scholarly journals Portal hyperflow in patients with hepatosplenic mansonic schistosomiasis

2004 ◽  
Vol 59 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Roberto de Cleva ◽  
William Abrão Saad ◽  
Paulo Herman ◽  
Vincenzo Pugliese ◽  
Bruno Zilberstein ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Portal Pressure ◽  
Previous History ◽  
Portal Flow ◽  
Portal Hemodynamics ◽  
Significant Drop ◽  
Hemodynamic Assessment ◽  
History Of ◽  
Hepatosplenic Schistosomiasis

PURPOSE: The purpose of this study was to assess portal hemodynamics in patients with portal hypertension due to hepatosplenic schistosomiasis as well as to assess the contribution of splanchnic hyperflow to the pathophysiology of the portal hypertension. METHODS: Sixteen patients with schistosomal portal hypertension and previous history of upper digestive bleeding due to esophageal varices rupture underwent elective esophagogastric devascularization and splenectomy and were prospectively studied. All patients underwent intraoperative invasive hemodynamic portal monitoring with a 4F-thermodilution catheter. The intraoperative portal hemodynamic assessment was conducted after laparotomy (initial) and after esophagogastric devascularization (final). RESULTS: The initial portal pressure was elevated (mean 28.5 ± 4.5 mm Hg), and a significant drop of 25% was observed at the end of the surgery (21.9 ± 4.9 mm Hg). The initial portal flow was elevated (mean 1766.9 ± 686.6 mL/min). A significant fall (42%) occurred at the end of the surgical procedure (1025.62 ± 338.7 mL/min). Fourteen patients (87.5%) presented a portal flow of more than 1200 mL/min, and in 5 cases, values greater than 2000 mL/min were observed. CONCLUSIONS: Esophagogastric devascularization and splenectomy promote a significant reduction of the elevated portal pressure and flow in schistosomal portal hypertension. These data favor the hypothesis of portal hyperflow in the physiopathology of portal hypertension of schistosomiasis.

scholarly journals Evaluation of patients with schistosomal portal hypertension treated in a tertiary hospital

2009 ◽  
Vol 22 (4) ◽  
pp. 212-215
Author(s):  
Fábio Ferrari Makdissi ◽  
Paulo Herman ◽  
Renata Potonyacz Colaneri ◽  
Barbara dos Santos Nunes ◽  
Vincenzo Pugliese ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Clinical Signs ◽  
Hemodynamic Instability ◽  
Tertiary Hospital ◽  
Public Health Issue ◽  
High Morbidity ◽  
Variceal Hemorrhage ◽  
Hemorrhagic Event ◽  
History Of

BACKGROUND: Schistosomiasis is an important public health issue in more than 70 countries around the world. About 600 million people are at risk to acquire the parasite and there are 200 million infected worldwide. AIM: To evaluate the characteristics of schistosomal portal hypertension individuals who underwent previous esophageal varices bleeding treated in a tertiary hospital. METHODS: The records of 155 patients were evaluated and clinical, laboratorial, endoscopic, epidemiological features and hemorrhagic event severity were analyzed to individualize this population. RESULTS: Mean age was 37.2 years and no clinical signs of hepatic failure were observed. Serum laboratory tests to evaluate liver function were normal or slightly alter. Anemia was present in 70 %, leucopenia in 75 % and thrombocytopenia in 86 % of the patients. At endoscopic evaluation varices were classified as grade III and IV in 91.3 %; red spots were observed in 40.3 % and congestive gastropathy in 13.6 %. Patients presented a mean of 2.8 previous episodes of variceal hemorrhage and, in 75 % with hemodynamic instability. CONCLUSIONS: Patients with schistosomal portal hypertension and history of upper digestive bleeding from esophageal varices are young individuals, without either clinical or laboratorial evidence of liver dysfunction, that present high morbidity due to the severity of the acute event of bleeding.

