An Evaluation of the Rectum-to-Lung Ether Time Test in Shunt Operations for Portal Hypertension and in Liver Disease

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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Portal Hypertension in Non-alcoholic Fatty Liver Disease: Association With Cardiovascular Risk and Identification of Non-invasive Biomarkers (THESIS)

Case Medical Research ◽

10.31525/ct1-nct04191044 ◽

2019 ◽

Author(s):

Keyword(s):

Portal Hypertension ◽

Cardiovascular Risk ◽

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Disease Association ◽

Alcoholic Fatty Liver ◽

Non Invasive ◽

Alcoholic Fatty Liver Disease

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Results of liver and spleen endoscopic ultrasonographic elastography predict portal hypertension secondary to chronic liver disease

Endoscopy International Open ◽

10.1055/a-1233-1934 ◽

2020 ◽

Vol 08 (11) ◽

pp. E1623-E1632

Author(s):

Carlos Robles-Medranda ◽

Roberto Oleas ◽

Miguel Puga-Tejada ◽

Manuel Valero ◽

Raquel Del Valle ◽

...

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Liver Disease ◽

Chronic Liver Disease ◽

Predictive Value ◽

Strain Ratio ◽

Chronic Liver ◽

Spleen Stiffness ◽

Eus Elastography ◽

Sensitivity Specificity

Abstract Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

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Prognostic Value of Liver and Spleen Stiffness in Patients with Fontan Associated Liver Disease (FALD): A Case Series with Histopathologic Comparison

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8030030 ◽

2021 ◽

Vol 8 (3) ◽

pp. 30

Author(s):

Massimo Padalino ◽

Liliana Chemello ◽

Luisa Cavalletto ◽

Annalisa Angelini ◽

Marny Fedrigo

Keyword(s):

Portal Hypertension ◽

Liver Disease ◽

Liver Fibrosis ◽

Prognostic Value ◽

Fontan Operation ◽

Vena Cava ◽

Case Series ◽

Morbidity And Mortality ◽

Post Mortem ◽

Spleen Stiffness

The Fontan operation is the current surgical procedure to treat single-ventricle congenital heart disease, by splitting the systemic and pulmonary circulations and thus permitting lifespan to adulthood for the majority of newborns. However, emerging data are showing that Fontan-associated liver disease (FALD) is an increasing related cause of morbidity and mortality in patients with the Fontan circuit. We described the clinical, laboratory, and transient elastography (TE) findings in a case series of adults with the Fontan circuit, and also correlated data with post-mortem histological features, aimed to define the prognostic value of TE in the staging of FALD. All patients presented signs of a long-standing Fontan failure, characterized by reoperation need, systemic ventricle dysfunction, and FALD stigmata (liver and spleen enlargement, portal vein and inferior vena cava dilation, and abnormal liver function tests). Liver and spleen stiffness (LS and SS) values were indicative of significant liver fibrosis/cirrhosis and the presence of suggestive portal hypertension (LS mean 35.9; range 27.3–44.7 kPa; SS mean 42.1, range 32.2–54.5 kPa). Post-mortem evaluations confirmed a gross hepatic architecture distortion in all cases. All patients died from severe complications related to liver dysfunction and bleeding. TE correlated well with pathological findings and FALD severity. We propose this validated and harmless technique to monitor liver fibrosis extension and portal hypertension over time in Fontan patients, and to identify the optimal timing for surgical reoperations or orthotopic-heart transplantation (OHT), avoiding a higher risk of morbidity and mortality in cases with severe FALD.

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Increased canine pancreatic lipase immunoreactivity (cPLI) and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR) lipase in dogs with evidence of portal hypertension and normal pancreatic histology: a pilot study

Journal of Veterinary Diagnostic Investigation ◽

10.1177/10406387211003987 ◽

2021 ◽

pp. 104063872110039

Author(s):

Gonçalo Serrano ◽

Dominique Paepe ◽

Tim Williams ◽

Penny Watson

Keyword(s):

Portal Hypertension ◽

Liver Disease ◽

Pilot Study ◽

Pancreatic Lipase ◽

Glutaric Acid ◽

Inclusion Criteria ◽

Reference Limit ◽

Clinical Presentations ◽

Upper Reference Limit

The clinical presentations of both liver disease and pancreatitis are nonspecific and overlapping, which may cause difficulty in diagnosis. In our retrospective pilot study, we assessed whether dogs with evidence of portal hypertension and absence of pancreatitis on pancreatic histology have increases in canine pancreatic lipase immunoreactivity (cPLI) and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR) lipase. We included dogs that had been presented between 2008 and 2019 if they had normal pancreatic histology, histologically confirmed hepatopathy, and if canine pancreas-specific lipase (Spec cPL; Idexx) or DGGR lipase had been measured. Only dogs with portal hypertension were included. Six dogs fulfilled the inclusion criteria. Four of 6 and 2 of 6 dogs had Spec cPL and DGGR lipase exceeding the upper reference limit, respectively. From the 4 dogs with increased Spec cPL, 2 had concentrations of 200–400 µg/L and 2 had concentrations ≥ 400 µg/L. Our results suggest that canine portal hypertension might lead to increased Spec cPL and DGGR lipase values in the absence of pancreatitis on histology. Until more evidence in a larger number of dogs with portal hypertension is available, both tests should be interpreted cautiously in the presence of portal hypertension.

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Polycystic Liver Disease with Portal Hypertension

JAMA ◽

10.1001/jama.1963.03700070159054 ◽

1963 ◽

Vol 183 (7) ◽

pp. 211

Keyword(s):

Portal Hypertension ◽

Liver Disease ◽

Polycystic Liver Disease ◽

Polycystic Liver

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Portal hypertension and its management in children

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310022 ◽

2017 ◽

Vol 103 (2) ◽

pp. 186-191 ◽

Cited By ~ 9

Author(s):

Tassos Grammatikopoulos ◽

Patrick James McKiernan ◽

Anil Dhawan

Keyword(s):

Portal Hypertension ◽

Liver Disease ◽

Gastrointestinal Bleeding ◽

Surgical Procedures ◽

Vascular Occlusion ◽

Portal System ◽

Mortality And Morbidity ◽

Non Invasive ◽

Intravascular Pressure

Portal hypertension (PHT), defined as raised intravascular pressure in the portal system, is a complication of chronic liver disease or liver vascular occlusion. Advances in our ability to diagnose and monitor the condition but also predict the risk of gastrointestinal bleeding have enabled us to optimise the management of children with PHT either at a surveillance or at a postbleeding stage. A consensus among paediatric centres in the classification of varices can be beneficial in streamlining future paediatric studies. New invasive (endoscopic and surgical procedures) and non-invasive (pharmacotherapy) techniques are currently used enabling clinicians to reduce mortality and morbidity in children with PHT.

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