 高原智; 董景辉; 齐雪欣; 宿贝贝; 安维民

    2014-01-01

    目的:探讨特发性门静脉高压症( Idiopathic Portal Hypertension Syndrome ,IPH) CT及MR影像特点,评价CT、MR检查对IPH诊断及分期的临床价值。方法对26例IPH患者进行CT或MR检查,观察肝脏表面、肝脏大小、形态及各叶比例、脾脏大小及肝内外门静脉系统等。结果26例患者中,肝脏表面光滑、形态规整者19例,肝表面欠光滑、形态欠规整者7例,肝左叶明显增大2例,肝尾叶增大4例,肝左叶缺如2例,门脉海绵样变12例,门脉系统血栓8例,食道、食道旁、胃底及胃冠状静脉、脾静脉曲张21例,腹水4例,26例患者脾脏均增大。结论临床上原因不明的门脉高压伴脾脏增大、门脉侧枝开放及门脉海绵样变的患者可提示IPH,并给予分期。%Objective To investigate idiopathic portal hypertension CT and MR imaging characteristics , evaluation of Ct and MR , the clinical value of examination in the the IPH diagnosis and staging .Methods 26 cases of patients with IPH CT or MR examination, observation of the surface of the liver , liver size, shape, and each leaf ratio, spleen size and liver inside and outside the portal vein system .Results 6 patients, liver smooth surface morphological rules , 19 ca-ses of liver surface less smooth shape due to the regular seven cases , the left lobe of the liver was significantly increased two cases, the caudate lobe increases four cases , the left hepatic lobe agenesis 2cases of portal vein cavernous change the 12 cases, eight cases of portal system thrombosis , esophagus, food road, fundus and gastric coronary vein , splenic vari-ces 21 cases, ascites 4 cases of 26 patients with spleen increases .Conclusions The unexplained clinical portal hyper-tension with splenomegaly , portal collateral open and cavernous transformation of the portal , patients can prompt IPH and given to installment.

  2. Effect of Helicobacter pylori and its Virulence Factors on Portal Hypertensive Gastropathy and Interleukin (IL)-8, IL-10, and Tumor Necrosis Factor-alpha Levels

    Science.gov (United States)

    Abbas, Zaigham; Yakoob, Javed; Usman, Muhammad W.; Shakir, Tanzila; Hamid, Saeed; Jafri, Wasim

    2014-01-01

    Background/Aim: We aimed to assess the influence of Helicobacter pylori and its virulent factors, cytotoxin associated gene (cag) A and E, on portal hypertensive gastropathy (PHG) and the levels of interleukin (IL)-8, IL-10, and tumor necrosis factor-alpha (TNF-α). Patients and Methods: The patients with cirrhosis underwent screening endoscopy and the lesions related to PHG were graded. Biopsies were obtained for histology, and polymerase chain reaction (PCR) of H. pylori 16S rRNA, cagA, cagE, and tissue cytokine levels was carried out. Absent or mild PHG was compared with moderate to severe PHG. Results: One hundred and forty patients with cirrhosis were studied; males numbered 92 and the mean age of the patients was 50.3 ± 12.0 years, H. pylori positivity in 87 (62.1%) patients was associated with male gender (P = 0.032), younger age (P = 0.029), hepatitis D etiology (P = 0.005), higher serum albumin (0.000), lower Child Pugh score (P = 0.001), and lower portal vein diameter (P = 0.001). There was no significant difference in the levels of TNF-α and IL-8. However, a decrease in the anti-inflammatory cytokine IL-10 was noted with moderate to severe gastropathy. Four H. pylori strains were positive for both cagA and cagE, while four were positive for cagA only. All the four patients with both virulent factors had mild gastropathy only. Conclusion: The presence of H. pylori infection neither affected the severity of PHG nor augmented the IL-8 and TNF-α levels. There was a decline of virulent H. pylori strains and IL-10 levels in patients with advanced PHG. PMID:24705150

  3. Effect of Helicobacter pylori and its virulence factors on portal hypertensive gastropathy and interleukin (IL-8, IL-10, and tumor necrosis factor-alpha levels

    Directory of Open Access Journals (Sweden)

    Zaigham Abbas

    2014-01-01

    Full Text Available Background/Aim: We aimed to assess the influence of Helicobacter pylori and its virulent factors, cytotoxin associated gene (cag A and E, on portal hypertensive gastropathy (PHG and the levels of interleukin (IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α. Patients and Methods: The patients with cirrhosis underwent screening endoscopy and the lesions related to PHG were graded. Biopsies were obtained for histology, and polymerase chain reaction (PCR of H. pylori 16S rRNA, cagA, cagE, and tissue cytokine levels was carried out. Absent or mild PHG was compared with moderate to severe PHG. Results: One hundred and forty patients with cirrhosis were studied; males numbered 92 and the mean age of the patients was 50.3 ± 12.0 years, H. pylori positivity in 87 (62.1% patients was associated with male gender (P = 0.032, younger age (P = 0.029, hepatitis D etiology (P = 0.005, higher serum albumin (0.000, lower Child Pugh score (P = 0.001, and lower portal vein diameter (P = 0.001. There was no significant difference in the levels of TNF-α and IL-8. However, a decrease in the anti-inflammatory cytokine IL-10 was noted with moderate to severe gastropathy. Four H. pylori strains were positive for both cagA and cagE, while four were positive for cagA only. All the four patients with both virulent factors had mild gastropathy only. Conclusion: The presence of H. pylori infection neither affected the severity of PHG nor augmented the IL-8 and TNF-α levels. There was a decline of virulent H. pylori strains and IL-10 levels in patients with advanced PHG.

  4. [Surgical therapy of proximal extrahepatic bile duct tumors (Klatskin tumors)].

    Science.gov (United States)

    Timm, S; Gassel, H-J; Thiede, A

    2007-08-01

    Due to their anatomical position, the tendency of early infiltrative growth and their poor prognosis without treatment, klatskin tumors are challenging concerning diagnosis and therapy. In contrast to other tumors of the gastrointestinal tract, for which exact diagnostic and stage dependent therapeutic guidelines could be formulated, clear recommendations for klatskin tumors are missing. Thus, survival rates after local resection, e. g. resection of the bile duct bifurcation alone, show high rates of R1/2 resection and early tumor recurrence. With an additional hepatic resection formally curative resections and long-term survival can be improved. Extended liver resections including the portal vein provide the highest rates of R0 resections for hilar carcinomas of the extrahepatic bile duct. Survival rates after liver transplantation for klatskin tumors are not yet convincing. Promising first results have been reported for the combination of neoadjuvant treatment and liver transplantation and might show future perspectives for the treatment of klatskin tumors.

  5. Diagnosis and treatment of idiopathic portal hypertension%特发性门静脉高压症的诊治体会

    Institute of Scientific and Technical Information of China (English)

    刘佳; 张绍庚; 魏炜明; 唐荣; 乐羿; 陈小刚

    2012-01-01

    Objective To investigate the diagnosis and treatment of idiopathic portal hypertension. Methods The clinical data of 7 patients with idiopathic portal hypertension (IPH) treated between June 2006 and January 2011 in the Department of Hepatobili-ary Surgery, Fuzhou General Hospital of PLA were analyzed retrospectively. Results Six cases were diagnosed as IPH, one misdiag-nosed as cryptogenic cirrhosis. All cases were diagnosed as IPH by pathology. Simultaneously, seven patients were treaeted operations, including Hand-assisted laparoscopic modified Sugiura procedure(3 patients) ,splenectomy and cardiac peripheral vascular disconnection(2 patients) ,splenectomy and cardiac peripheral vascular disconnection and distal splenorenal shunt(1 patients),splenectomy(1 patients). Patients were followed up for 6 months to 5 years, an average of 2. 3 years. Only one patient who treated the splenectomy and cardiac peripheral vascular disconnection appeared melena one month after operation, but improved by conservative treatment. Conclusion The Color Doppler Ultrasound plays an important role in the diagnosis for IPH, but the diagnosis required pathology. Surgical treatment of IPH has a clear and definite effect. Hand-assisted laparoscopic modified Sugiura procedure is a safe,effective and minimally invasive method for the patient with severe esophageal and gastric veins varicose.%目的 探讨特发性门静脉高压症(idiopathic portal hypertension,IPH)的诊断及治疗方法.方法 回顾分析福州总医院肝胆外科自2006年6月-2011年1月收治的7例IPH患者的临床资料.结果 7例患者6例诊断为IPH,1例误诊为隐源性肝硬化;后均经病理证实为IPH.7例均行手术治疗:3例行手助腹腔镜改良Sugiura术,2例行脾切除+贲门周围血管离断术,1例行脾切除+贲门周围血管离断+远端脾肾分流术,1例行脾切除术.术后随访6个月~5年,平均2.3年,仅1例行脾切除+贲门周围血管离断术的患者术后1月出

  6. Regeneração do fígado após hepatectomia parcial em ratos submetidos à hipertensão portal pós-hepática Liver regeneration after partial hepatectomy in rats submitted to post-hepatic portal hypertension

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Farion de Aguiar

    2011-06-01

    : 1. atraso no processo regenerativo diretamente proporcional aos níveis pressóricos no sistema porta; 2. após dez dias, persiste a proliferação de hepatócitos proporcionalmente mais intensa quanto maior a elevação da pressão no sistema porta, porém níveis extremos de pressão portal inibem a proliferação, e, no estímulo para regeneração do fígado, demonstrou-se atraso da angiogênese influenciado pelos valores de pressão portal; 3. hipertensão portal extrema promove elevação da expressão de fator VIII, o que sugere capilarização dos sinusóides; 4. quanto mais elevados os níveis de pressão portal, menor será a quantidade de colágeno depositada, podendo-se inferir que o aumento da pressão portal ocasiona atraso na restauração da matriz extracelular; 5. a análise da função hepática evidenciou que a hepatectomia parcial a 70%, após dez dias, não interferiu com a fisiologia hepática, a qual permaneceu dentro dos limites da normalidade, mas com a hipertensão portal pode haver comprometimento funcional do fígado remanescente durante o processo regenerativo.BACKGROUND: The normal adult liver is quiescent and only a small percentage of its cells is subjected to cell division at any time, but can quickly initiate cell proliferation in response to a stimulus. This process can be triggered by partial hepatectomy. AIM: To evaluate the effect of portal hypertension caused by partial occlusion of hepatic venous drainage on regeneration of remnant liver of rats after partial hepatectomy. METHODS: It was performed two-thirds hepatectomy in 50 adult male Wistar rats. The animals were divided into five groups: a control group and four study groups were subjected to different degrees of plication of inferior vena cava-hepatic above. After 240 hours of the stimulus for regeneration took place relaparotomy with measurement of portal pressure and inferior vena cava, and liver biopsy. Fragments were analyzed by immunohistochemistry for the markers Ki

  7. Extrahepatic manifestations of hepatitis E virus.

    Science.gov (United States)

    Kamar, Nassim; Marion, Olivier; Abravanel, Florence; Izopet, Jacques; Dalton, Harry R

    2016-04-01

    Hepatitis E virus can cause acute, fulminant and chronic hepatitis and has been associated with a range of extrahepatic manifestations. Guillain-Barré syndrome, neuralgic amyotrophy and encephalitis are the main neurological manifestations associated with acute and chronic hepatitis E virus infection. Renal injuries have been also reported, including membranoproliferative glomerulonephritis with or without cryoglobulinemia and membranous glomerulonephritis. Acute pancreatitis, haematological disorders and other autoimmune extrahepatic manifestations of hepatitis E virus, such as myocarditis and thyroiditis, have been also reported. In this comprehensive article, we review all published reports describing hepatitis E virus-associated extrahepatic manifestations.

  8. Pancreatic portal cavernoma in patients with cavernous transformation of the portal vein: MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Vilgrain, Valerie [Universite Paris 7 Denis Diderot, Paris (France); AP-HP, Hopital Beaujon, Department of Radiology, Clichy (France); INSERM, Centre de recherche Biomedicale Bichat-beaujon, CRB3, Paris (France); Hopital Beaujon, Department of Radiology, Paris (France); Condat, Bertrand; Plessier, Aurelie [AP-HP, Hopital Beaujon, Department of Gastroenterology, Clichy (France); O' Toole, Dermot [Centre de reference des maladies vasculaires du foie, AP-HP, Hopital Beaujon, Department of Hepatology, PMAD, Clichy (France); Ruszniewski, Philippe [Universite Paris 7 Denis Diderot, Paris (France); INSERM, Centre de recherche Biomedicale Bichat-beaujon, CRB3, Paris (France); Centre de reference des maladies vasculaires du foie, AP-HP, Hopital Beaujon, Department of Hepatology, PMAD, Clichy (France); Valla, Dominique C. [Universite Paris 7 Denis Diderot, Paris (France); INSERM, Centre de recherche Biomedicale Bichat-beaujon, CRB3, Paris (France); AP-HP, Hopital Beaujon, Department of Gastroenterology, Clichy (France)

    2009-11-15

    The purpose of the article was to prospectively evaluate the MR findings of pancreatic portal cavernoma in a consecutive series of patients with cavernous transformation of the portal vein. This study was approved by the review board of our institution, and informed consent was obtained. The clinical and biological data and the MR imaging for 20 patients (11 female, 9 male; median age, 49 years) with cavernous transformation of the portal vein and no evidence of previous pancreatic disease were reviewed. The presence of pancreatic portal cavernoma (defined as intra- and/or peripancreatic portal cavernoma), morphological changes in the pancreas, biliary and ductal pancreatic abnormalities, and extension of the portal venous thrombosis were qualitatively assessed. Fifteen patients (75%) had pancreatic portal cavernoma with collateral formation in the pancreas and/or collaterals around the pancreas seen on dynamic contrast-enhanced MR sequences: three patients had both intra- and peripancreatic portal cavernoma, six had intrapancreatic portal cavernoma alone and six had peripancreatic portal cavernoma only. The presence of intra- or peripancreatic portal cavernoma was significantly associated with extension of the thrombosis to the splenic and superior mesenteric veins (p = 0.05). Morphological changes in the pancreas, heterogeneity on T2-weighted sequences and main ductal pancreatic abnormalities were seen in two, four and two patients, respectively. All these patients had intrapancreatic portal cavernoma. Bile duct dilatation was observed in 13 (65%) patients: among them three had extrahepatic dilatation only and these three patients had associated intrapancreatic portal cavernoma. In patients with cavernous transformation of the portal vein, intra- or peripancreatic portal cavernoma is common. In conclusion, intra- or peripancreatic portal cavernoma was only observed in patients with extension of the thrombosis to the splenic vein and/or the superior mesenteric

  9. [Hypertension].

    Science.gov (United States)

    Ohishi, Mitsuru

    2014-04-01

    Hypertension is well known to one of the risk factors to reduce cognitive function, however, it is still unclear whether anti-hypertensive therapy is effective to prevent development of dementia or Alzheimer's disease. Epidemiological studies suggested antihypertensive therapy from the middle-age could reduce risk of dementia. The meta-analysis including HYVET also suggested blood pressure lowering from the elderly might be also effective to prevent development of dementia. The network meta-analysis and the cohort study using mega-data bank suggested ARB might be effective to prevent development of dementia or Alzheimer's disease compared to administration with other anti-hypertensive drugs. Although the further major clinical investigation is required, anti-hypertensive treatment might be useful to manage hypertensive patients with dementia.

  10. Portal vein stent placement with or without varix embolization of jejunal variceal bleeding after hepatopancreatobiliary surgery.

    Science.gov (United States)

    Shim, Dong Jae; Shin, Ji Hoon; Ko, Gi-Young; Kim, Yook; Han, Kichang; Gwon, Dong-Il; Ko, Heung-Kyu

    2017-04-01

    Background Extrahepatic portal hypertension after surgery involving the duodenum or jejunum might result in massive ectopic variceal bleeding. Purpose To report the results of portal vein stent placement with the addition of variceal embolization. Material and Methods Between January 2000 and June 2015, portal vein stent placement was attempted in 477 patients. Of these, 22 patients (age, 63 ± 10 years) with jejunal variceal bleeding caused by portal vein obstruction after surgery were included in this study. Computed tomography (CT) findings before and after treatment and the rates of technical and clinical success, complications, and clinical outcomes were retrospectively evaluated. Results Stent placement was successful in 19 of 22 patients. Additional variceal embolization was performed in five cases. Clinical success, defined as the cessation of bleeding without recurrence within 1 month, was achieved in 18 of 19 patients with technical success. One patient developed recurrent bleeding 4 days after stent placement and was successfully treated with additional variceal embolization. There were no procedure-related complications. A regression of the jejunal varices was noted in 14 of 19 patients on follow-up CT scans. During the follow-up period (258 days; range, 7-1196 days), stent occlusion and recurrent bleeding occurred in six and four patients, respectively, of the 19 patients who achieved technical success. Statistical analyses revealed no significant differences regarding stent patency between benign and malignant strictures. Conclusion Percutaneous, transhepatic, portal vein stent placement with or without jejunal variceal embolization appears to be a safe and effective treatment for jejunal variceal bleeding after surgery.

  11. A transgenic model for conditional induction and rescue of portal hypertension reveals a role of VEGF-mediated regulation of sinusoidal fenestrations.

    Directory of Open Access Journals (Sweden)

    Dalit May

    Full Text Available Portal hypertension (PH is a common complication and a leading cause of death in patients with chronic liver diseases. PH is underlined by structural and functional derangement of liver sinusoid vessels and its fenestrated endothelium. Because in most clinical settings PH is accompanied by parenchymal injury, it has been difficult to determine the precise role of microvascular perturbations in causing PH. Reasoning that Vascular Endothelial Growth Factor (VEGF is required to maintain functional integrity of the hepatic microcirculation, we developed a transgenic mouse system for a liver-specific-, reversible VEGF inhibition. The system is based on conditional induction and de-induction of a VEGF decoy receptor that sequesters VEGF and preclude signaling. VEGF blockade results in sinusoidal endothelial cells (SECs fenestrations closure and in accumulation and transformation of the normally quiescent hepatic stellate cells, i.e. provoking the two processes underlying sinusoidal capillarization. Importantly, sinusoidal capillarization was sufficient to cause PH and its typical sequela, ascites, splenomegaly and venous collateralization without inflicting parenchymal damage or fibrosis. Remarkably, these dramatic phenotypes were fully reversed within few days from lifting-off VEGF blockade and resultant re-opening of SECs' fenestrations. This study not only uncovered an indispensible role for VEGF in maintaining structure and function of mature SECs, but also highlights the vasculo-centric nature of PH pathogenesis. Unprecedented ability to rescue PH and its secondary manifestations via manipulating a single vascular factor may also be harnessed for examining the potential utility of de-capillarization treatment modalities.