Portal Hypertension and Variceal Hemorrhage

2015 ◽  
Author(s):  
Amir Qamar
Keyword(s):  
Portal Hypertension ◽  
Natural History ◽  
Esophageal Varices ◽  
Variceal Hemorrhage ◽  
Portal Hypertensive Gastropathy ◽  
Gastric Antral Vascular Ectasia ◽  
Esophageal Variceal ◽  
Gastroesophageal Varices ◽  
Vascular Ectasia ◽  
History Of

Gastrointestinal bleeding in patients with cirrhosis can occur from a number of different causes, including portal hypertension, gastric antral vascular ectasia, and acute variceal hemorrhage. The management of these conditions involves a combined medical and endoscopic approach, with radiologic and surgical therapies restricted to refractory cases. This review covers the natural history of gastroesophageal varices, portal hypertensive gastropathy, and gastric antral vascular ectasia; diagnostic principles; primary and secondary prophylaxis relating to esophageal variceal hemorrhage; and treatment overviews for gastric variceal hemorrhage, portal hypertensive gastropathy, and gastric antral vascular ectasia. Figures show the pathophysiology of complications of cirrhosis, esophageal varices as seen during an upper endoscopic procedure, natural history of esophageal varices in patients with cirrhosis, portal hypertensive gastropathy, gastric antral vascular ectasia, and management principles for acute variceal hemorrhage, esophageal variceal ligation, and gastric varices. Tables list the prevalence of various etiologies of hemorrhage in patients with cirrhosis, current recommendations for follow-up screening and surveillance of varices, sensitivities and specificities of some noninvasive markers, and principles of initial management of acute variceal hemorrhage. This review contains 8 highly rendered figures, 4 tables, and 44 references.

scholarly journals Endoscopic Obliteration of Fundal Varices

1990 ◽  
Vol 4 (9) ◽  
pp. 643-646 ◽  
Author(s):  
N Soehendra ◽  
H Grimm ◽  
A Maydeo ◽  
VC Nam ◽  
B Eckman ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Portal Pressure ◽  
Vascular Anatomy ◽  
The Individual

In cases of portal hypertension, the fundus of the stomach is second to the esophagus as the most likely area for varices, at a frequency of about 10%, in all patients having esophageal varices. It is relatively rare, probably due to the individual vascular anatomy rather than the level of portal pressure. The authors' experience shows that fundal varices appear more frequently with prehepatic block than intrahepatic.

scholarly journals Portal hypertension after prolonged use of trastuzumab emtansine: nodular regenerative hyperplasia with autoimmune features

2021 ◽  
Vol 10 (8) ◽  
pp. e10810817005
Author(s):  
Gustavo Vargas Borgongino Monteiro ◽  
Marcela Chagas Lima Mussi ◽  
Mateus Jorge Nardelli ◽  
Bruno Campos Santos ◽  
Cláudia Alves Couto
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Ductal Carcinoma ◽  
Rare Complication ◽  
Nodular Regenerative Hyperplasia ◽  
Trastuzumab Emtansine ◽  
Her2 Breast Cancer ◽  
History Of ◽  
The Right

We report a rare complication associated with prolonged use of trastuzumab emtansine (T-DM1) – a composed therapy for HER2+ breast cancer – presenting with laboratorial autoimmune features that could have delayed the diagnosis or led to misdiagnosis. A 55-year-old female was referred to the hepatologist with a computed tomography suggestive of portal hypertension for etiological investigation. History of invasive ductal carcinoma in the right breast undergoing treatment for 5 years. She had already undergone neoadjuvant chemotherapy, mastectomy, radiotherapy and adjuvant chemotherapy. By the time of metastatic diagnosis, she was in monotherapy with T-DM1 for 2.5 years. Upper endoscopy showed esophageal varices and portal hypertension gastropathy. Laboratorial tests revealed increased transaminases, hypergammaglobulinemia and positive antinuclear antibody. Liver biopsy was performed for autoimmune hepatitis differential diagnosis but revealed nodular regenerative hyperplasia. T-DM1 was discontinued. After a 2-year follow-up, the patient did not present any complications of portal hypertension, although persisted with esophageal varices.

scholarly journals Banti’s Syndrome Presenting as Hematemesis - A Case Report

2021 ◽  
Vol 10 (10) ◽  
pp. 749-751
Author(s):  
Aishwarya Ghule ◽  
Sourya Acharya ◽  
Samarth Shukla ◽  
Sunil Kumar ◽  
Parth Godhiwala
Keyword(s):  
Portal Hypertension ◽  
Portal Pressure ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Massive Bleeding ◽  
Idiopathic Portal Hypertension ◽  
Hepatic Veins ◽  
Massive Splenomegaly ◽  
History Of ◽  
Banti's Syndrome

Massive splenomegaly presenting with hypersplenism, pancytopenia and portal hypertension, without any underlying known cause is known as Banti’s syndrome. There are various causes of splenomegaly. When all the known causes of portal hypertension are ruled out, it is termed as Banti’s syndrome. This syndrome was discovered by Guido Banti in 1882 and is named after him. Banti’s syndrome is also known as idiopathic portal hypertension or non-cirrhotic portal fibrosis.1 Banti’s syndrome is commonly found in India and Japan than in the West. 2 There is absence of any haematologic cause, primary hepatic cause or any tumour or mass lesion involving the spleen. Banti had stated that the primary organ involved was spleen and not the liver leading to secondary splenomegaly. Other features include normal liver function tests, varices seen in endoscopy, cytopenia of one or more cell lines, absence of cirrhosis, patent hepatic veins and elevated portal pressure with multiple collaterals. The complications include rupture of varices and massive bleeding. 3 We report a case of a 20-year-old male who presented to us with a history of fever for 7 days and one-episode of hematemesis on the day of admission. All known causes of hypersplenism were ruled out and he was diagnosed to have idiopathic massive splenomegaly with portal hypertension and hypersplenism.

Interaction of flow and resistance in maintenance of portal hypertension in a rat model

1986 ◽  
Vol 250 (2) ◽  
pp. G205-G212 ◽  
Author(s):  
E. Sikuler ◽  
R. J. Groszmann
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Rat Model ◽  
Portal Pressure ◽  
Flow Theory ◽  
Sham Operation ◽  
Portal Flow ◽  
Hemodynamic Changes ◽  
Forward Flow ◽  
Arteriolar Resistance

To clarify the roles that portocollateral resistance ("backward-flow" theory) and portal flow ("forward-flow" theory) play in maintaining chronic portal hypertension, we studied, in a rat model with prehepatic portal hypertension, the hemodynamic changes that occur when portocollateral resistance is reduced and high portal venous inflow is maintained. In 30 portal-hypertensive rats the constriction around the portal vein was removed 4 days after induction of portal hypertension, 30 rats were used as portal vein-constricted controls, and 30 additional rats were subjected to a sham operation. The removal of the ligature constricting the portal vein was followed by an immediate decrease in portal pressure (from 16.3 +/- 0.8 to 9.6 +/- 0.8 mmHg, P less than 0.001). Two days after the ligature removal, hyperdynamic circulation was still evident and was characterized by a decreased splanchnic arteriolar resistance and an increased portal venous inflow. The coexistence of high portal venous inflow and normal portal pressure indicates that high portal venous inflow per se is not sufficient to produce an increase in portal pressure when it faces a low-resistance vascular bed. We conclude that portal hypertension is induced by the interaction of an abnormally high portal venous inflow and high resistance offered to the flow by the portocollateral vessels. Neither the forward-flow theory nor the backward-flow theory can be applied solely to explain the increased portal pressure.