  12. [Extrahepatic manifestations of hepatitis C virus infection].

    Science.gov (United States)

    Roca, Bernardino

    2004-10-01

    Hepatitis C virus predominantly affects the liver, although it may also produce a number of extrahepatic manifestations, such as mixed cryoglobulinemia, salivary and lacrimal gland dysfunction, and several types of kidney disease. The pathogenesis of these conditions is not completely understood, but immunologic mechanisms are involved in many cases. In some patients with hepatitis C virus infection, the extrahepatic manifestations predominate and their proper diagnosis and management is very important.

  13. A study of the relationship between the portal vein thrombosis and clinical progression in portal hypertension on multi-slice CT portal venography%MSCT门静脉成像对门脉高压症中门静脉血栓形成与临床病情关系的研究

    Institute of Scientific and Technical Information of China (English)

    王克扬; 贺文; 赵丽琴

    2012-01-01

    目的:采用64排螺旋CT门静脉成像探讨肝硬化(LC)门脉高压症(PH)门静脉血栓(PVT)形成对临床病程进展的影响.方法:对183例LC患者行CT检查,其中并发PVT者109例,无血栓者74例,应用MIP、MPR、CPR方法多角度多层面显示门静脉系统血管结构和侧支循环,测量血栓范围和狭窄程度.分别比较PVT组和对照组之间、不同Child-Pugh(CP)分级亚组间的肝功能、凝血功能、门脉系统血管宽度、侧支循环、脾脏大小的差异,分析PVT组各影像特之间及其与肝功能的相关性.结果:PVT组与对照组间的血清总胆红素、门静脉和脾静脉宽度、脾面积、脾/胃-肾分流的差异均有统计学意义(t=-2.830、P=0.005;t=3.576、P0.05);前腹壁静脉曲张在各分级中差异均有统计学意义(χ2=4.485,P=0.034).PVT组肠系膜上静脉血栓与肠壁水肿有一定的相关性(r=0.227,P=0.018);脾静脉与胃左静脉宽度有一定的相关性(r=0.371,P<0.001).结论:门静脉血栓形成与门脉高压症病情密切相关,可能为促进肝硬化临床病程发展的重要因素.%Objective: To investigate the effect of the portal vein thrombosis (PVT) on disease progression of liver cirrhosis (LC) portal hypertension (PH) using CT portal venography (CTPV). Methods:183 patients with LC,divided into PVT group (n = 109) and control group (n = 74) ,were performed by multi slice CT (MSCT). MIP,MPR and CPR were used to display the portal venous system and collateral circulations,and to measure the thrombosis as well as stenosis. The liver function,coagulation function,the imaging features of portal veins and PVT were compared between these two groups, then in different Child Pugh (CP) classifications. Results. There were significant differences between the two groups in total serum bilirubin,the width of main portal vein (MPV) and spleen vein (SPV),sectional area of spleen,splenic or gastric re nal shunt (t = - 2. 830,P = 0. 005 ; t=3. 576,P<0. 001;t=0. 780

  14. Extrahepatic intraductal ectopic hepatocellularcarcinoma:bileductifllingdefect

    Institute of Scientific and Technical Information of China (English)

    Moritz Schmelzle; Wolfram T. Knoefel; Claus F. Eisenberger; Hanno Matthaei; Nadja Lehwald; Andreas Raffel; Roy Y. Tustas; Natalia Pomjanski; Petra Reinecke; Marcus Schmitt; Jan Schulte am Esch

    2009-01-01

    BACKGROUND: Obstructive jaundice caused by an intraductal hepatocellular carcinoma is a rare initial symptom. We report a rare case of an extrahepatic icteric type hepatocellular carcinoma. METHODS: A 75-year-old patient was admitted to our hospital because of obstructive jaundice 3 months after resection of multilocular hepatocellular carcinoma. A postoperative bile leakage was treated by placement of a decompressing stent in the common bile duct. Endoscopic retrograde choledochoscopy showed extended blood clots iflling the bile duct system and computed tomography revealed a local swelling in the common extrahepatic bile duct. The level of alpha-fetoprotein (AFP) was only slightly elevated but that of CA19-9 was dramatically increased. Cholangiography showed an intraductal iflling defect typical of a cholangiocellular carcinoma. RESULTS: Bile duct brushing cytology showed no cholangiocellular carcinoma but hepatocellular carcinoma cells in the extrahepatic bile duct. An extrahepatic bile duct resection was performed. Histological examination conifrmed the diagnosis of extrahepatic intraductal growth of hepatocellular carcinoma. CONCLUSION: Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct iflling defect.

  15. Hypertension

    OpenAIRE

    2012-01-01

    Hypertension is responsible for roughly one-in-six adult deaths annually in the United States and is associated with five of the top nine causes of death. 1 Ten trillion dollars is the estimated annual cost worldwide of the direct and indirect effects of hypertension. 2,3 In the U.S. alone, costs estimated at almost $74 billion in 2009 placed a huge economic burden on the health care system. 4 The prevalence of hypertension increases with advancing age to the point where more than half of peo...

  16. CAVERNOUS TRANSFORMATION OF PORTAL VEIN : A RARE ANATOMIC DEVELOPMENT WITH EMPHASIS ON ANATOMY AND PHYSIOLOGY OF PORTAL BLOOD FLOW

    Directory of Open Access Journals (Sweden)

    Ashfaq Ul Hassan

    2014-03-01

    Full Text Available Portal vein contributes to more than 70 % blood flow to the liver the significant increases in portal venous blood pressure is associated with major systemic manifestations. Having a knowledge about Portal Blood supply is important tio any clinician, gastroenterologist or any Hepatic Surgeon. The Article outlines the rare development of Portal Cavernoma in a patient who had Portal Hypertension. Portal cavernoma is a consequence of portal vein thrombosis. We Present a case of a lady with mild Right hypochondriac pain who on evaluation was found to have Cavernomatous transformation of Portal vein without any other abnormality.

  17. Protein induced by vitamin K absence or antagonist-II production is a strong predictive marker for extrahepatic metastases in early hepatocellular carcinoma: a prospective evaluation

    Directory of Open Access Journals (Sweden)

    Yoon Jung-Hwan

    2011-10-01

    Full Text Available Abstract Background Clinicians often experience extrahepatic metastases associated with hepatocellular carcinoma (HCC, even if no evidence of intrahepatic recurrence after treatment is observed. We investigated the pretreatment predictors of extrahepatic metastases in HCC patients. Methods Patients diagnosed with HCC without evidence of extrahepatic metastases were prospectively enrolled. We evaluated the correlation between extrahepatic metastases and pretreatment clinical variables, including serum tumor markers. Results A total of 354 patients were included. Seventy-six patients (21% had extrahepatic metastases during the observation period (median, 25.3 months; range, 0.6-51.3 months. Cox regression multivariate analysis showed that serum protein induced by vitamin K absence or antagonist-II (PIVKA-II production levels, the intrahepatic tumor stage, platelet count, and portal vein thrombosis were independent risk factors for extrahepatic metastases. Patients with a PIVKA-II production ≥ 300 mAU/mL had a 2.7-fold (95% confidence interval; 1.5-4.8; P Conclusion PIVKA-II production levels might be a good candidate predictive marker for extrahepatic HCC metastases, especially in patients with smaller and/or fewer tumors in the liver with in stages regardless of serum alpha-fetoprotein.

  18. Hypertension

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — These datasets provide de-identified insurance data for hypertension hyperlipidemia. The data is provided by three managed care organizations in Allegheny County...

  19. Pancreatitis autoinmune: pseudotumor inflamatorio, afectación multifocal, hipertensión portal y evolución a largo plazo Autoimmune pancreatitis: inflammatory pseudotumor, multifocal fibrosclerosis, portal hypertension, and long-term outcome

    Directory of Open Access Journals (Sweden)

    J. L. Beristain

    2008-10-01

    -year-old female presented with obstructive jaundice and abdominal tenderness, as well as a mass at the pancreatic head on a CT scan, suggestive of pancreatic neoplasia. Surgery showed an increase of the whole pancreas, malignancy was intraoperatively ruled out, and a cholecystectomy and choledochoduodenostomy were carried out. The diagnosis was chronic pancreatitis. Over the following years different autoimmune complications developed, including asthma, salivary gland swelling, and sclerosing cholangitis, as well as recurrent episodes of jaundice, and exocrine and endocrine pancreatic failure. The development of these complications combined with the demonstration of high serum levels of IgG4 and carbonic anhydrase II led to a re-evaluation of the initial histology of the pancreas, leading to a final diagnosis of autoimmune pancreatitis: IgG4+ lymphoplasmacytic infiltrates, fibrosis, and obliterative phlebitis. New complications developed during the last few years: retroperitoneal fibrosis with portal hypertension, esophageal varices, and splenomegaly.

  20. 多层螺旋CT门静脉成像对门静脉高压症的诊断及分类价值%Evaluation of the Diagnosis and Classification of Portal Hypertension on Multi-slice Spiral CT Portal Venography

    Institute of Scientific and Technical Information of China (English)

    梁萍; 方华盛; 陈更瑞

    2015-01-01

    Objective Discussion on classification and diagnostic value of multi-slice spiral CT portography (CTPV) on portal hypertension (PHT). Methods A total of 42 patients with PHT, 26 cases of intrahepatic PHT, both in patients with liver cirrhosis, and hepatocellular carcinoma in 7 cases,3 cases of intrahepatic portal vein tumor thrombosis;before the liver of PHT13patients, including 3 cases of portal vein thro mbosis in 4 cases of outer segment, portal vein tumor thrombus in 6 cases of outer segment,cavernous transformation, liver after PHT Budd Chiari syndrome in 3 cases; underwent imaging of 64 slice spiral CT portal, MIP, VR,MPR or CPR reconstruction using volume data, observation of portal vein branches, collateral circulation, characteristics of imaging. Results CTPV can clearly show the initial distribution, evaluating collateral circulation of portal hypertension degree and position classification. Conclusion CTPV can accurately diagnose PHT and differential classification, have important significance to establish prediction of its complications, operation scheme.%目的:探讨多层螺旋CT门静脉成像(CTPV)对门静脉高压症(PHT)的诊断及分类价值。方法收集42例PHT,肝内性PHT 26例,均为肝硬化患者,合并肝癌7例,门静脉肝内分支癌栓形成3例;肝前性PHT13例,其中门静脉肝外段血栓3例,门静脉肝外段癌栓4例,海绵样变6例;肝后性PHT3例,为布加综合征患者;均行64层螺旋CT门静脉成像检查,容积数据采用MIP、VR、MPR或CPR重建,观察门静脉、属支及侧支循环的影像学特征。结果 CTPV能清楚显示侧支循环的分布范围、初步评估门静脉高压程度及部位分类。结论 CTPV能准确诊断PHT及鉴别分类,对预测其并发症、手术方案的制定具有重要的指导意义。

  1. Treatment of portal hypertension with laparoscopic azygoportal disconnection%腹腔镜断流术处理门静脉高压症临床研究

    Institute of Scientific and Technical Information of China (English)

    竺杨文; 王跃东; 谢志杰; 叶再元

    2009-01-01

    Objective To evaluate the safety and effectiveness of laparoscopic splenectomy and azygoportal disconnection.Methods From January 2000 to April 2007, 30 patients with cirrhosis and portal hypertension, secondary hypersplenism, and bleeding from the upper alimentary tract were op-erated with laparoscopic splenectomy and devascularization of the lower esophagus and upper stomach in our hospital.For 30 patients, 2 were firstly operated with a small accessory incision, then the lower esophagus was transected and reanastromosed with a circular stapler, and 3 were operated entirely un-der laparoscopy to complete the transaction and reanastomosation of the lower esophagus with a circu-lar stapler.Results Operation on the 30 patients were successful without a single conversion from laparoscopic to open surgery.The operative duration varied from 4 to 5.5 hours, and the bleeding vol-ume were between 60 to 400 ml.The fart was resumed between 24 to 96 hours after operation.There were no serous complications.The duration of hospitalization was 8-15 days (mean= 12 days).The up GI X-ray examination revealed that esophageal variees was significantly attenuated 1 month after surgery.The follow-up in twenty-two patients for 1 month to 4 years after surgery indicated that hy-persplenism was virtually corrected, no hepatic encephalopathy was found, and no hematemesis and melena occurred.Conclusion Laparoscopic splenectomy and devasclarization of the lower esophagus and upper stomach are safe and effective, providing a new alternative choice to treat portal hyperten-sion and bleeding from the upper digestive tract.%目的 探讨腹腔镜脾切除和断流术的手术方法、安全性和有效性.方法 从2000年1月至2007年4月为30例肝硬化门静脉高压症、继发性脾功能亢进和上消化道出血的病人进行了腹腔镜脾切除和门奇静脉断流术,其中2例于上腹部作小切口,再行管型吻合器完成食管下段横断再吻合术,3例完全腹腔镜

  2. Extrahepatic manifestations of chronic viral hepatitis.

    Science.gov (United States)

    Pyrsopoulos, N T; Reddy, K R

    2001-02-01

    Hepatitis B (HBV) and C (HCV) viruses are well-recognized causes for chronic hepatitis, cirrhosis, and even for hepatocellular carcinoma. Apart from liver disease, these viral infections are known to be associated with a spectrum of extrahepatic manifestations. The prevalence of clinically significant extrahepatic manifestations is relatively low, but it can be associated with significant morbidity and even mortality. An awareness and recognition of these manifestations is of paramount importance in facilitating early diagnosis and in offering treatment. However, treatments are not necessarily effective, and patients may continue with disabling extrahepatic manifestations. Hepatitis B virus has been well recognized as causing a variety of manifestations that include skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis. More recently, infection with hepatitis C virus has elicited considerable interest for its role in a spectrum of extrahepatic manifestations. Among the best-reported are cryoglobulinemia, glomerulonephritis, high titer of autoantibodies, idiopathic thrombocytopenic purpura, lichen planus, Mooren's corneal ulcer, Sjögren's syndrome, porphyria cutanea tarda, and necrotizing cutaneous vasculitis. The precise pathogenesis of these extrahepatic complications has not been determined, although the majority represent the clinical expression of autoimmune phenomena.

  3. Extensive portal venous gas: Unlikely etiology and outcome

    Directory of Open Access Journals (Sweden)

    Tiffany P. Schatz

    2015-01-01

    Full Text Available Portal venous gas or hepatic portal venous gas (HPVG found on imaging portends grave outcomes for patients suffering from ischemic bowel disease or mesenteric ischemia. HPVG is more rarely seen with severe but treatable abdominal infection as well as multiple benign conditions, and therefore must be aggressively evaluated. We report a 70-year old female who developed extensive intra- and extra-hepatic portal venous gas, pneumatosis intestinalis and free air associated with a perforation of the jejunojejunostomy after a gastrectomy for gastric carcinoma.

  4. Extensive portal venous gas: Unlikely etiology and outcome.

    Science.gov (United States)

    Schatz, Tiffany P; Nassif, Mohammed O; Farma, Jeffrey M

    2015-01-01

    Portal venous gas or hepatic portal venous gas (HPVG) found on imaging portends grave outcomes for patients suffering from ischemic bowel disease or mesenteric ischemia. HPVG is more rarely seen with severe but treatable abdominal infection as well as multiple benign conditions, and therefore must be aggressively evaluated. We report a 70-year old female who developed extensive intra- and extra-hepatic portal venous gas, pneumatosis intestinalis and free air associated with a perforation of the jejunojejunostomy after a gastrectomy for gastric carcinoma.

  5. Three cases of digestive tract hemorrhage of portal hypertension combine portal vein wide embolism after transjugular intrahepatic portosystemic stent shunt treatment%颈静脉肝内门体分流术治疗门静脉高压并门静脉广泛栓子后消化道出血三例

    Institute of Scientific and Technical Information of China (English)

    张军华; 张金龙; 张弢; 张素静; 徐慧军; 李玉

    2013-01-01

    目的 探讨经颈静脉肝内门体分流术(TIPS)治疗门静脉高压并门静脉内栓子广泛形成后消化道出血的治疗效果.方法 3例急性上消化道出血患者,均经CT明确诊断为门静脉、肠系膜上静脉内(含1例脾静脉内栓子形成)广泛栓子形成,行TIPS止血治疗,将支架放置于造影所见栓子的远端.结果 TIPS治疗后,随访4~6周3例患者均未再发生出血,不适症状消失.结论 TIPS治疗门静脉高压并门静脉内广泛栓子形成后消化道出血,安全可行,疗效可靠,值得推广.%Objective To investigate the effect of transjugular intrahepatic portosystemic stent shunt (TIPS) on gastrointestinal bleeding after portal hypertension and portal vein wide embolism.Methods Three patients with acute upper gastrointestinal bleeding were diagnosed by CT with wide embolus formation in portal vein and superior mesenteric vein,of which,1 case was with spleen vein embolism formation.TIPS hemostatic treatment was applied to stop bleeding,and stents was placed where distal embolus can be observed by angiography.Results After TIPS treatment,no patients were re-bleeding during following-up periods (4-6 weeks).Uncomfortable symptoms of 3 cases were disappeared.Conclusion TIPS was a safe and effective way to treat gastrointestinal bleeding caused by portal hypertension and wide embolus formation.

  6. Establishment of portal hypertension induced esophageal varices in canine by ameroid coustrictor%门静脉收缩器建立犬门静脉高压食管静脉曲张模型的实验研究

    Institute of Scientific and Technical Information of China (English)

    孙斌; 许建明; 熊奇如; 汪正广; 张超

    2009-01-01

    Objective To establish the canine model of esophageal variees caused by portal hyper-tension. Methods The model was established in 12 dogs with a side-to-side portacaval shunt, an ameroid constrictor around the portal vein and double ligation and cross suture of the cephalic part of the inferior vena cava (IVC), and the development of esophageal varices was confirmed 6 weeks later by endoscopy and portal vein angiography. Results The mean pre- and postoperative portal pressure were (11.0 ± 1.1) mm Hg and (22. 9 ± 1.2) nun Hg, respectively (P =0. 010). Endoscopy detected mild to moderate esophageal varices in all dogs, which was confirmed by portal vein angiography, and varices was also seen in abdominal wall. Conclusion Canine model of esophageal varices induced by portal hypertension can be established with the procedure.%目的 探讨建立稳定的门脉高压食管静脉曲张犬模型的可行性.方法 12只杂交犬,采用门静脉.下腔静脉侧侧分流术+门静脉主干环置amemid收缩器+下腔静脉头侧双线交叉缝合结扎的方法制作动物模型.6周后,胃镜和门静脉造影检查观察食管曲张静脉形成情况.结果 造模手术前门静脉压力为(11.0 ±1.1)mm Hg,造模后门静脉压力升高至(22.9±1.2)mm as(P=0.010).胃镜发现所有的杂交犬均形成了轻-中度食管曲张静脉,门静脉造影检杳证实食管中下段有曲张静脉形成,同时腹壁形成了肉眼可见的曲张静脉.结论 门静脉收缩器法能成功地建立门脉高压食管静脉曲张动物模型.

  7. [Clinical and laboratory characteristics of patients with pulmonary hypertension and pulmonary vascular complications hospitalized at the Instituto Nacional de Salud del Niño].

    Science.gov (United States)

    Ormeño Julca, Alexis Jose; Alvarez Murillo, Carlos Melchor; Amoretti Alvino, Pedro Miguel; Florian Florian, Angel Aladino; Castro Johanson, Rosa Aurora; Celi Perez, Maria Danisa; Huamán Prado, Olga Rocío

    2017-01-01

    The hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHN) are distinct pulmonary vascular complications of portal hypertension (PHT) and are associated with increased morbidity and mortality. To describe the clinical and laboratory characteristics of patients with pulmonary hypertension and pulmonary vascular complications hospitalized at the Instituto Nacional de Salud del Niño. We included patients with HTP hospitalized from January 2012 to June 2013 and that during its evolution progressed with SHP or HTPP. For analysis, they were divided into a first group of patients with liver cirrhosis and a second group with extrahepatic portal vein obstruction. Of 22 patients with HPT 45.5% were male and the age range was between 1 month and 17 years. The etiology in the group of cirrhosis (n=14) was: autoimmune hepatitis (35.7%), cryptogenic cirrhosis (35.7%), inborn error of metabolism (14.3%), chronic viral hepatitis C (7.15%) virus and atresia extra-hepatic bile ducts (7.15%). Pulmonary vascular complications more frequently occurred in patients with liver cirrhosis (1 case of HPS and a case of PPHTN). They most often dyspnea, asthenia, edema, malnutrition, ascites, hypersplenism and gastrointestinal bleeding from esophageal varices was found. Also, they had elevated ALT values, alkaline phosphatase and serum albumin values decreased. In children with pulmonary hypertension, pulmonary vascular complications are rare. In the evaluation of these patients pulse oximetry should be included to detect hypoxemia and ubsequently a Doppler echocardiography and contrast echocardiography necessary. Dueto the finding of systolic pulmonary hypertension it is necessary to perform right heart catheterization.

  8. Hypertension

    OpenAIRE

    2016-01-01

    Defining hypertension in pregnancy is challenging because blood pressure levels in pregnancy are dynamic, having a circadian rhythm and also changing with advancing gestational age. The accepted definition is a sustained systolic (sBP) of ≥140 mmHg or a sustained diastolic blood pressure (dBP) ≥90 mmHg, by office (or in-hospital) measurement. Measurement of blood pressure in pregnancy should follow standardised methods, as outside pregnancy. Blood pressure measurement may occur in three types...

  9. Atresia das vias biliares extra-hepáticas: conhecimentos atuais e perspectivas futuras Extrahepatic biliary atresia: current concepts and future directions

    Directory of Open Access Journals (Sweden)

    Elisa de Carvalho

    2007-04-01

    mainly on its etiopathogenesis, diagnosis, treatment and prognosis. SOURCES: MEDLINE and PubMed databases were searched using the following keywords: biliary atresia,etiopathogenesis, diagnosis, treatment, prognosis, children. SUMMARY OF THE FINDINGS: Extrahepatic biliary atresia is the main indication for liver transplantation among pediatric patients. As to its etiology, cytomegalovirus, reovirus and rotavirus have been widely investigated as possible triggers of the immunomediated obstruction of the biliary tree. The immune response, especially the predominant TH1 and interferon-gamma responses, genetic susceptibility and disorders related to the embryonic development of the biliary tree can play a role in the etiopathogenesis of extrahepatic biliary atresia. Yet today, portoenterostomy is the only available treatment, with better results when performed in the first 2 months of life. As to prognosis, all untreated children eventually die due to complications resulting from portal hypertension and liver cirrhosis, and most treated children have to undergo liver transplantation. CONCLUSIONS: Extrahepatic biliary atresia is still the major indication for pediatric liver transplantation, and to change this scenario some more light should be shed upon the etiopathogenesis of biliary atresia in different disease phenotypes. Future research into the role of interferon-gamma and of other cytokines is necessary in order to assess whether these aspects should be potential targets for therapeutic intervention.

  10. Portal cavernoma cholangiopathy-clinical characteristics.

    Science.gov (United States)

    Duseja, Ajay

    2014-02-01

    Because of the presence of portal cavernoma, paracholedochal and pericholedochal varices, portal cavernoma cholangiopathy (PCC) has become an entity unique to patients with extrahepatic portal venous obstruction (EHPVO). Majority of patients with these abnormalities are asymptomatic and are incidentally detected to have the presence of biliary abnormalities on cholangiography. Minority of patients present with symptoms of chronic cholestasis with or without biliary pain or acute cholangitis related most often to the presence of biliary strictures or stones. Other than the age of the patient and duration of EHPVO, presence of gall stones and common bile duct stones are other risk factors for the causation of symptoms in patients with PCC. This review summarizes the clinical characteristics of asymptomatic and symptomatic patients with PCC giving details of the prevalence of symptoms, their risk factors and overall burden of symptomatic PCC.

  11. 肝硬化门脉高压性胃病的相关性研究%Study of portal hypertensive gastropathy in the patients with hepatocirrhosis

    Institute of Scientific and Technical Information of China (English)

    敬长春; 岳宗柱; 高雪英; 朱玉森; 杨茂梧; 冯如青

    2008-01-01

    Objective To study the relationship between the occurrence of portal hypertensive gastropathy(PHG) and grade of liver function and esphageal variees and the effects of endoscopic varieeal ligation (EVL). Methods Gantroscopy was performed in 268 cases with hepatocirrhosis with the different levels of liver function was retrospectived and PHG after the EVL was analyzed. Results Of all 268 patients,246 cases had varicosity of esophagus fundus(91.8%), and 102 eases(38.1%)had PHG which were classfied into A、B and C grades according to child-pugh. The incidence rate of PHG was increasing with the ineresed grade of liver function and was on an increasing trend with the increased severity of varicosity of esophagus fundus (P< 0.05). Conclusion the incidence of rate of PHG was increasing with the increased grade of liver funcion and with the increased severity of varicosity of esophagus fundus and with the increased times of EVL.%目的 探讨肝硬化门脉高压性胃病(PHG)的临床特点及其与肝功能分级、食管静脉曲张以及食管静脉曲张套扎术干预治疗的关系.方法 对268例肝硬化患者进行肝功能及常规胃镜检查,并对其并发PHG及干预治疗后PHG情况进行分析.结果 268例肝硬化患者有不同程度的食管静脉曲张246例(91.8%),PHG发生率为102例(38.1%),原为轻型PHG 22例患者在接收套扎术治疗后6例(27.2%)转化为重型PHG.随肝功能分级积分(级别)的增加以及食管静脉曲张严重程度的增加,PHG发病率增加(P<0.05).结论 肝硬化患者PHG发病率随肝功能分级、食管静脉曲张严重程度的增加以及多次干预食管静脉曲张治疗手段而上升.

  12. Zolmitriptan: a novel portal hypotensive agent which synergizes with propranolol in lowering portal pressure.

    Directory of Open Access Journals (Sweden)

    Mercedes Reboredo

    Full Text Available OBJECTIVE: Only a limited proportion of patients needing pharmacological control of portal hypertension are hemodynamic responders to propranolol. Here we analyzed the effects of zolmitriptan on portal pressure and its potential interaction with propranolol. METHODS: ZOLMITRIPTAN, PROPRANOLOL OR BOTH WERE TESTED IN TWO RAT MODELS OF PORTAL HYPERTENSION: common bile duct ligation (CBDL and CCl4-induced cirrhosis. In these animals we measured different hemodynamic parameters including portal venous pressure, arterial renal flow, portal blood flow and cardiac output. We also studied the changes in superior mesenteric artery perfusion pressure and in arterial wall cAMP levels induced by zolmitriptan, propranolol or both. Moreover, we determined the effect of splanchnic sympathectomy on the response of PVP to zolmitriptan. RESULTS: In both models of portal hypertension zolmitriptan induced a dose-dependent transient descent of portal pressure accompanied by reduction of portal flow with only slight decrease in renal flow. In cirrhotic rats, splanchnic sympathectomy intensified and prolonged zolmitriptan-induced portal pressure descent. Also, propranolol caused more intense and durable portal pressure fall when combined with zolmitriptan. Mesenteric artery perfusion pressure peaked for about 1 min upon zolmitriptan administration but showed no change with propranolol. However propranolol enhanced and prolonged the elevation in mesenteric artery perfusion pressure induced by zolmitriptan. In vitro studies showed that propranolol prevented the inhibitory effects of β2-agonists on zolmitriptan-induced vasoconstriction and the combination of propranolol and zolmitriptan significantly reduced the elevation of cAMP caused by β2-agonists. CONCLUSION: Zolmitriptan reduces portal hypertension and non-selective beta-blockers can improve this effect. Combination therapy deserves consideration for patients with portal hypertension failing to respond to non

  13. Positive lymph node metastasis has a marked impact on the long-term survival of patients with hepatocellular carcinoma with extrahepatic metastasis.

    Directory of Open Access Journals (Sweden)

    Feng Xia

    Full Text Available BACKGROUND: The prognosis of hepatocellular carcinoma (HCC patients with extrahepatic metastasis is extremely poor. However, what is the main risk factor for survival remains unclear for these patients. We aimed to find out the relative frequency, incidence and locations of extrahepatic metastases and the risk factors of long-term survival of the patients. METHODS: 132 HCC patients with extrahepatic metastasis diagnosed by 18F-FDG PET/CT and conventional workup were enrolled into this study. The incidence and locations of extrahepatic metastases were summarized, and the related risk factors of overall survival were analyzed. RESULTS: The most frequent extrahepatic metastatic sites were lymph nodes in 72 (54.5%, bone in 33 (25.0% and lung in 28 (21.2% patients. On univariate analysis, prothrombin time, Child-Pugh grade, portal/hepatic vein invasion and lymph node metastasis were independent risk factors of overall survival. On multivariate analysis, lymph node metastasis was the only independent risk factor of overall survival. The cumulative survival rates at 1- and 3-years after diagnosis of extrahepatic metastasis of HCC were 34.4% and 9.3%, respectively. The median survival time was 7 months (range 1 ∼38 months. The median survival time for patients with or without lymph node metastasis were 5 months (range 1∼38 months and 12 months (range 1∼30 months, respectively (P = 0.036. CONCLUSIONS: This study showed lymph nodes to be the most frequent site of extrahepatic metastases for primary HCC. Lymph node metastasis was the main risk factor of overall survival in patients with HCC with extrahepatic metastasis.

  14. Hemodynamic changes after selective decongestive devascularizatien shunt of gastrosplenic region in portal hypertension dogs%选择性脾胃区减断分流术后血流动力学变化的实验研究

    Institute of Scientific and Technical Information of China (English)

    张谊; 廖毅; 陈云志; 张启瑜; 吴琪; 陶崇林

    2009-01-01

    Objective To study the changes of hemodynamics after selective decongestive devas-cularization shunt of gastrosplenic region (SDDS-GSR) for treatment of portal hypertensive dogs. Methods SDDS-GSR were performed on portal hypertensive dogs. The portal venous pressure, he-modynamic parameters of portal vein, hepatic artery, spleen artery and vein were measured regularly. Results In 30 days after SDDS-GSR, the venous pressure in the gastrosplenic area decreased obvious-ly (P<0.01). Compared with those preoperative values, the parameters of blood flow in portal vein, splenic artery and vein markedly reduced (P<0.01) and the inner diameters of aforesaid vessels were narrowed (P<0.01), while the inner diameter and the parameters of blood flow in hepatic artery in-creased (P<0.01). In 60 days after the operation, the changes of aforesaid parameters were still sig-nificant as compared with those preoperative values (P<0. 01). Conclusion SDDS-GSR can decrease the venous pressure in the gastrosplenic area significantly while maintain portal perfusion by reducing the parameters of blood flow in splenic artery and ameliorating the resistance splenic vein blood cur-rent. It is reasonable and reliable for surgical management of portal hypertension.%目的 研究门静脉高压症犬行选择性脾胃区减断分流术(selective decongestive devascular-ization shunt of gastrosplenic region,SDDS-GSR)后血流动力学变化.方法 用正常犬制备门静脉高压脾亢模型并进行SDDS-GSR术.制模前、成模后,分流术后30 d和术后60 d观察门静脉压力,门静脉、肝动脉、脾静脉和脾动脉的内径、血流速度和血流量参数的变化,作自身对照研究.结果 SDDS-GSR术后30 d的脾胃区静脉压力显著下降(P<0.01),门静脉、脾动脉和脾静脉内径显著缩小(P<0.01),门静脉、脾动脉和脾静脉血流量参数减少(P<0.01),肝动脉内径和血流量参数显著增加(P<0.01),术后60 d上述指标改变仍保持稳定.结论 sDDS

  15. Dictionary Portals

    NARCIS (Netherlands)

    Sijens, H.; Dykstra, A.; Boelhouwer, Bob; Fuertes-Olivera, Pedro A.

    2016-01-01

    Web portals have been one of the first web services that have helped users to find the information they need in the ever expanding World Wide Web. A web portal is basically a website that groups links to information available on the web. These links are selected based on certain criteria. Some web p

  16. Dictionary Portals

    NARCIS (Netherlands)

    Sijens, H.; Dykstra, A.; Boelhouwer, Bob; Fuertes-Olivera, Pedro A.

    2016-01-01

    Web portals have been one of the first web services that have helped users to find the information they need in the ever expanding World Wide Web. A web portal is basically a website that groups links to information available on the web. These links are selected based on certain criteria. Some web

  17. Establishment of a model of portal hypertension by portal vein coarctation and splenic vein ligation in dogs%门静脉主干缩窄附加脾静脉结扎制备犬门脉高压症模型

    Institute of Scientific and Technical Information of China (English)

    陈云志; 张谊; 廖毅; 曾其强; 程水兵; 张启瑜

    2009-01-01

    Objective To observe the changes of portal vein system after coarctation of portal vein and ligation of splenic vein with the purpose of making sure whether it could prepare a model of portal hypertension with hypersplenism or not.Methods The model was established through coarctation of portal vein and ligation of splenic vein in 15 dogs.Monitoring the hemogram preoperative and weekly after the op-eration.At the point of the 5th,Tth,9th week after the operation, respectively and randomly selected 5 ani-mals to observe the condition of portal vein pressure, sizes of spleen and the collateral circulation, in addi-tion, also to take the pathology examination of the spleens and detect the accrementition of bone marrow.Results After coarctation of portal vein and ligation of splenic vein, the RBC and PLT counts decreased obviously, and could effectively last for 9 weeks.The splenic histopathology changes conformed to the chan-ges of the congestive splenomegaly, and the accrementition of bone marrow was much more active.Conclu-sion The alleosis of portal vein system conformed to the Portal hypertension,especially the condition of hypersplenism was satisfactory, so the model would have favourable value of scientific research.%目的 观察犬门静脉主干缩窄加脾静脉结扎后门静脉系统的变化,为该方法能否建立一种具有脾亢的门静脉高压症大动物模型提供依据.方法 犬15条,采用门静脉主干缩窄加脾静脉结扎的方法建立模型,术前及术后每周观察实验动物血象的变化,在预定时间点分别随机选择5条犬开腹观测门静脉自由压、脾脏大小、门体侧支循环形成情况,并切取脾脏行组织病理学检查.此外,术前及术后预定时间点了解骨髓增生情况变化.结果 建模后,外周血红细胞、血小板下降,脾脏肿大明显,并且能够有效持续到第9周;术后第5、7、9周的脾脏组织病理学改变符合脾脏慢性淤血改变,而且骨髓增生情况

  18. Poorly Differentiated Adenocarcinoma with Signet-ring Cell Carcinoma of the Extrahepatic Bile Duct in a 42-year-old Japanese Female: A Case Report

    Directory of Open Access Journals (Sweden)

    Nakanishi,Kuniaki

    2010-02-01

    Full Text Available Poorly differentiated adenocarcinoma without papilla or tubule formation of the extrahepatic bile duct is rare. Here we present a case (a 42-year-old Japanese woman without either pancreatobiliary maljunction or liver disease. The patient had obstructive jaundice. Imaging studies revealed a bile duct tumor obstructing the common bile duct and invading the surrounding tissues. Pathologic examination revealed a dense periductal growth of poorly differentiated adenocarcinoma containing signet-ring cells, but without papilla or tubule formation in the extrahepatic bile duct. The tumor cells directly invaded the pancreatic parenchyma and the portal vein. In the extrahepatic bile duct, poorly differentiated adenocarcinoma may be established as a distinct clinicopathologic entity if the tumors are characterized by:1 the absence of papilla or tubule formation, 2 Asian preponderance, 3 occurrence at a younger age than is usual for patients with biliary cancers, and 4 an aggressive mural invasiveness.

  19. 三种不同门脉高压模型犬舌下络脉的特征观察%Observation on characteristics of subglossal collateral vessels from three different portal hypertension dog models

    Institute of Scientific and Technical Information of China (English)

    王丽娜; 李白羽; 岳小强

    2011-01-01

    Objective; To observe sublingual venae characteristics of three kinds of portal hypertension canine models. Methods; The portal hypertension models were made. The characteristics of sublingual venae were observed, and the diameters were quantitated by Slide calliper rule. The protein expression of CD31 were detected by immunohistochemical to represent capillary density. Endothelial cell morphology changes were observed with transmission electron microscope (TEM). Results; The sublingual venae became circuity and thick with dark and violet color, and there were many petechia and microcollaterals around them in intrahepatic and composite portal hypertension canines compared with normal and sham animals. However, only color changes were abserved in prehepatic model. It was significantly increased expression of CD31 of animals in model group and the maximum expression was observed in composite model group. TEM results showed vessel wall of sublingual venae became thicker totally and partly, lumens became smaller, and new capillary appearanced, the edge of endothelial cells were blurred, and there were no nucleus almostly. As for the extent , the composite group was most serious, followed by the intrahepatic group, and prehepatic group was slightly. Conclusion; Micro or macro changes in sublingual venae of model animal may caused by portal hypertension. These demonstrated that the elevation of portal pressure is a crucial factor leading to abnormal of sublingual venae%目的:复制肝前、肝内、复合型门脉高压大模型,观察模型犬的舌底络脉变化.方法:制备3种门脉高压犬模型并行成模检测.肉眼观察舌下络脉形态和颜色,游标卡尺测量舌底根部络脉宽度,免疫组化检测舌底CD31的表达,透射电镜观察舌下络脉内皮细胞形态.结果:肝内和复合型组犬舌下血管较正常迂曲粗大,出现瘀点细络,颜色暗紫,络脉直径明显增粗,肝前型组仅络脉颜色变暗;与正常和假手术组

  20. Extrahepatic bile duct neurilemmoma mimicking Klatskin tumor.

    Science.gov (United States)

    Kamani, Fereshteh; Dorudinia, Atosa; Goravanchi, Farhood; Rahimi, Farzaneh

    2007-04-01

    Neurilemmoma rarely develops in the biliary tree. Here, we report a 39-year-old Iranian woman with neurilemmoma in the extrahepatic bile duct presenting with progressively deepening jaundice. On the basis of clinical and radiological features, this tumor was initially suspected as Klatskin tumor. Histologically, the tumor was a typical neurilemmoma. Immunostaining showed that tumor cells were strongly and diffusely positive for S-100 protein, which supported the diagnosis of neurilemmoma. Neurilemmoma should be considered in the differential diagnosis of obstructive jaundice.

  1. The extrahepatic manifestations of hepatitis B virus.

    Science.gov (United States)

    Baig, Saeeda; Alamgir, Mohiuddin

    2008-07-01

    Hepatitis B Virus (HBV) leads to a number of hepatic complications, from acute to chronic hepatitis, cirrhosis and hepatocellular carcinoma, is a well-established fact. Upcoming clinical research, over the years, associates numerous extrahepatic manifestations during the acute and chronic episodes of hepatitis B with significant morbidity and mortality. A causal relationship between HBV and serious autoimmune disorders has also been observed among certain susceptible vaccine recipients in a defined temporal period following immunization. The cause of these extrahepatic manifestations is generally believed to be immune mediated. The most commonly described include skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis etc. The serum-sickness like "arthritis-dermatitis" prodrome has also been observed in approximately one-third of patients acquiring HBV infections. Skin manifestations of HBV infection typically present as palpable purpura reported to be caused by chronic HBV, although this association remains controversial. To consider the relationship between HBV and other clinically significant disorders as well as serious autoimmune disorders among certain vaccine recipients is the topic of this review. Variable factors that influence extrahepatic manifestation are discussed, including possible synergy between hepatitis B virus and the immune system.

  2. Clinical Study on Hepatic Cirrhotic Portal Hypertension Treated with Iontophoresis of Chinese Drugs%中药离子导入治疗肝硬化门静脉高压征的临床研究

    Institute of Scientific and Technical Information of China (English)

    孙现广; 陈其铭; 何振雄

    2001-01-01

    To explore the clinical effect of chinese herbal medicine in treating Hepatic Cirrhotic Portal Hypertension(HCPH).Methods:The 46 cases of HCPH were divided into two groups randomly.The treatment group (26 cases)were with iontophoresis of chinese herbal medicine once a day for 30 days.Hemadynamics changes before and after treatment were observed with colour Doppler.Another 20 cases were used as control group with take progranol orally.Results:The whole effective rate for decrease of diameter of Portal Vein(PV) and Spleen Vein(SV) in the treatment group(61.5%,53.6%)were higher than that in control group(25.0%,20.0%)(p<0.05).The portal vein system blood flow reduced significantly after iontophoresis of chinese herbal medicine.Conclusion:Iontophoresis of chinese herbal medicine has marked effect on lowering portal hypertension.%目的:观察中药离子导入治疗肝硬化门静脉高压征的降压效果。方法:46例门静脉高压征患者随机分成两组。治疗组(26例)用中药离子导入治疗,用彩色多普勒观察治疗前后血流动力学变化;对照组(20例)口服心得安。结果:治疗组门静脉和脾静脉内径分别缩小,总有效率分别为61.5%、53.6%,与对照组(25.0%、20.0%)比较,有显著差异(P<0.05)。中药离子导入治疗后门脉系统血流量明显减少。结论:中药离子导入治疗肝硬化有明显降低门静脉压的效果。

  3. GEO portal

    Data.gov (United States)

    US Agency for International Development — The USAID GeoPortal is a new application that groups web-based capabilities for on-demand discovery of and access to geospatial content, services, expertise, and...

  4. 胰源性区域性门静脉高压的MRI表现%MR imaging features of pancreatic segmental portal hypertension

    Institute of Scientific and Technical Information of China (English)

    颜月萍; 蔡香然; 杨晓宇; 谢念危

    2014-01-01

    目的:探讨胰源性区域性门静脉高压(PSPH)的MR特点及临床意义。方法收集2005年5月~2012年12月73例PSPH患者的MRI图像,包括T1 WI双回波序列,轴位T2 WI压脂序列及轴位和冠状位多期动态增强扫描序列(LAVA),分析原发病灶、脾静脉及侧支循环的MR表现。结果73例PSPH均表现为脾静脉狭窄、闭塞、中断。(1)胃冠状静脉(GCV)入口未受累的52例中,胃冠状静脉迂曲扩张43例、胃短静脉(GSV)扩张52例、胃网膜静脉(GEV)扩张52例、胃结肠干(GCT)迂曲扩张30例,食管静(esophageal vein,EV)迂曲扩张2例,脾静脉-(左)肾静脉交通支3例;(2)胃冠状静脉入口受累的21例病例中,胃冠状静脉、胃短静脉、胃网膜静脉及胃结肠干均迂曲扩张,食管静脉迂曲扩张16例,脾静脉-(左)肾静脉交通支19例。结论 MR可显示胰腺原发病灶及其相关的胰源性门静脉高压的侧支循环特点。%Objective To explore the value of MRI in diagnosing pancreatic segmental portal hypertension(PSPH). Methods 73 patients with PSPH underwent MRI between May 2005 and December 2012.MRI included dual-echo T1-,fat-saturated T2-and multiphasic contrast-enhanced T1-weighted sequences.The imaging features of primary pancreatic lesion,splenic vein and collateral circulation were analyzed.Results Occlusion or stenosis of the splenic veins with collateral vessels was seen in all patients.Of 52 patients with patent gastric coronary veins,there was varicosity of the gastric coronary veins(43),short gastric veins (52),gastroepiploic veins(52),gastrocolic trunks(30)and esophageal veins(2)as well as left renal-splenic venous shunt(3).Of 21 patients with gastric coronary vein compression,there was varicosity of the gastric coronary veins,short gastric veins,gastroepiploic veins,and gastrocolic trunks in all patients,varicosity of the esophageal veins in 16 and left renal-splenic venous

  5. Clinical analysis of regional portal hypertension%区域性门静脉高压症的临床分析

    Institute of Scientific and Technical Information of China (English)

    高茹; 高峰; 郝建宇

    2011-01-01

    目的 探讨区域性门静脉高压症(RPH)的病因、临床特点和诊治方法.方法 回顾性分析2005年1月至2010年6月收治的26例RPH患者临床资料.分析26例患者的临床首发症状、血常规、肝功能、乙型和丙型肝炎标志物、肿瘤标志物、腹部超声、腹部增强CT、胃镜检查结果,以及16例行腹部CT血管造影(CTA)者的检查结果.结果 胰源性疾病(18例)是RPH主要病因.临床表现为脾肿大26例,无规律性上腹痛14例,上消化道出血10例.内镜检查示孤立性胃底静脉曲张25例,同时合并食管下段静脉曲张1例.4例行内镜下胃底曲张静脉组织胶注射止血,4例行脾脏切除术,2例行脾脏切除+贲门血管离断术,2例行脾脏切除+胰尾切除+脾肾静脉分流术,3例行脾脏栓塞治疗.结论 RPH常伴胰腺疾病,表现为脾肿大、脾功能亢进,但肝功能正常、无肝硬化,孤立性胃底静脉曲张是其特征性表现.良性病因所致的RPH可治愈.伴消化道出血者脾脏切除的疗效优于单纯内镜下止血治疗.%Objective To investigate the etiology, clinical features, diagnosis and treatment of regional portal hypertension (RPH).Methods The clinical data of 26 patients with RPH treated in Beijing Chaoyang Hospital Affiliated to Capital Medical University between January 2005 and June 2010 were analyzed with retrospective analysis.The first symptom, routine analysis of blood, liver function test, hepatitis B and C markers, tumor markers, abdominal ultrasound, abdominal enhanced CT, endoscopy findings of 26 patients and the results of abdominal CT angiography (CTA) of 16cases were analyzed.Results Pancreatic disease (18 cases) was the leading cause of RPH.The main clinical manifestations of splenomegaly in 26 cases, irregularly abdominal pain in 14 cases, and upper gastrointestinal bleeding in 10 cases.Isolated gastric varices were revealed by endoscopy in 25 cases,complicated with lower esophageal varices in 1 case.4

  6. Portal biliopathy.

    Science.gov (United States)

    Khuroo, Mohammad S; Rather, Ajaz A; Khuroo, Naira S; Khuroo, Mehnaaz S

    2016-09-21

    Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy).

  7. Analysis of the reasons of portal vein thrombosis after splenectomy for portal hypertension due to hepatic cirrhosis%肝硬化脾切除术后门静脉血栓形成的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    柯宇

    2012-01-01

    目的 探讨肝硬化脾脏切除后门静脉系统血栓形成的原因,并且对各种可能的影响因素进行分析总结.方法 回顾性分析本院于2009年2月-2012年2月收治的216例肝硬化脾脏切除术后患者的临床资料,分别对患者的性别、年龄、门静脉和脾静脉的直径、脾脏的大小、肝功能分级、术后并发症、手术前后的门静脉血液流速和压力、手术前后的血小板数量和凝血酶原延长时间等因素进行考察和分析.结果 脾切除术后发生门静脉血栓(portal vein thrombosis,PVT)36例,未发生PVT 180例.术后发生PVT患者的门静脉和脾静脉的直径、脾脏的大小、术后门静脉血液流速、手术前后门静脉的压力以及术后并发症的情况与发生门静脉血栓有显著性关联,差异有统计学意义(P<0.05),但是患者的性别、年龄、肝功能分级、手术前后的血小板数目、术前门静脉血液流速和手术前后的凝血酶原延长时间与门静脉血栓的形成无显著性关联,差异无统计学意义(P>0.05).结论 门静脉和脾静脉直径较粗、脾脏较大、手术后门静脉血液流速较慢、手术前后门静脉压力较小以及手术后并发症较多是肝硬化脾切除术后PVT形成的主要危险因素,因此可针对上述指标及时对患者的术后情况进行检测,减少肝硬化脾切除术后PVT的形成,促进患者术后康复.%Objective To explore the risk factors of portal system thrombosis after splenectomy in patient, analyze and summary the various possible influencing factors. Methods 216 patients with liver cirrhosis received in our hospital from Feb. 2009 to Feb. 2012 undergone splenectomy were analyzed retrospectively. The patient's gender, age, diameter of portal vein and splenic vein, spleen size, liver function, postoperative complications, the blood flow rate and pressure of postoperative portal vein, platelet count and prothrombin extending time before and after

  8. Influencing Factors and Significance of Portal Hypertensive Gastropathy in Liver Cirrhosis%影响门静脉高压性胃病的多因素回归分析

    Institute of Scientific and Technical Information of China (English)

    赵智; 罗俊卿; 刘小利; 段泽星

    2015-01-01

    【目的】探讨肝硬化门脉高压性胃病(portal hypertensive gastropathy ,PHG)的影响因素及其意义。【方法】将158例肝硬化患者分为无 PHG 组、轻度 PHG 组与重度 PHG 组,比较各组终末期肝病模型(MELD)评分、血氨、血清白蛋白、腹水、食管静脉曲张程度、脾脏大小、门静脉内径、胃蛋白酶原比值(PGI/PGII ,PGR)、幽门螺杆菌(Hp)感染差异,随后进行多因素 Logistic 回归分析。【结果】不同组别肝硬化患者的 MELD 评分、血清白蛋白、食管静脉曲张程度、门静脉内径、PGR 比较差异具有统计学意义;多因素 Logistic 回归分析表明 MELD 评分、食管静脉曲张程度、门静脉内径、PGR 与 PHG 有较高相关度。【结论】肝硬化患者的 MELD 评分、食管静脉曲张程度、门静脉内径是 PHG 的危险因素,而 PGR 是 PHG 的保护因素,对于指导治疗及判断预后有一定帮助。%Objective] To explore the influencing factors and significance of portal hypertensive gastropathy (PHG) in liver cirrhosis .[Methods] A total of 158 cases of liver cirrhosis were divided into non‐PHG ,mild PHG and severe PHG groups .And the scores of model for end‐stage liver disease (MELD) were assessed .The profiles of blood ammonia ,serum albumin ,ascites ,esophageal varices ,spleen size ,diameter of main portal vein ,pepsino‐gen ratio (PGR) and HP infection were compared among three groups .Multivariate Logistic regression analyses were performed .[Results] The differences were statistically significant for MELD score ,serum albumin ,esopha‐geal varices ,diameter of main portal vein and PGR among three groups .Multivariate logistic regression analysis indicated that MELD score ,esophageal varices ,diameter of main portal vein and PGR were highly correlated with PHG .[Conclusion] MELD score ,esophageal varices and diameter of main portal vein are the risk factors .How‐ever ,PGR is a

  9. Assessment and management of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension%胆道多次手术合并肝硬化门静脉高压症的评估及处理

    Institute of Scientific and Technical Information of China (English)

    柏立山; 柴新群; 胡志坚; 冯贤松

    2011-01-01

    Objective To probe the assessment and management of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension. Methods The clinical data of 18 patients of bile duct re operation accompanied with hepatocirrhosis and portal hypertension from January 2005 to December 2008 were retro spectively analyzed. Results Of the 18 patients. 4 were grouped to Child A according to Child-Pugh classificalion. 10 were child B, another 4 were Child C. As to the causes of hepatoeirrhosis: 14 patients (77.8%)resulted from biliary cirrhosis. 2 posthepatitic cirrhosis. 2 schistosomiasis cirrhosis. Sixteen patients received simply hiliary tract re-operation. 2 received biliary tract re-operation with devascularization; the bleeding amount during operation was up to 800~1 600 mL. Three of whom had post operative complications: 1 with biliary fistula, I with intestinal fistula and 1 with upper gastrointestinal bleeding. The other patient died of multi-organ dysfunction in preoperative period. Conclusion To the patients of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension, surgical operation will get good results if the assessment of relevant pre-operative issues are enhanced and the appropriate treatments are executed. Child-Pugh classification is not appropriate to assess the patients of biliary tract re-operation accompanied with hepatocirrhosis and portal hypertension.%目的 探讨胆道多次手术同时合并肝硬化门静脉高压症的评估及处理.方法 回顾性分析2005年1月至2008年12月我院收治的18例胆道多次手术同时合并肝硬化门静脉高压症患者的临床资料.结果 18例胆道多次手术同时合并肝硬化门静脉高压症患者中,按照Child-Pugh分级,A级4例,B级10例,C级4例.肝硬化原因:胆汁性肝硬化14例(77.8%),肝炎后肝硬化2例,血吸虫性肝硬化2例.单独行胆道多次手术16例,联合行胆道多次手术和断流术2例;术中出血量达800

  10. ASH External Web Portal (External Portal) -

    Data.gov (United States)

    Department of Transportation — The ASH External Web Portal is a web-based portal that provides single sign-on functionality, making the web portal a single location from which to be authenticated...

  11. Inhibition of P-glycoprotein, multidrug resistance-associated protein 2 and cytochrome P450 3A4 improves the oral absorption of octreotide in rats with portal hypertension.

    Science.gov (United States)

    Sun, Xiao-Yu; Duan, Zhi-Jun; Liu, Zhen; Tang, Shun-Xiong; Li, Yang; He, Shou-Cheng; Wang, Qiu-Ming; Chang, Qing-Yong

    2016-12-01

    The aim of the present study was to increase the intestinal transport of octreotide (OCT) by targeting the first-pass impact to identify a potential method for decreasing portal vein pressure (PVP) using oral OCT. Thus, the bioavailability of intestinally absorbed OCT was evaluated in normal rats and rats with portal hypertension (PH) that had been administered P-glycoprotein/multidrug resistance-associated protein 2/cytochrome P450 3A4 (P-gp/MRP2/CYP3A4) inhibitors. The mRNA and protein expression levels of P-gp, MRP2 and CYP3A4 were evaluated in normal and PH rats with or without OCT and the inhibitors using RT-PCR, western blot and immunohistochemical analyses. The potential effects of the inhibitor administration on PVP were also examined. The results suggest that P-gp, MRP2 and CYP3A4 play important roles in prohibiting the enteral absorption of OCT, particularly under a PH environment. Moreover, inhibitors of P-gp, MRP2 and CYP3A4 decrease the first-pass effects of OCT and effectively reduce PVP under PH conditions. Therefore, the present results suggest P-gp, MRP2 and CYP3A4 are key factors in the intestinal absorption of OCT. The inhibition of P-gp, MRP2 and CYP3A4 can markedly decrease the first-pass effects of OCT, and their use may facilitate the use of orally administered OCT.

  12. 门静脉高压症并上消化道出血的介入治疗进展%Interventional Therapy Progress of Portal Hypertension with Upper Gastrointestinal Bleeding

    Institute of Scientific and Technical Information of China (English)

    张铠

    2012-01-01

    Portal hypertension ( PHT ) with upper gastrointestinal hemorrhage ( UGH ) is mainly caused by the stomach esophagus varicosity burst,which is the most critical complication of portal hypertension. The PHT with UGH often lead to hemorrhagic shock, worsen liver cell damage,evoke ascites and hepatic encephalopathy, endangering patient life. Compared to traditional surgery, intervention treatment has lower perioperative risk, lower complication incidence and lower mortality. Recently, intervention treatment has gradually become the main technical means of PHT with UGH. Different kinds of interventional treatment have different principles, paths, advantages and disadvantages. Doctors should have full understanding and make choice according to the different clinical circumstance. Here is to make a comprehensive review of intervention treatment technology and its research progress in PHT with UGH.%门静脉高压症并上消化道出血主要由食管胃底静脉曲张破裂引起,是门静脉高压最危急的并发症.常致患者失血性休克,加重肝细胞损害、诱发腹水和肝性脑病,危及患者生命.介入治疗与传统外科手术相比,围术期风险低、并发症发生率低、病死率较低,近年逐渐成为治疗该症的主要技术手段.各种介入方法原理和路径不同,优缺点和难易程度各异,介入医师应该充分认识,并根据临床情况进行选择.现就该症的介入治疗技术及其研究进展进行综述.

  13. Endotoxin and tumor necrosis factor-receptor levels in portal and hepatic vein of patients with alcoholic liver cirrhosis receiving elective transjugular intrahepatic portosystemic shunt

    DEFF Research Database (Denmark)

    Trebicka, Jonel; Krag, Aleksander; Gansweid, Stefan

    2011-01-01

    In cirrhosis portal hypertension can promote bacterial translocation and increase serum endotoxin levels. Vice versa, endotoxin aggravates portal hypertension by induction of systemic and splanchnic vasodilation, and by triggering hepatic inflammatory response via tumor necrosis factor α (TNFα......). However, the hepatic elimination of endotoxin in cirrhotic patients with severe portal hypertension, in the absence of acute complications, has not been investigated so far....

  14. Chronic hepatitis C with extrahepatic manifestations.

    Science.gov (United States)

    Poantă, Laura; Albu, Adriana

    2007-01-01

    Chronic hepatitis C is often asymptomatic and is mostly discovered accidentally. The natural course of viral C infection varies considerably from one person to another. Chronic hepatitis C more than other forms of hepatitis is diagnosed because of extrahepatic manifestations associated with the presence of HCV such as thyroiditis, porphyria cutanea tarda, cryoglobulinemia and glomerulonephritis, specifically membranoproliferative glomerulonephritis, sicca syndrome, thrombocytopenia, lichen planus, diabetes mellitus and B-cell lymphoproliferative disorders. We report here a case of a young man with hepatitis C and porphyria cutanea tarda who developed psoriasis after the beginning of systemic interferon therapy.

  15. Extrahepatic Manifestations of Hepatitis C Virus.

    Science.gov (United States)

    Viganò, Mauro; Colombo, Massimo

    2015-12-01

    Chronic infection with the hepatitis C virus (HCV) is a major cause of liver disease worldwide and is also responsible for extrahepatic manifestations (EHMs) involving the skin, kidneys, salivary glands, eyes, thyroid, and immune system. Mixed cryoglobulinemia is the prototype EHM related to HCV infection. Although these HCV-related EHMs may contribute to significant rates of morbidity affecting patient's quality of life and survival, most of these complications can reverse after HCV eradication by interferon therapy. This notwithstanding, individual patients may have an irreversible injury in various organs that is not reversed by a cure of the HCV infection.

  16. [Extrahepatic manifestations of infection with hepatitis C virus].

    Science.gov (United States)

    García Ferrera, Waldo O; Nodarse Cuní, Hugo; Moredo Romo, Edelisa

    2009-01-01

    Since the identification of hepatitis C in 1989, it has been studied extensively. In addition to its hepatotropic; have extrahepatic effects that are directly related to extrahepatic replication with high affinity to lymphoid tissues. As a result of that characteristics, autoimmune manifestations or a widespread immune stimulation, hematological, endocrine, dermatological, Ophtalmic, salival and other miscellaneous problems can be presented in affected patients.

  17. Extrahepatic manifestations and insulin resistance in an HCV hyperendemic area.

    Science.gov (United States)

    Nagao, Yumiko; Kawaguchi, Takumi; Tanaka, Kazuo; Kumashiro, Ryukichi; Sata, Michio

    2005-08-01

    Hepatitis C virus (HCV) causes extrahepatic manifestations as well as liver diseases, and contributes to insulin resistance and type 2 diabetes mellitus. The purpose of the present study was to evaluate the relationship of extrahepatic manifestations and insulin resistance in an HCV hyperendemic area. We investigated the incidence of extrahepatic manifestations among 139 inhabitants living in an HCV hyperendemic area in 2002 and compared it to 1999 data for the same inhabitants. Insulin resistance was tested for some non-HCV or HCV-infected inhabitants we had identified during mass screenings in 1999 and 2002. For some of the inhabitants in 2002, we examined records on the prevalence of insulin resistance seven years earlier. The prevalence of extrahepatic manifestations among individuals with positivity for anti-HCV antibodies was higher than among those without HCV in both 1999 and 2002. The prevalence of each extrahepatic manifestation which we identified in 2002 was higher than in 1999. Moreover, in some non-HCV or HCV-infected inhabitants, insulin resistance in 2002 was significantly higher than in 1999. Among inhabitants who had HCV infection with extrahepatic manifestations, fasting insulin levels or HOMA-IR findings seven years prior was significantly higher than for inhabitants who had neither HCV infection nor extrahepatic manifestations (p = 0.03, p = 0.01, respectively). Insulin resistance induces HCV infection, which causes an increase in the incidence of extrahepatic manifestations in HCV-infected individuals.

  18. 合并原发性肝细胞癌的门静脉高压症临床特征及生存分析%Clinical features and survival analysis of portal hypertension combined with hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    徐威; 赵国刚; 李敬东; 石刚; 田云鸿

    2012-01-01

    Objective: To determine the clinical features and prognosis of portal hypertension (PH) combined with hepatocellular carcinoma (HCC).Methods: The clinical data of PH patients combined with HCC (HCC-PH) and the patients with liver cirrhosis-induced PH (LC-PH) admitted and treated in our department during the same 8-year period were retrospectively analyzed. Univariate and multivariate survival analysis were conducted using Cox proportional hazard model. Receiver operating characteristic (ROC) curves were used to determine the cutoff values of continuous variables.Results: Compared with the clinical features of the LC-PH patients, the HCC-PH patients showed higher incidence of esophagogastric varices, portal hypertensive gastropathy and concomitant portal vein thrombus,but lower incidence of compensatory enlargement of the portal vein luminal diameter (≥1.3 cm) and mild hypersplenism. Compared to LC-PH patients, the HCC-PH patients had worse liver function and poorer survival outcomes after upper gastrointestinal bleeding. Multivariate analysis revealed that the combination of HCC, aspartate aminotransferase (AST)≥65.6 U/L, presence of portal vein (tumor) thrombus, total bilirubin (TBIL)≥ 34.0 μmol/L and albumin (ALB) value were factors affecting the survival of PH patients. Conclusion: The clinical features of HCC-PH is different from those of LC-PH, so HCC-PH cannot be simply treated as LC-PH. A combination of HCC is the most important factor affecting the survival of PH patients.%目的:探讨合并原发性肝细胞癌(HCC)的门静脉高压症(PH)的临床特征及预后.方法:回顾性分析8年间收治的HCC-PH患者与同时期肝硬化PH(LC-PH)患者的临床资料.采用Cox比例风险模型行生存单因素和多因素分析,ROC曲线确定连续变量截点值.结果:与LC-PH患者临床特征比较,HCC-PH患者表现为食管胃底静脉曲张、门静脉高压性胃病和合并门静脉栓子发生率高,但门静脉内径代偿性扩张(≥1

  19. Current management approaches to portopulmonary hypertension.

    OpenAIRE

    2010-01-01

    Abstract Portopulmonary hypertension (PoPH) is a rare but life-threatening complication of portal hypertension that is characterised by proliferative changes in the pulmonary microvasculature indistinguishable from other forms of pulmonary arterial hypertension (PAH). Although PoPH is most commonly observed in the setting of cirrhosis, patients with noncirrhotic portal hypertension are also at risk of developing the disorder. A definitive diagnosis requires invasive hemodynamic co...

  20. Liver size, bodyweight, and tolerance to acute complete occlusion of congenital extrahepatic portosystemic shunts in dogs.

    Science.gov (United States)

    Doran, Ivan P; Barr, Frances J; Hotston Moore, Alasdair; Knowles, Toby G; Holt, Peter E

    2008-10-01

    To investigate the relationship between preoperative liver size, bodyweight, and tolerance to shunt occlusion in dogs with congenital extrahepatic portosystemic shunt(s) (CPSS). Longitudinal cohort study. Dogs with CPSS (n=35). Ultrasonography was used to measure preoperative maximum transverse dimension of the liver (TS) of each dog. Intraoperative portal pressures were measured, before and after CPSS occlusion, via a jejunal vein catheter. Tolerance to shunt occlusion was judged on gross visceral observations, and on changes in portal pressure, central venous and mean arterial pressures. TS was significantly related to bodyweight (P7 were more likely to tolerate CPSS occlusion than dogs with a TS/bodyweight ratio of portal pressure rise after shunt occlusion, based on liver dimensions and bodyweight (R=0.668). Intestinal oxygenation did not correlate significantly with tolerance to CPSS occlusion (P=.29). In dogs with CPSS, liver size (relative to bodyweight) is significantly greater (P=.025) in dogs that are tolerant of full ligation than intolerant of occlusion. Preoperative measurement of bodyweight and liver size help indicate the likelihood of tolerance to acute complete occlusion of CPSS in dogs.

  1. Prognostic significance of contrast-enhanced CT attenuation value in extrahepatic cholangiocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Asayama, Yoshiki [Kyushu University, Department of Advanced Imaging and Interventional Radiology, Graduate School of Medical Sciences, Fukuoka (Japan); Nishie, Akihiro; Ishigami, Kousei; Ushijima, Yasuhiro; Takayama, Yukihisa; Okamoto, Daisuke; Fujita, Nobuhiro; Honda, Hiroshi [Kyushu University, Departments of Clinical Radiology, Fukuoka (Japan); Ohtsuka, Takao [Kyushu University, Departments of Surgery and Oncology, Fukuoka (Japan); Yoshizumi, Tomoharu [Kyushu University, Departments of Surgery and Sciences, Fukuoka (Japan); Aishima, Shinichi [Saga University, Pathology and Microbiology, Faculty of Medicine, Saga (Japan); Kyushu University, Departments of Anatomic Pathology, Graduate School of Medical Sciences, Fukuoka (Japan); Oda, Yoshinao [Kyushu University, Departments of Anatomic Pathology, Graduate School of Medical Sciences, Fukuoka (Japan)

    2017-06-15

    To determine whether washout characteristics of dynamic contrast-enhanced computed tomography (CT) could predict survival in patients with extrahepatic cholangiocarcinoma (EHC). This study collected 46 resected cases. All cases were examined by dynamic contrast study on multidetector-row CT. Region-of-interest measurements were obtained at the non-enhanced, portal venous phase and delayed phase in the tumour and were used to calculate the washout ratio as follows: [(attenuation value at portal venous phase CT - attenuation value at delayed enhanced CT)/(attenuation value at portal venous phase CT - attenuation value at unenhanced CT)] x 100. On the basis of the median washout ratio, we classified the cases into two groups, a high-washout group and low-washout group. Associations between overall survival and various factors including washout rates were analysed. The median washout ratio was 29.4 %. Univariate analysis revealed that a lower washout ratio, venous invasion, lymphatic permeation and lymph node metastasis were associated with shorter survival. Multivariate analysis identified the lower washout ratio as an independent prognostic factor (hazard ratio, 3.768; p value, 0.027). The washout ratio obtained from the contrast-enhanced CT may be a useful imaging biomarker for the prediction of survival of patients with EHC. (orig.)

  2. Secure portal.

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Cynthia Lee

    2007-09-01

    There is a need in security systems to rapidly and accurately grant access of authorized personnel to a secure facility while denying access to unauthorized personnel. In many cases this role is filled by security personnel, which can be very costly. Systems that can perform this role autonomously without sacrificing accuracy or speed of throughput are very appealing. To address the issue of autonomous facility access through the use of technology, the idea of a ''secure portal'' is introduced. A secure portal is a defined zone where state-of-the-art technology can be implemented to grant secure area access or to allow special privileges for an individual. Biometric technologies are of interest because they are generally more difficult to defeat than technologies such as badge swipe and keypad entry. The biometric technologies selected for this concept were facial and gait recognition. They were chosen since they require less user cooperation than other biometrics such as fingerprint, iris, and hand geometry and because they have the most potential for flexibility in deployment. The secure portal concept could be implemented within the boundaries of an entry area to a facility. As a person is approaching a badge and/or PIN portal, face and gait information can be gathered and processed. The biometric information could be fused for verification against the information that is gathered from the badge. This paper discusses a facial recognition technology that was developed for the purposes of providing high verification probabilities with low false alarm rates, which would be required of an autonomous entry control system. In particular, a 3-D facial recognition approach using Fisher Linear Discriminant Analysis is described. Gait recognition technology, based on Hidden Markov Models has been explored, but those results are not included in this paper. Fusion approaches for combining the results of the biometrics would be the next step in realizing

  3. 肝细胞癌伴肝硬化门静脉高压患者肝切除术可行性研究%A Feasibility Analysis on Hepatic Resection for Hepatocellular Carcinoma in Portal Hypertensive Cirrhotic Patients

    Institute of Scientific and Technical Information of China (English)

    江涛; 何谦; 张诚华; 杜振双

    2015-01-01

    Objective To analyze the feasibility of curative hepatectomy for hepatocellular carcinoma ( HCC) in portal hypertensive ( PH) cirrhotics patients. Methods Clinical data of 512 liver cirrhosis and HCC cases in the hospital during Janu-ary 2009 and March 2013, were retrospectively analyzed. According to the portal venous pressure, the patients were divided into hypertension group (n=143) and non hypertension group (n=369);General data of the postoperative mortality, operation situ-ation, postoperative complications, and survival rates of the 2 group during the follow-up period were compared. Living status and factors influencing the living status and the cause of death of two groups were analyzed. Results Before operation, the pro-portion of Child-Pugh class B, serum total bilirubin >20μmol/L, albumin 20μg/L, the tumor diameter was≥5 cm, liver resection was >1 hepatic seg-ment, no transcatheter hepatic arterial chemoembolization (TACE) before operation, low histologic differentiation was low, cut-ting edge was 20μmol/L、血白蛋白20μg/L、肿瘤直径≥5 cm、肝切除范围>1个肝段、术前无肝动脉化疗栓塞术(TACE)、组织学分化低、切缘<0.5 cm、多发病灶肝硬化HCC患者生存率明显降低(P<0.05)。利用Cox回归模型进行分析后得出肿瘤直径≥5 cm、多发病灶及术前无TACE是导致肝硬化HCC患者肝切除术后死亡的独立危险因子(P<0.05)。结论门静脉高压并非影响肝硬化HCC肝切除术后生存的独立危险因子,HCC伴肝硬化门静脉高压患者可行肝切除术,肝脏功能保护为肝切除术后重要环节。

  4. Extrahepatic bile duct atresia from the pathologist’s perspective: pathological features and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Peter Van Eyken

    2014-06-01

    Full Text Available Extrahepatic biliary atresia (EHBA refers to stenosis or atresia of the extrahepatic biliary tree. It accounts for 25-30% of cases of neonatal cholestasis. If left untreated, EHBA progresses to biliary cirrhosis and is universally fatal within the first 2 years of life. Early diagnosis is crucial since surgical treatment (Kasai procedure is the only treatment option. Histopathologic examination of liver biopsy specimens is a key element in the diagnostic work-up of infants with suspected EHBA. Pathologic diagnosis aims at excluding non-surgically correctable causes of neonatal cholestasis thereby leading to surgical exploration for confirmation of the diagnosis. All published data indicate that pathologists can diagnose EHBA with high sensitivity, high specificity and reasonable interobserver agreement. The most useful histologic features in the diagnosis of EHBA are portal tract changes including ductular proliferation and bile plugs in ducts and ductules. These lesions are not pathognomonic but can be seen in extrahepatic obstruction of any cause. Total parenteral nutrition (TPN-associated cholestasis and alpha1-antitrypsin (A1AT deficiency cannot be differentiated from EHBA without access to clinical data and may lead to false-positive diagnosis. False-negative interpretation may be caused by early age at diagnosis or by small/indequate specimens. The pathologist also plays a role in the examination of the resected fibrotic segment and of explant specimens. Histopathology can yield prognostic information, being also an indispensable tool in research for the possible pathogenesis of this disease. A well-coordinated, multidisciplinary approach is required in the assessment of suspected cases of EHBA.  Proceedings of the International Course on Perinatal Pathology (part of the 10th International Workshop on Neonatology · October 22nd-25th, 2014 · Cagliari (Italy · October 25th, 2014 · The role of the clinical pathological dialogue in

  5. PORTAL VEIN THROMBOSIS-ULTRASOUND IMAGING

    Directory of Open Access Journals (Sweden)

    Trajkovska Meri

    2016-07-01

    Full Text Available Portal venous system, apart from the main portal vein, includes its tributaries: superior and inferior mesenteric vein, as well as splenic vein, so the term portal venous thrombosis encompasses a broad spectrum of pathological conditions. Usually, one or more causative factors can be recognized, either local endothelial/ flow disturbances, or systemic inherited /acquired conditions. Portal vein thrombosis can be associated with benign or malignant disorders. Weather we are speaking about acute or chronic thrombosis, the clinical presentation is different. Acute thrombosis can be presented in a wide range, from mild abdominal discomfort to a state of intestinal ischemia and life-threatening infarction. Chronic thrombosis is usually recognized when variceal bleeding or other symptoms of portal hypertension express. Fast and accurate diagnosis sometimes is a life-saving procedure, especially in acute vascular alterations. Recently, due to the improvement of imaging procedures the number of patients with diagnosed portal vein thrombosis is increasingly growing. With a negative predictive value of 98% color Doppler ultrasound is considered as imaging modality of choice in detecting portal vein thrombosis. Based on large studies it is presumed that overall risk of getting portal vein thrombosis during lifetime is 1% in general population, but much bigger 5%-15% in cirrhotic patients. Existence of specific ultrasound criteria, if fulfilled, has ensured that diagnosis of portal vein thrombosis is fast and non-invasive. Procedure is convenient for the patient and healthcare providers, and above all, allows prompt treatment preventing further deterioration.

  6. 门静脉高压症动物模型血流动力学的CT灌注成像研究%Hemodynamics assessment by perfusion computed tomography in a canine model of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    林元为; 熊兵; 陈伟建; 黄求理; 杨运俊; 梁盼; 杨博洋; 王宏清; 林德新; 张启瑜

    2011-01-01

    目的 探讨CT灌注成像监测肝硬化门静脉高压症(PHT)门静脉压力变化的应用价值.方法 采用门静脉主干缩窄联合硫代乙酰胺溶液喂养诱导建立比格犬肝硬化门静脉高压症模型,分别对PHT组和对照组比格犬行螺旋CT肝脏灌注成像扫描,用去卷积法计算肝脏各血流灌注参数,开腹后采用玻璃水柱法测定两组比格犬的门静脉压力,并将相应指标进行统计学分析.结果 ①对照组门静脉压力为(14.5±2.2) cm H2O,PHT组门静脉压力为(23.1±2.8)cm H2O,两组之间相比差异具有统计学意义(t=-8.979,P<0.05).②对照组与PHT组肝血流量分别为(112±14)ml·100 g-1·min-1和(96±11)ml·100 g-1·min-1;肝血容量分别为(10±3)ml·100 g-1和(11±5)ml·100 g-1;平均通过时间分别为(7.1±2.0)s和(10.4±3.5) s;肝动脉分数分别为(24%±5%)和(37%±6%);肝动脉灌注量分别为(27±6)ml·100 g-1·min-1和(35±5)ml·100 g-1·min-1;门静脉灌注量分别为(85±13)ml·100 g-1·min-1和(61±11)ml·100 g-1·min-1,统计结果显示两组除肝血容量外其余各参数之间相比差异均有统计学意义(P<0.05).③PHT组门静脉压力与门静脉灌注量、肝血流量之间呈负相关,与平均通过时间、肝动脉分数之间呈正相关,其中与门静脉灌注量相关性最显著(r=-0.842),两者关系的直线回归方程为Y=36.624-0.219X.利用门静脉压力与门静脉灌注量的直线回归方程计算PHT组比格犬门静脉压力为(23.2±2.4)am H2O,与手术实测的门静脉压力(23.1±2.8)cm H2O具有良好的相关性(r=0.843,P<0.05).结论 肝脏CT灌注成像为无创、有效监测门静脉压力提供了一种新途径.%Objective To evaluate perfusion computed tomography in the assessment of portal vein pressure changes in an experimental dog model of liver cirrhosis and portal hypertension.Methods The canine model of cirrhosis and portal hypertension was induced by portal vein stenosis with combination of

  7. Safety, efficacy, and response predictors of anticoagulation for the treatment of nonmalignant portal-vein thrombosis in patients with cirrhosis: a propensity score matching analysis

    Directory of Open Access Journals (Sweden)

    Jung Wha Chung

    2014-12-01

    Full Text Available Background/AimsPortal-vein thrombosis (PVT develops in 10-25% of cirrhotic patients and may aggravate portal hypertension. There are few data regarding the effects of anticoagulation on nonmalignant PVT in liver cirrhosis. The aim of this study was to elucidate the safety, efficacy, and predictors of response to anticoagulation therapy in cirrhotic patients.MethodsPatients with liver cirrhosis and nonmalignant PVT were identified by a hospital electronic medical record system (called BESTCARE. Patients with malignant PVT, Budd-Chiari syndrome, underlying primary hematologic disorders, or preexisting extrahepatic thrombosis were excluded from the analysis. Patients were divided into two groups (treatment and nontreatment, and propensity score matching analysis was performed to identify control patients. The sizes of the thrombus and spleen were evaluated using multidetector computed tomography.ResultsTwenty-eight patients were enrolled in this study between 2003 and 2014: 14 patients who received warfarin for nonmalignant PVT and 14 patients who received no anticoagulation. After 112 days of treatment, 11 patients exhibited significantly higher response rates (complete in 6 and partial in 5 compared to the control patients, with decreases in thrombus size of >30%. Compared to nonresponders, the 11 responders were older, and had a thinner spleen and fewer episodes of previous endoscopic variceal ligations, whereas pretreatment liver function and changes in prothrombin time after anticoagulation did not differ significantly between the two groups. Two patients died after warfarin therapy, but the causes of death were not related to anticoagulation.ConclusionsWarfarin can be safely administered to cirrhotic patients with nonmalignant PVT. The presence of preexisting portal hypertension is a predictor of nonresponse to anticoagulation.

  8. Livergraftvascularvariantwith 3 extra-hepatic arteries

    Institute of Scientific and Technical Information of China (English)

    Paulo N Martins

    2010-01-01

     Vascular anatomy of the liver is varied, and the"standard"anatomy is seen in 55%-80%of cases. It is very important that extrahepatic arteries are identiifed precisely at the time of graft procurement to avoid injuries that might compromise the liver function. In the present case the liver donor had the vascular anatomy of Michels type Ⅶ, e.g. a hepatic artery originating from the celiac trunk and going to the left lobe, an accessory left hepatic artery coming from the left gastric artery, and a replaced right hepatic artery coming from the superior mesenteric artery. This pattern of vascular supply is uncommon, representing less than 5%of cases. The replaced hepatic artery was reconstructed in the back-table with polypropylene suture 7.0 by connecting it to the stump of the splenic artery, and the celiac trunk of the graft was anastomosed to the recipient common hepatic artery.

  9. Extrahepatic manifestations of chronic hepatitis B.

    Science.gov (United States)

    Han, Steven-Huy B

    2004-05-01

    Several extrahepatic manifestations are associated with chronic HBV infection, many with significant morbidity and mortality. The cause of these extrahepatic manifestations is generally believed to be immune mediated. PAN is a rare, but serious, systemic complication of chronic HBV affecting the small- and medium-sized vessels. PAN is seen more frequently in North American and European patients and rarely in Asian patients. PAN ultimately involves multiple organ systems, some with devastating consequences, though the hepatic manifestations are often more mild. The optimal treatment of HBV-associated PAN is thought to include a combination of antiviral and immunosuppressive therapies. HBV-associated GN occurs mainly in children, predominantly males, in HBV endemic areas of the world, but is only occasionally reported in the United States. In children, GN is usually self-limited with only rare progression to renal failure. In adults, the natural disease course of GN may be more relentless, slowly progressing to renal failure. Immunosuppressive therapy in HBV-related GN is not recommended, but antiviral therapy with alpha-interferon has shown promise. The serum-sickness like "arthritis-dermatitis" prodrome is seen in approximately one third of patients acquiring HBV. The joint and skin manifestations are varied, but the syndrome spontaneously resolves at the onset of clinical hepatitis with few significant sequelae. Occasionally, arthritis following the acute prodromal infection may persist; however, joint destruction is rare. The association between HBV and mixed essential cryoglobulinemia remains controversial; but a triad of purpura, arthralgias, and weakness, which can progress to nephritis, pulmonary disease, and generalized vasculitis, has characterized the syndrome. Finally, skin manifestations of HBV infection typically present as palpable purpura. Though papular acrodermatitis of childhood has been reported to be caused by chronic HBV, this association

  10. Magnetic resonance imaging of extrahepatic bile duct disruption

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Yon-Cheong; Wang, Li-Jen; Chen, Chi-Jen [Department of Radiology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan); Chen, Ray-Jade [Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan)

    2002-10-01

    Blunt injury of the extrahepatic bile duct is rare and hence a large series of scientific study of its MRI is difficult to perform. We present the MRI and MR cholangiography of a case of blunt extrahepatic bile duct injury proven at surgery. The diagnosis could be established based on MRI findings of an abrupt tapering of the extrahepatic bile duct with a retracted end, a discordant small-caliber proximal duct, massive ascites, and a hematoma in proximity to the bile duct injury. This non-invasive MRI study is a promising imaging modality to evaluate biliary tract injury. (orig.)

  11. 原位肝移植后门脉高压和脾功能亢进的恢复过程%Recovery of portal vein hypertension and hypersplenism after orthotopic liver transplantation

    Institute of Scientific and Technical Information of China (English)

    陈大志; 刘爱武; 陈嘉薇; 张新宇; 杨致富; 胡占良; 韩德恩; 陈昭民

    1998-01-01

    By using color Doppler ultrasonography and blood cell counter, the recovery of blood cell counts and hypersplenism in 2 patients, undergoing orthotopic liver transplantation, who were diagnosed having hepatocirrhosis with portal vein hypertension and congestive splenomegaly before the transplantation were clinically observed.It was found that one month af-ter the transplantation, the RBC count gradually returned to normal.13 days after transplanta-tion, WBC count and the platelet count returned to normal.Before transplantation, dilated portal and splenic veins with slow blood flow, and increased spleen volume were observed, while hepatic vein was smaller than normal with recurred blood flow.After transplantation, the size of both portal and splenic veins was reduced gradually, but the size of hepatic vein increased and the veloc-ity of blood flow in these veins increased by more than 200%.One month after transplantation, the size and the blood flow of these veins were close to normal, but there was no significant change in the spleen volume which was still higher than normal.%采用全血细胞计数监测和彩色多普勒超声断层的方法对两例因肝硬化合并门脉高压脾功能亢进而行同种异体原位肝移植术的患者进行了临床观察.全血细胞计数监测显示:与术前相比,红细胞计数在术后一个月之内未见明显改善,一个月之后逐渐恢复近于正常.术后13天白细胞计数和血小板计数恢复至正常范围.彩色多普勒超声断层检查结果表明:术前门、脾静脉口径显著扩张,血流速度缓慢,肝静脉口径相应缩小,血流量减少,脾脏体积显著增大.术后门、脾静脉口径逐渐缩小,肝静脉扩张,各血管的血流速度显著加快(两倍以上),1个月后各血管口径和血流速度虽然近于正常,但脾脏体积仍持续高值.

  12. Endoscopic Doppler ultrasound for measurement of azygos blood flow. Validation against thermodilution and assessment of pharmacological effects of terlipressin in portal hypertension

    DEFF Research Database (Denmark)

    2001-01-01

    BACKGROUND: Endoscopic ultrasound (EUS) is a new modality allowing real-time flow measurements by means of the Doppler technique. The aim of the study was to evaluate azygos blood flow measurements by endoscopic ultrasound. METHODS: Measurements of azygos blood flow by EUS and by the thermodilution....... RESULTS: The EUS Doppler and thermodilution measurements correlated significantly (R=0.81, P blood flow was found to be 14% higher by the EUS method than by thermodilution. The coefficient of variation of the EUS Doppler measurements of the azygos blood flow was 14.8%. After...... administration of terlipressin, the azygos blood flow, as measured by EUS Doppler, decreased significantly by 23% from 915 to 704 ml/min (P = 0.014) and the portal venous flow decreased by 28% from 1170 to 789 ml/min (P = 0.03). No effects of placebo were detected. CONCLUSIONS: These results show that EUS...

  13. Varizes de fundo gástrico na hipertensão portal esquistossomótica: resultados cirúrgicos Gastric fundus varices in schistossomotic portal hypertension: surgical results

    Directory of Open Access Journals (Sweden)

    Álvaro Antônio Bandeira Ferraz

    2003-02-01

    Full Text Available OBJETIVO: Apresentar dados epidemiológicos de pacientes esquistossomóticos na forma hepatoesplênica com varizes do fundo gástrico, assim como avaliar os resultados de uma estratégia cirúrgica no manuseio destas varizes. MÉTODO: No período de janeiro de 1992 à julho de 2001 foram acompanhados no Serviço de Cirurgia Geral do Hospital das Clínicas da Universidade Federal de Pernambuco 125 pacientes submetidos à esplenectomia com ligadura da veia gástrica esquerda (LVGE, desvascularização da grande curvatura do estômago e esclerose endoscópica pós-operatória, para o tratamento da hipertensão portal esquistossomótica com antecedentes de hemorragia digestiva. Quando da presença de varizes de fundo gástrico (44/125 foi associado ao procedimento cirúrgico, a abertura do estômago e sutura das varizes. RESULTADOS: Varizes de fundo gástrico foram identificadas em 35,2% (44/125 dos pacientes com esquistossomose hepatoesplênica e antecedentes de hemorragia digestiva alta. Durante o seguimento de 26 meses o procedimento cirúrgico erradicou 76,5% das varizes de fundo gástrico. A incidência de trombose da veia porta no período pós-operatório foi maior no grupo de pacientes sem varizes de fundo gástrico (16,3% quando comparado com os pacientes portadores de varizes de fundo gástrico (8,8%, sem que, no entanto, esta diferença tivesse respaldo estatístico (p = 0,62. Não se identificou correlação entre a presença de varizes do fundo gástrico e o grau de fibrose periportal e o peso do baço. Na análise bioquímica e hematológica, no período pré-operatório dos grupos estudados, o número de leucócitos foi estatisticamente menor no grupo de pacientes que apresentavam varizes de fundo gástrico. CONCLUSÃO: A esplenectomia associada a desvascularização da grande curvatura do estômago, ligadura da veia gástrica esquerda, gastrotomia e sutura da varizes de fundo gástrico, erradicou 76,5% das varizes de fundo g

  14. Implementing BEA Portal 92

    CERN Document Server

    Kolb, Mark

    2007-01-01

    Portals have come into their own in the last several years. Over this time, I have seen portal technology become the latest expression of businesses trying to organize the torrent of information that computers bring. BEA portal is a leader in portal technology. It allows for an enterprise level of support, stability, and capability. Portal 92 has the tools to make your next portal project a success. It also has the sophistication to keep your portal running and remaining relevant to your business. If you are investigating BEA Portal technology, or if you are a seasoned BEA administrator, you

  15. A Rare Presentation of Hepatitis A Infection with Extrahepatic Manifestations

    OpenAIRE

    Geetika Bhatt; Sandhu, Varrinder S.; Mitchell, Charlene K

    2014-01-01

    Hepatitis A has a variety of associated extrahepatic manifestations that clinicians should be aware of for early diagnosis and treatment. We report a unique case of hepatitis A presenting with multiple extrahepatic manifestations not previously described in a single patient. A 34-year-old male presented with sudden onset of left sided facial pain, swelling, and skin rash, with diffuse body pains and muscle weakness, and was found to be positive for hepatitis A immunoglobulin M (IgM). He was i...

  16. Wiki portals

    OpenAIRE

    Kočar, Anja

    2013-01-01

    In our everyday life we are faced with the internet and various web pages that are created on a particular topic. Construction of these can be addressed in different ways. One of them is the usage of wiki portals. Wiki is a collection of web pages, whose content is simple to create and modify, we only need a web browser and an internet connection. If we want to start our own wiki, we need a software called wiki engine. In this thesis we treat wiki as a system of websites, which enables ...

  17. Extrahepatic morbidity and mortality of chronic hepatitis C.

    Science.gov (United States)

    Negro, Francesco; Forton, Daniel; Craxì, Antonio; Sulkowski, Mark S; Feld, Jordan J; Manns, Michael P

    2015-11-01

    Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations. Patients with HCV may develop mixed cryoglobulinemia and its sequelae, ranging from cutaneous and visceral vasculitis to glomerulonephritis and B-cell non-Hodgkin lymphoma. HCV-infected patients have increased rates of insulin resistance, diabetes, and atherosclerosis, which may lead to increased cardiovascular morbidity and mortality. Neurological manifestations of HCV infection include fatigue and cognitive impairment. The mechanisms causing the extrahepatic effects of HCV infection are likely multifactorial and may include endocrine effects, HCV replication in extrahepatic cells, or a heightened immune reaction with systemic effects. Successful eradication of HCV with interferon alfa and ribavirin was shown to improve some of these extrahepatic effects; sustained virological response is associated with resolution of complications of cryoglobulinemia, reduced levels of insulin resistance, reduced incidence of diabetes and stroke, and improved fatigue and cognitive functioning. The availability of new interferon-free, well-tolerated anti-HCV treatment regimens is broadening the spectrum of patients available for therapy, including those in whom interferon was contraindicated, and will likely result in greater improvements in the extrahepatic manifestations of HCV. If these regimens are shown to confer significant benefit in the metabolic, cardiovascular, or neuropsychiatric conditions associated with HCV infection, extrahepatic manifestations of HCV may become a major indication for treatment even in the absence of liver disease.

  18. 肝硬化门静脉高压症患者切口延迟愈合分析%Retrospective analysis on delayed healing of abdominal postoperative incision in patients with portal hypertension

    Institute of Scientific and Technical Information of China (English)

    赫嵘; 张珂; 穆毅; 蒋力; 黄容海; 鲁岩

    2013-01-01

    目的探讨肝硬化门静脉高压症患者术后切口延迟愈合的危险因素。方法采用回顾性调查的方法,分析228例肝炎后肝硬化门静脉高压症患者接受断流术的临床资料,切口延迟愈合病例为观察组(95例),切口愈合良好病例为对照组(133例),筛选分析与术后切口延迟愈合相关的影响因素。结果观察组共95例,切口延迟愈合发生率41.67%。观察组中切口感染29例(1.27%);切口脂肪液化60例(26.32%);切口裂开6例(2.63%)。观察组的急诊手术比例、术前住院时间、皮下脂肪厚度、肝功能Child-Pugh分级、脾脏功能亢进程度、手术时间、术中出血量、开腹使用电刀功率等与对照组比较,差异均有统计学意义(P均<0.05)。结论肝硬化门静脉高压症患者切口延迟愈合,除与皮下脂肪厚度、电刀的使用、手术持续时间等因素相关外,患者围手术期肝功能状态及脾功能亢进程度对于术后切口愈合亦有显著影响。%Objective To analyze the risk factors of delayed healing of abdominal postoperative incision in patients with portal hypertension. Methods Clinical data of 228 cases of posthepatitic cirrhosis with portal hypertension were analyzed retrospectively. Cases of delated healing of incision were taken as observation group (95 cases) and incision healed well cases as control group (133 cases). The influencing factors of postoperative delayed healing of incision were screened and analyzed. Results Incidence rate of delated healing of incision was 41.67%. In observation group, the infection of incisional wound occured on 29 cases (1.27%), the fat liquefaction of incision on 60 cases (26.32%), the disruption of wound on 6 cases (2.63%). The influencing factor included with or without emergency operation, fat thickness, Child-Pugh classification, hyperfunction degrees of the spleen, operation time, volume of blood loss and power of the

  19. Primary cancers of extrahepatic biliary passages

    Energy Technology Data Exchange (ETDEWEB)

    Mittal, B.; Deutsch, M.; Iwatsuki, S.

    1985-04-01

    The records of 22 patients with cancers of extrahepatic biliary passages (EHBP) were analyzed to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From the data, it is difficult to comment on the effectiveness of chemotherapy. The authors have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed.

  20. Primary cancers of extrahepatic biliary passages.

    Science.gov (United States)

    Mittal, B; Deutsch, M; Iwatsuki, S

    1985-04-01

    We analyzed the records of 22 patients with cancers of extrahepatic biliary passages (EHBP) to understand their natural histories and patterns of failure and to evaluate the effectiveness of various treatments. None of the preoperative investigations consistently defined the entire extent of tumor. Percutaneous transhepatic cholangiography (PTHC) was the most helpful (100%) in accurately defining the site of ductal obstruction. Computed tomography was helpful in diagnosing liver metastases in 53% and primary tumor mass in 23% of patients. The most common sites of tumor failure or persistence were: liver (67%), tumor bed (56%), peritoneum (22%), porta hepatis and lymph nodes (17%). The median survival for the entire group was 6.8 months. Surgery plays an important role in managing these tumors and in defining tumor extent for subsequent adjuvant irradiation. Patients receiving radiation doses greater than or equal to 70 TDF had a longer median survival (11 months) than patients receiving less than 70 TDF (4.4 months). All three patients, who were alive and free of disease greater than 1 year, received radiation doses greater than or equal to 70 TDF. From our data, it is difficult to comment on the effectiveness of chemotherapy. We have made suggestions regarding radiation volume and doses to various structures. The need for entering these patients into multi-institutional clinical trials is stressed.

  1. Portal flow into the liver through veins at the site of biliary-enteric anastomosis.

    Science.gov (United States)

    Hashimoto, M; Heianna, J; Yasuda, K; Tate, E; Watarai, J; Shibata, S; Sato, T; Yamamoto, Y

    2005-07-01

    The aim of this study was to establish the role played by jejunal veins in hepatopetal flow after biliary-enteric anastomosis and to evaluate the helical CT features of hepatopetal flow through the anastomosis. We retrospectively analyzed helical CT images of the liver in 31 patients with biliary-enteric anastomosis who underwent hepatic angiography with (n=13) or without (n=18) CT arterial portography within 2 weeks of the CT examination during the last 4 years. Arterial portography showed hepatopetal flow through small vessels located (communicating veins) between the elevated jejunal veins and the intrahepatic portal branches in two (9%) of 22 patients with a normal portal system. Helical CT showed focal parenchymal enhancement around the anastomosis in these two patients. All nine patients with extrahepatic portal vein occlusion (100%) had hepatopetal flow through the anastomosis, and four of the nine had decreased portal flow. CT revealed small communicating veins in two of these four patients. In five patients with normal portal perfusion despite extrahepatic portal vein occlusion, CT detected dilated communicating veins and elevated jejunal veins. The presence of communicating veins and/or focal parenchymal enhancement around the anastomosis indicates hepatopetal flow through the elevated jejunal veins.

  2. Surgical management of portal cavernoma cholangiopathy.

    Science.gov (United States)

    Varma, Vibha; Behera, Arunanshu; Kaman, Leileshwar; Chattopadhyay, Somnath; Nundy, Samiran

    2014-02-01

    The majority of patients with portal cavernoma cholangiopathy (PCC) are asymptomatic, however some (5-38%) present with obstructive jaundice, cholangitis, or even biliary pain due to bile duct stones which form as a result of stasis. Most patients with extrahepatic portal venous obstruction (EHPVO) present with variceal bleeding and hypersplenism and these are the usual indications for surgery. Those who present with PCC may also need decompression of their portosystemic system to reverse the biliary obstruction. It is important to realize that though endoscopic drainage has been proposed as a non-surgical approach to the management of PCC it is successful in only certain specific situations like those with bile duct calculi, cholangitis, etc. A small proportion of such patients will continue to have biliary obstruction and these patients are thought to have a mechanical ischemic stricture. These patients will require a second stage procedure in the form of a bilioenteric bypass to reverse the symptoms related to PCC. In the absence of a shuntable vein splenectomy and devascularization may resolve the PCC in a subset of patients by decreasing the portal pressure.

  3. 肝硬化门静脉高压症合并胆囊结石88例相关因素分析%An analysis on the relevant factors of 88 cases of cirrhotic portal hyper-tension complicated with gallstone

    Institute of Scientific and Technical Information of China (English)

    温怡洪; 罗仪; 李国伟; 方海星

    2015-01-01

    目的:分析肝硬化门静脉高压症合并胆囊结石88例临床特征及相关因素。方法收集366例肝硬化门静脉高压患者,按临床诊断分为结石组88例和对照组278例,回顾分析两组临床资料及辅助检查资料,并采用单因素和多因素分析肝硬化门静脉高压症合并胆囊结石危险因素。结果 Child-Pugh分级≥B级、腹水、肝动脉收缩期峰值流速、门静脉血栓、胰腺周围静脉曲张、胆囊静脉曲张是肝硬化门静脉高压症合并胆囊结石的独立危险因素(P<0.05)。结论肝硬化门静脉高压症合并胆囊结石与肝功能、腹水、肝动脉血流动力学、门静脉侧支循环有关,其中Child-Pugh分级≥B级、腹水、肝动脉收缩期峰值流速、门静脉血栓、胰腺周围静脉曲张、胆囊静脉曲张是独立危险因素。%Objective To analyze the clinical characteristics and relevant factors of 88 cases of cirrhotic portal hyper-tension complicated with gallstone. Methods A total of 366 patients with cirrhotic portal hypertension complicated with gallstone were selected. 88 patients were assigned to a gallstone group and 278 patients were assigned to a control group on the basis of clinical diagnosis. Retrospective analysis was carried out for clinical data and auxiliary examina-tion data of the two groups, and single-factor and multi-factor analyses were applied for the risk factors of cirrhotic portal hypertension complicated with gallstone. Results Child-Pugh grade ≥B, ascites, peak systolic flow velocity of hepatic artery, portal thrombosis, peripancreatic varicose veins, and varicose veins of gallbladder were independent risk factors of cirrhotic portal hypertension complicated with gallstone (P<0.05). Conclusion Cirrhotic portal hypertension complicated with gallstone is related to hepatic functions, ascites, hemodynamics of hepatic artery, and collateral circu-lation of portal vein, and Child-Pugh grade≥B, ascites, peak

  4. Dermatologic Extrahepatic Manifestations of Hepatitis C

    Science.gov (United States)

    Dedania, Bhavtosh; Wu, George Y.

    2015-01-01

    Hepatitis C virus (HCV) affects millions of people worldwide, and an estimated 3.2 million people in the United States. HCV is a hepatotropic and lymphotropic virus that causes not only liver disease, but also a significant number of extrahepatic manifestations (EHMs). Up to 74% of patients affected by HCV will have HCV-related EHMs of some severity in their lifetime. The EHMs vary from simple cutaneous palpable purpura to complex lymphoproliferative disorders, including lymphomas and immune-complex deposit diseases causing local and/or systemic complications. Mixed cryoglobulinemia (MC) is manifested by multiple systemic organ involvement, mainly skin, kidney, peripheral nerves, and salivary glands, and less frequently causes widespread vasculitis and malignant lymphoma. MC affects up to 3% of HCV-infected patients with cryoglobulinemia of clinical significance, i.e. >6%. Severe disease requires immunosuppressive or plasma exchange therapy. HCV prevalence in the United States in patients with porphyria cutanea tarda (PCT) was reported to be 66%, much higher than that in general population. Therefore, all patients with PCT should be screened for HCV. The skin rash of PCT varies from large blisters to small vesicles and/or milia on the hands. Skin manifestations due to PCT usually respond to anti‐HCV treatment together with reducing skin sun exposure, avoiding triggers, having routine phlebotomy (especially for people with chronic iron overload states), and using chloroquine. Lichen planus (LP), which typically affects both the skin and oral mucosa is a chronic inflammatory disease of squamous cell origin affecting about 1% of the worldwide population. The prevalence of HCV in patients with LP varies based on geographic location. We review here the basic pathophysiology, clinical features, and management of dermatologic manifestations of HCV. PMID:26357639

  5. Dermatologic Extrahepatic Manifestations of Hepatitis C.

    Science.gov (United States)

    Dedania, Bhavtosh; Wu, George Y

    2015-06-28

    Hepatitis C virus (HCV) affects millions of people worldwide, and an estimated 3.2 million people in the United States. HCV is a hepatotropic and lymphotropic virus that causes not only liver disease, but also a significant number of extrahepatic manifestations (EHMs). Up to 74% of patients affected by HCV will have HCV-related EHMs of some severity in their lifetime. The EHMs vary from simple cutaneous palpable purpura to complex lymphoproliferative disorders, including lymphomas and immune-complex deposit diseases causing local and/or systemic complications. Mixed cryoglobulinemia (MC) is manifested by multiple systemic organ involvement, mainly skin, kidney, peripheral nerves, and salivary glands, and less frequently causes widespread vasculitis and malignant lymphoma. MC affects up to 3% of HCV-infected patients with cryoglobulinemia of clinical significance, i.e. >6%. Severe disease requires immunosuppressive or plasma exchange therapy. HCV prevalence in the United States in patients with porphyria cutanea tarda (PCT) was reported to be 66%, much higher than that in general population. Therefore, all patients with PCT should be screened for HCV. The skin rash of PCT varies from large blisters to small vesicles and/or milia on the hands. Skin manifestations due to PCT usually respond to anti-HCV treatment together with reducing skin sun exposure, avoiding triggers, having routine phlebotomy (especially for people with chronic iron overload states), and using chloroquine. Lichen planus (LP), which typically affects both the skin and oral mucosa is a chronic inflammatory disease of squamous cell origin affecting about 1% of the worldwide population. The prevalence of HCV in patients with LP varies based on geographic location. We review here the basic pathophysiology, clinical features, and management of dermatologic manifestations of HCV.

  6. Extrahepatic manifestations in chronic hepatitis C virus carriers.

    Science.gov (United States)

    Rosenthal, E; Cacoub, P

    2015-04-01

    Patients with chronic hepatitis C virus (HCV) infection frequently present with extrahepatic manifestations covering a large spectrum, involving different organ systems leading to the concept of systemic HCV infection. These manifestations include autoimmune phenomena and frank autoimmune and/or rheumatic diseases and may dominate the course of chronic HCV infection. Chronic HCV infection causes liver inflammation affecting the development of hepatic diseases. HCV is also a lymphotropic virus that triggers B cells and promotes favorable conditions for B lymphocyte proliferation, including mixed cryoglobulinemia (MC) and MC vasculitis, which is the most prominent extrahepatic manifestation of chronic HCV infection. HCV may also promote a low-grade chronic systemic inflammation that may affect the development of some extrahepatic manifestations, particularly cardiovascular and cerebral vascular diseases. Recognition of extrahepatic symptoms of HCV infection could facilitate early diagnosis and treatment. The development of direct-acting antiviral agents (DDAs) has revolutionized HCV treatment. DDAs, as well as new B-cell-depleting or B-cell-modulating monoclonal antibodies, will expand the panorama of treatment options for HCV-related extrahepatic manifestations including cryoglobulinemic vasculitis. In this context, a proactive, integrated approach to HCV therapy should maximize the benefits of HCV therapy, even when liver disease is mild.

  7. The VITRO Score (Von Willebrand Factor Antigen/Thrombocyte Ratio as a New Marker for Clinically Significant Portal Hypertension in Comparison to Other Non-Invasive Parameters of Fibrosis Including ELF Test.

    Directory of Open Access Journals (Sweden)

    Stephanie Hametner

    Full Text Available Clinically significant portal hypertension (CSPH, defined as hepatic venous pressure gradient (HVPG ≥10 mmHg, causes major complications. HVPG is not always available, so a non-invasive tool to diagnose CSPH would be useful. VWF-Ag can be used to diagnose. Using the VITRO score (the VWF-Ag/platelet ratio instead of VWF-Ag itself improves the diagnostic accuracy of detecting cirrhosis/ fibrosis in HCV patients.This study tested the diagnostic accuracy of VITRO score detecting CSPH compared to HVPG measurement.All patients underwent HVPG testing and were categorised as CSPH or no CSPH. The following patient data were determined: CPS, D'Amico stage, VITRO score, APRI and transient elastography (TE.The analysis included 236 patients; 170 (72% were male, and the median age was 57.9 (35.2-76.3; 95% CI. Disease aetiology included ALD (39.4%, HCV (23.4%, NASH (12.3%, other (8.1% and unknown (11.9%. The CPS showed 140 patients (59.3% with CPS A; 56 (23.7% with CPS B; and 18 (7.6% with CPS C. 136 patients (57.6% had compensated and 100 (42.4% had decompensated cirrhosis; 83.9% had HVPG ≥10 mmHg. The VWF-Ag and the VITRO score increased significantly with worsening HVPG categories (P<0.0001. ROC analysis was performed for the detection of CSPH and showed AUC values of 0.92 for TE, 0.86 for VITRO score, 0.79 for VWF-Ag, 0.68 for ELF and 0.62 for APRI.The VITRO score is an easy way to diagnose CSPH independently of CPS in routine clinical work and may improve the management of patients with cirrhosis.

  8. TIPS para o controle das complicações da hipertensão portal: eficácia, fatores prognósticos associados e variações técnicas TIPS for controlling portal hypertension complications: efficacy, predictors of outcome and technical variations

    Directory of Open Access Journals (Sweden)

    Néstor Hugo Kisilevzky

    2006-12-01

    Full Text Available OBJETIVO: Avaliar a eficácia do TIPS (transjugular intrahepatic portosystemic shunt para tratar as complicações clínicas em pacientes com hipertensão portal. MATERIAIS E MÉTODOS: Quarenta e quatro pacientes, sendo 30 do sexo masculino e 14 do feminino e com idade média de 52 anos foram analisados. A indicação para realização de TIPS foi hemorragia gastrintestinal em 28 e ascite refratária em 16. Houve 7 pacientes Child-Pugh A, 24 Child-Pugh B e 11 Child-Pugh C. RESULTADOS: O TIPS foi realizado com sucesso em todos os pacientes (100%, verificando-se queda do gradiente pressórico porto-sistêmico médio de 49,69% (de 18,98 mmHg para 9,55 mmHg. Comprovou-se melhora clínica em 35 pacientes (79,55%. A mortalidade pós-operatóriaia foi de 13,64%, sendo mais incidente nos pacientes Child-Pugh C (45,45%. Os fatores mais relevantes de mau prognóstico foram o aumento da bilirrubina e do nível de creatinina. A sobrevida média de pacientes Child-Pugh A foi de 11,5 meses, nos Child-Pugh B foi de 10,97 meses e nos Child-Pugh C foi de apenas 5,9 meses. Foram observadas complicações em nove casos (20,44%. CONCLUSÃO: O TIPS é eficiente para reduzir a pressão portal. As complicações e a morbi-mortalidade relacionadas com o procedimento podem ser consideradas aceitáveis. A mortalidade foi influenciada por alguns fatores clínicos, tais como classe Child-Pugh C e elevação dos níveis séricos de bilirrubina e creatinina.OBJECTIVE: To evaluate the efficacy of TIPS (transjugular intrahepatic portosystemic shunt for resolving clinical complications in patients with portal hypertension. MATERIALS AND METHODS: Forty-four caucasian patients, 30 men and 14 women, with a mean age of 52 years have been evaluated. Indication for TIPS has been gastrointestinal hemorrhage in 28 patients, and refractory ascites in 16. There has been 7 Child-Pugh A patients, 24 Child-Pugh B, and 11 Child-Pugh C. RESULTS: TIPS was successfully performed in all the

  9. Clinical efficacy of splenectomy combined with coronary-caval shunt in treatment of portal hypertension%脾切除联合冠腔分流术治疗门静脉高压症的临床疗效

    Institute of Scientific and Technical Information of China (English)

    曲凯; 刘昌

    2016-01-01

    Objective To investigate the clinical efficacy of splenectomy combined with coronary-caval shunt in treatment of portal hypertension (PHT).Methods The retrospective descriptive study was conducted.The clinical data of 21 patients with PHT who underwent splenectomy combined with coronary-caval shunt at the First Affiliated Hospital of Xi'an Jiaotong University from January 2001 to December 2015 were collected.Observation indicators included (1) operation situations,changes of pre-and post-operative portal hemodynamics including operation time and volume of intraoperative blood loss,diameter and blood flow velocity of portal vein (PV),gastric coronary vein and superior mesenteric vein (SMV).(2) Clinical indexes in perioperative period (before operation,at postoperative 1 week and 1 month):① blood routine test:the counts of red blood cell (RBC),white blood cell (WBC) and platelet (PLT),② liver function:Child-Pugh score,alanine transaminase (ALT),total bilirubin (TBil),albumin (Alb),extended time of prothrombin time (PT) and international normalized ratio (INR).(3) Follow-up:postoperative 1-,3-,5-year complications [upper gastrointestinal re-bleeding,peritoneal effusion,hepatic encephalopathy,hepatic failure,portal vein thrombosis (PVT) and anastomotic stoma thrombosis].The follow-up using outpatient examination and telephone interview was regularly conducted once every 3 months within postoperative 1 year and once every 6 months after postoperative 1 year up to March 2016 or end of follow-up (death).Measurement data with normal distribution were presented as x ± s.The comparison of different time-point was analyzed by the repeated measures ANOVA and Student t test.Measurement data with sknewed distribution were presented as M (range).Results (1) Operation situations and changes of pre-and post-operative portal hemodynamics:21 patients underwent successful splenectomy combined with coronary-caval shunt,including 19 receiving splenic vein bypass combined with

  10. Association of Extrahepatic Manifestations with Autoimmune Hepatitis.

    Science.gov (United States)

    Wong, Guan Wee; Heneghan, Michael A

    2015-01-01

    For many patients with autoimmune hepatitis (AIH), the presence of extrahepatic features is well recognised both at the time of presentation and during long-term follow-up. Concomitant 'autoimmune disorders' have been described in 20-50% of patients with AIH, both in adults and children. Indeed, the presence of these associated phenomena has been incorporated into both the original and revised International AIH group scoring systems as an aid to codifying the diagnosis. In acute index presentations, non-specific joint pains sometimes flitting in nature have been reported in 10-60% of patients, and while joint swelling is uncommon, rheumatoid arthritis and mixed connective tissue disease have been reported in 2-4% of patients with AIH. For a majority of patients, these joint symptoms resolve within days of the introduction of immunosuppressive therapy. Rarer features at index presentation include a maculopapular skin rash and unexplained fever, which are features that tend to resolve quickly with treatment. Interestingly, joint pain and stiffness are also well recognised in the context of steroid withdrawal and cessation in AIH. The occasional co-presentation of AIH with coeliac disease is clinically important (1-6%), since for some patients, there is a risk of immunosuppression malabsorption, thus delaying effective treatment. Similarly, the co-existence of selective IgA deficiency (IgAD) can occur in patients with coeliac disease or in isolation. Selective IgAD as a co-existing extraheaptic feature seems to be more common in paediatric patients with AIH. For these patients, they are at an increased risk of respiratory and sinus infections. Although, typically associated with primary sclerosing cholangitis, the presence of inflammatory bowel disease (IBD; both Crohn's disease and ulcerative colitis) has been described in 2-8% of patients with AIH. Interestingly, for patients with autoimmune sclerosing cholangitis, a distinct pattern of IBD has been recently

  11. 声触诊组织量化技术在预测肝纤维化患者门静脉高压发生风险中的价值%Value ofvirtual touch tissues quantification technique in predicting the occurrence risk of portal hyperten-sion of patients suffering from hepatic fibrosis

    Institute of Scientific and Technical Information of China (English)

    王琳; 蔡丽萍; 孙燕双

    2015-01-01

    Objective To research the value of virtual touch tissues quantification technique in predicting the occurrence risk of portal hypertension of patients suffering from hepatic fibrosis. Methods Siemens Acuson S2000 ultrasonic diagnostic apparatus was used to conduct common color Doppler ultrasonic examination and liver VTQ test on 61 examinees ( including healthy people and pa⁃tients suffering from chronic liver diseases) , and the relativity among all parameters were compared. Results With the portal hyper⁃tension becoming more and more serious, the patients'liver VTQ value increased with it, portal vein diameter became wide and portal vein peak velocity reduced. There is a certain relativity between them. The test results of the liver VTQ value of the patients suffering from hepatic fibrosis in this region show that when the liver VTQ value is larger than 2.23 m/s, the occurrence risk of portal hyperten⁃sion of patients will significantly rise. Conclusion Virtual touch tissues quantification technique is of a certain value in predicting the occurrence risk of portal hypertension of patients suffering from hepatic fibrosis.%目的:研究声触诊组织量化( VTQ)技术在预测肝纤维化患者门静脉高压发生风险中的价值。方法使用西门子Acuson S2000超声诊断仪,对61例受检者(包括除外肝病史的就诊患者和慢性肝病患者)进行普通彩超检查及肝脏VTQ值测量,对比研究各参数之间的相关性。结果慢性肝病患者随着门静脉高压程度的加重,肝脏VTQ值增大,门静脉内径增宽,门静脉峰值流速减低,各参数之间有一定相关性。根据本地区肝纤维化患者肝脏VTQ检测结果显示,当肝脏VTQ值大于2�23 m/s时,患者发生门静脉高压的风险显著提高。结论声触诊组织量化技术在预测肝纤维化患者门静脉高压发生风险中具有一定价值。

  12. Usefulness and pitfalls of MAA SPECT/CT in identifying digestive extrahepatic uptake when planning liver radioembolization

    Energy Technology Data Exchange (ETDEWEB)

    Lenoir, Laurence; Garin, Etienne [Comprehensive Cancer Institute Eugene Marquis, Department of Nuclear Medicine, CS 44229, Rennes (France); University of Rennes 1, Rennes (France); Liver Metabolisms and Cancer, INSERM, U-991, Rennes (France); Edeline, Julien [University of Rennes 1, Rennes (France); Comprehensive Cancer Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France); Rolland, Yann [Comprehensive Cancer Institute Eugene Marquis, Department of Medical Imaging, CS 44229, Rennes (France); Pracht, Marc [Comprehensive Cancer Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France); Raoul, Jean-Luc [Comprehensive Cancer Institute Paoli Calmette, Department of Medical Oncology, Marseille (France); Ardisson, Valerie [Comprehensive Cancer Institute Eugene Marquis, Department of Nuclear Medicine, CS 44229, Rennes (France); Bourguet, Patrick [Comprehensive Cancer Institute Eugene Marquis, Department of Nuclear Medicine, CS 44229, Rennes (France); University of Rennes 1, Rennes (France); Clement, Bruno [Liver Metabolisms and Cancer, INSERM, U-991, Rennes (France); Boucher, Eveline [Liver Metabolisms and Cancer, INSERM, U-991, Rennes (France); Comprehensive Cancer Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France)

    2012-05-15

    Identifying gastroduodenal uptake of {sup 99m}Tc-macroaggregated albumin (MAA), which is associated with an increased risk of ulcer disease, is a crucial part of the therapeutic management of patients undergoing radioembolization for liver tumours. Given this context, the use of MAA single photon emission computed tomography (SPECT)/CT may be essential, but the procedure has still not been thoroughly evaluated. The aim of this retrospective study was to determine the effectiveness of MAA SPECT/CT in identifying digestive extrahepatic uptake, while determining potential diagnostic pitfalls. Overall, 139 MAA SPECT/CT scans were performed on 103 patients with different hepatic tumour types. Patients were followed up for at least 6 months according to standard requirements. Digestive, or digestive-like, uptake other than free pertechnetate was identified in 5.7% of cases using planar imaging and in 36.6% of cases using SPECT/CT. Uptake sites identified by SPECT/CT included the gastroduodenal region (3.6%), gall bladder (12.2%), portal vein thrombosis (6.5%), hepatic artery (6.5%), coil embolization site (2.1%) as well as falciform artery (5.0%). For 2.1% of explorations, a coregistration error between SPECT and CT imaging could have led to a false diagnosis by erroneously attributing an uptake site to the stomach or gall bladder, when the uptake actually occurred in the liver. SPECT/CT is more efficacious than planar imaging in identifying digestive extrahepatic uptake sites, with extrahepatic uptake observed in one third of scans using the former procedure. However, more than half of the uptake sites in our study were vascular in nature, without therapeutic implications. The risk of coregistration errors must also be kept in mind. (orig.)

  13. The Knowledge Portal

    Data.gov (United States)

    Office of Personnel Management — Information on various courses, as well as personal data of employees and training records from The Knowledge Portal (TKP), a web-based training portal used for the...

  14. Giant Intrahepatic Portal Vein Aneurysm: Leave it or Treat it?

    Science.gov (United States)

    Shrivastava, Amit; Rampal, Jagdeesh S; Nageshwar Reddy, D

    2017-03-01

    Portal vein aneurysm (PVA) is a rare vascular dilatation of the portal vein. It is a rare vascular anomaly representing less than 3% of all visceral aneurysms and is not well understood. Usually, PVA are incidental findings, are asymptomatic, and clinical symptoms are proportionally related to size. Patients present with nonspecific epigastric pain or gastrointestinal bleeding with underlying portal hypertension. PVA may be associated with various complications such as biliary tract compression, portal vein thrombosis/rupture, duodenal compression, gastrointestinal bleeding, and inferior vena cava obstruction. Differential diagnoses of portal vein aneurysms are solid, cystic, and hypervascular abdominal masses, and it is important that the radiologists be aware of their multi-modality appearance; hence, the aim of this article was to provide an overview of the available literature to better simplify various aspects of this rare entity and diagnostic appearance on different modality with available treatment options. In our case, a 55-year-old male patient came to the gastroenterology OPD for further management of pancreatitis with portal hypertension and biliary obstruction with plastic stents in CBD and PD for the same. In this article, we have reported a case of largest intrahepatic portal vein aneurysm and its management by endovascular technique. As per our knowledge, this is the largest intrahepatic portal vein aneurysm and first case where the endovascular technique was used for the treatment of the same.

  15. The research of hemodynamic changes in portal hypertension combining with subtotal gastrectomy%猪远端胃大部分切除术后合并门静脉高压症模型中门脉血流系统的变化

    Institute of Scientific and Technical Information of China (English)

    张贺云; 李文滨; 褚忠华; 彭耀荣; 吴卓; 王捷

    2011-01-01

    Objective To build up a pig model of portal hypertension combined with subtotal gastrectomy,and study the hemodynamic changes of portal vein system.Methods 26 Susscrota domesticas are divided into three groups randomly.The experimental group ( EG,n =10) will receive the subtotal gastrectomy in the onestage operation,and will be subtotally coarctated the vena portae after one month.The portal hypertension group (PG,n =10) will receive the sham subtotal gastrectomy at first and followed by subtotally coarctated the vena portae.And the shamoperated group ( SG,n =6) will receive the sham subtotal gastrectomy at first and the sham subtotally coarctated the vena portae one month later.The portal pressure will be measured,and the hemodynamic changes in all groups will be detected by computer tomography and cast form.Results ( 1 ) The portal pressure in the EG and PG are statistically significance higher than the SG.And no difference was found between the EG and PG after the operation.(2) After subtotal gastrectomy,there are no new blood vessel appear in the gastric stump and the anastomosis between the stomach and the intestines.The blood supply of the gastric stump are mainly supported by the left gastric arteria and arteriae gastro-omentalis sinistra.The venous return of the gastric are mainly through the left gastric vein and left gastroepiploic vein.Conclusion ( 1 ) The method of subtotally coarctating the vena portae can build up a model of portal hypertension combined with subtotal gastrectomy.(2) The patients of portal hypertension who alreadly underwent subtotal gastrectomy is not suitable for the pericardial devascularization and the modified Sugiura procedure.%目的 建立猪远端胃大部分切除术后合并门静脉高压症模型,观察该模型门脉系统的血流动力学变化.方法 将26只家猪随机分为3组,实验组(EG,10只)一期行远端胃大部分切除、二期行门静脉部分缩窄术;门静脉高压组(PG,10只)一期行开关腹

  16. Portals people, processes, technology

    CERN Document Server

    Cox, Andrew

    2006-01-01

    First applied to internet gateways such as Yahoo, the concept of the ""portal"" has evolved in a number of directions. How can information services best take advantage of internet portals to improve access to resources? This collection seeks answers to such questions, providing an overview of how portals are being used.

  17. Evaluating Open Source Portals

    Science.gov (United States)

    Goh, Dion; Luyt, Brendan; Chua, Alton; Yee, See-Yong; Poh, Kia-Ngoh; Ng, How-Yeu

    2008-01-01

    Portals have become indispensable for organizations of all types trying to establish themselves on the Web. Unfortunately, there have only been a few evaluative studies of portal software and even fewer of open source portal software. This study aims to add to the available literature in this important area by proposing and testing a checklist for…

  18. Usability of Discovery Portals

    NARCIS (Netherlands)

    Bulens, J.D.; Vullings, L.A.E.; Houtkamp, J.M.; Vanmeulebrouk, B.

    2013-01-01

    As INSPIRE progresses to be implemented in the EU, many new discovery portals are built to facilitate finding spatial data. Currently the structure of the discovery portals is determined by the way spatial data experts like to work. However, we argue that the main target group for discovery portals

  19. Usability of Discovery Portals

    NARCIS (Netherlands)

    Bulens, J.D.; Vullings, L.A.E.; Houtkamp, J.M.; Vanmeulebrouk, B.

    2013-01-01

    As INSPIRE progresses to be implemented in the EU, many new discovery portals are built to facilitate finding spatial data. Currently the structure of the discovery portals is determined by the way spatial data experts like to work. However, we argue that the main target group for discovery portals

  20. TIPS Placement via Combined Transjugular and Transhepatic Approach for Cavernous Portal Vein Occlusion: Targeted Approach

    Directory of Open Access Journals (Sweden)

    Natanel Jourabchi

    2013-01-01

    Full Text Available Purpose. We report a novel technique which aided recanalization of an occluded portal vein for transjugular intrahepatic portosystemic shunt (TIPS creation in a patient with symptomatic portal vein thrombosis with cavernous transformation. Some have previously considered cavernous transformation a contraindication to TIPS. Case Presentation. 62-year-old man with chronic pancreatitis, portal vein thrombosis, portal hypertension and recurrent variceal bleeding presents with melena and hematemesis. The patient was severely anemic, hemodynamically unstable, and required emergent portal decompression. Attempts to recanalize the main portal vein using traditional transjugular access were unsuccessful. After percutaneous transhepatic right portal vein access and navigation of a wire through the occluded main portal vein, an angioplasty balloon was inflated at the desired site of shunt takeoff. The balloon was targeted and punctured from the transjugular approach, and a wire was passed into the portal system. TIPS placement then proceeded routinely. Conclusion. Although occlusion of the portal vein increases difficulty of performing TIPS, it should not be considered an absolute contraindication. We have described a method for recanalizing an occluded portal vein using a combined transhepatic and transjugular approach for TIPS. This approach may be useful to relieve portal hypertension in patients who fail endoscopic and/or surgical therapies.

  1. 多层螺旋CT门静脉血管成像在胰源性门脉高压症诊断中的应用%The application of multi-slice spiral CT portography in pancreatic portal hypertension disease

    Institute of Scientific and Technical Information of China (English)

    靳勇; 林晓珠; 吴云林; 朱晖; 吴志远; 瞿晴; 徐学勤; 陈克敏

    2008-01-01

    Objective To study the application of multi-slice spiral CT(MSCT) portography in diagnonsis of pancreatic portal hypertension. Methods Forty-seven patients with lesion in body or tail of pancrease,47 normal subjects and 126 patients with portal hypertension underwent MSCT portography with LightSpeed 16 CT scanner. The inner diameter of portal system and the main collateral veins were measured in maximun intensity projection (MIP) image. The volume of liver and spleen were also measured in volume rendering (VR) image. The liver parenchyma and main portal vein enhancement in portal vein phase were also taken. The endoscopy examination was made in 57 patiens with portal hypertension. Results In 47 patiens with lesion in body or tail of pancreas , stenosis or occlusion of spleen vein were found in 38 patients(pancreatic portal hypertension in 27 patients, chronic and acute pancreatitis in 11 patients). In 38 patients with pancreatic portal hypertension, esophageal varices was found in 5 patients(13.2%), gastric fundus varix in 25 patients (65.8%), gastric body variees in 22 patients (57.9%), short-gastric vein/post-gastric vein(SGV/PGV) in 26 patients (68.4%), coronal gastric vein in 26 patients (68.4%),dilated gasto-omenta vein in 24 patients(63.2%), mesenterica varicesin 1 patient, splenic vein occlusion in 14 patients (36.8%), splenic vein stenosis in 23 patinets(63.2%). Conclusions The patients with pancreatic portal hypertension were demonstrate characteristic changes in MSCT portography. The MSCT portography is helpful in etiological diagnosis of pancreatic portal hypertension by supplying images in vessel morphology.%目的 研究多层螺旋CT门静脉血管成像在胰源性门静脉高压患者诊断中的应用.方法 应用16排多层螺旋CT门静脉血管成像,对47例临床怀疑胰腺体尾部病变的患者的门静脉系统形态改变与126例肝源性门脉高压患者和47例正常对照组进行形态学对比观察,并测量胃

  2. 优化腹腔镜脾切除和贲门周围血管离断术的临床研究%Modified laparoscopic splenectomy plus pericardial devascularization for the treatment of portal hypertension

    Institute of Scientific and Technical Information of China (English)

    成剑; 洪德飞; 沈国樑; 谢志杰; 孙晓东; 王知非; 张远标; 黄东胜

    2014-01-01

    Objective To evaluate a modified totally laparoscopic splenectomy plus pericardial devascularization (LSPD) for the treatment of portal hypertension.Methods We applied the technique of ligating the splenic artery in advance followed by the establishment of a tunnel underneath the splenic hilum and the consecutive transection of secondary splenic pedicles and gastric coronary vein with Endo-GIA during the process of splenectomy.Results Totally laparoscopic procedures were performed successfully in 28 cases.Procedure was converted to open surgery in one case because of uncontrollable splenic bleeding.Of the 28 patients that received the total LSPD,the operation time was (207.2 ± 59.3) min,intraoperative blood loss was (287.7 ± 212) ml,intraoperative blood transfusion volume was (106.7 ± 98.3) ml,postoperative passing gas time was (4.6 ± 1.7) d,postoperative hospital stay was (11.8 ± 2.9) d.Abdominal infection,postoperative portal vein thrombosis and liver failure were found in 1,1,2 cases respectively.There were no pancreatic fistula,intraabdominal hemorrhage,postoperative upper gastrointestinal hemorrhage cases.One patient died of liver failure,the other was cured by artificial liver therapy.Conclusions The technique of modified LSPD could reduce the conversion rate of laparoscopic splenectomy and intraoperative blood loss.%目的 探讨完全腹腔镜脾切除、贲门周围血管离断术(laparoscopic splenectomy plus pericardial devascularization,LSPD)的优化技术.方法 应用预先结扎脾动脉,建立脾门后隧道,根据脾门形态应用直线或可转弯切割闭合器分次离断二级脾蒂、应用直线切割闭合器离断胃冠状曲张静脉丛的方法优化LSPD来治疗门静脉高压症及脾功能亢进.结果 29例患者手术均顺利完成,1例中转开腹.28例腹腔镜手术时间(207.2±59.3)min,术中出血量(287.7 ±212) ml,术中输血量(106.7 ±98.3) ml.术后肛门排气时间(4.6±1.7)d,术后住院时间(11.8±2.9)d

  3. Analysis of portal vein thrombosis of portal hypertension after pericardial devascularization by prophylactic anticoagulation%门静脉高压症贲门周围血管离断术后预防性抗凝对门静脉系统血栓形成的影响

    Institute of Scientific and Technical Information of China (English)

    卢志坤; 吴永强; 杨进华; 何德谋; 张权锋

    2015-01-01

    目的 分析门静脉高压症患者实施贲门周围血管离断术后给予预防性抗凝对门静脉系统血栓形成(PVT)的影响.方法 选择我院2009年1月至2014年12月收治的乙型肝炎肝硬化门静脉高压症患者86例,均给予贲门周围血管离断术治疗,以是否术后给予预防性抗凝治疗将其分为观察组(给予抗凝治疗,46例)与对照组(未给予抗凝治疗,40例),对比两组术后并发PVT的情况及临床特征.结果 观察组术后PVT的发