scholarly journals Endoscopic Band Ligation in Patients with Variceal Bleeding

2018 ◽  
Vol 3 (1) ◽  
pp. 320-324
Author(s):  
Narayan Prasad Belbase ◽  
Aditya Jalan ◽  
Hari Prasad Upadhya ◽  
Rohit Mishra ◽  
Mukesh Karki ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Esophageal Varices ◽  
Alcoholic Cirrhosis ◽  
Oesophageal Varices ◽  
Common Cause ◽  
Band Ligation ◽  
Male Predominance ◽  
History Of ◽  
Cirrhosis Mortality

Introduction: Esophageal varices (EV) affect about 50% of patients with liver cirrhosis. Mortality rate from the initial EV bleeding can rise up to 30% in patients with advanced liver disease and large varices. Several RCTs have shown endoscopic variceal banding to be more effective than sclerotherapy for the long-term prevention of variceal bleeding.Objective: This study was conducted to see the outcome of endoscopic banding in the management of esophageal varices in Nepalese population.Methodology: This was a prospective observational study conducted in the Department of Surgical Gastroenterology, College of Medical Sciences and Teaching Hospital (COMS-TH), Bharatpur, Nepal over a period of 2 years. Patients attending the COMS emergency/surgical OPD with history of UGI bleed with features consistent with portal hypertension during this period were enrolled. The endoscopic variceal band ligation was done based on similar principles applied to Barren and ligation in the treatment of internal haemorrhoids.Results During this period of two years 50 patients were analysed. The mean age of the study subjects was 52.26+/-12.80 years and male predominance was seen (M:F=42:8). Alcoholic chronic liver disease (CLD) (74%) was the most common cause of portal hypertension. Child's B score was seen among 54%, grade III varices were seen in 36% and grade II in 32%. Acute bleeding of varices was present in nine (18%) cases. On an average 3.8 sessions were required to obliterate the varices. Control of acute bleed and variceal eradication was seen in 77.78% cases and in 96% cases respectively. Complications following banding were seen in 20% cases. Mortality was seen in two (4%) cases.Conclusions: Alcoholic cirrhosis was the most common cause of portal hypertension and endoscopic banding of oesophageal varices in Nepalese population had comparable eradications, complications and recurrences with similar other studies conducted in other parts of the world. BJHS 2018;3(1)5 : 320-324

Effects of the combined administration of propranolol plus sorafenib on portal hypertension in cirrhotic rats

2012 ◽  
Vol 302 (10) ◽  
pp. G1191-G1198 ◽  
Author(s):  
M. D'Amico ◽  
M. Mejías ◽  
E. García-Pras ◽  
J. G. Abraldes ◽  
J. C. García-Pagán ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Fibrosis ◽  
Beta Blockers ◽  
Combined Therapy ◽  
Portal Pressure ◽  
Additive Effect ◽  
Sham Operation ◽  
Portal Flow ◽  
Similar Reduction ◽  
Sorafenib Treatment

Low doses of sorafenib have been shown to decrease portal pressure (PP), portal-systemic shunts, and liver fibrosis in cirrhotic rats. Nonselective beta blockers (NSBB) are the only drugs recommended for the treatment of portal hypertension. The aim of our study was to explore whether the combination of propranolol and sorafenib might show an additive effect reducing PP in cirrhotic rats. Groups of common bile duct-ligated cirrhotic rats (CBDL) and sham-operated control rats were treated by gavage with vehicle, propranolol (30 mg·kg−1·day−1), sorafenib (1 mg·kg−1·day−1), or propranolol+sorafenib. Treatment began 2 wk after the CBDL or sham operation. Hemodynamic evaluation was performed after 2 wk of treatment. In cirrhotic rats, propranolol and sorafenib produced a significant ( P < 0.001) and similar reduction in PP (−19 and −15%, respectively). This was achieved through different mechanisms: whereas propranolol decreased PP by reducing portal blood flow (−35%; P = 0.03), sorafenib decreased PP without decreasing portal flow indicating decreased hepatic resistance. After propranolol+sorafenib, the fall in PP was significantly greater (−30%; P < 0.001) than with either drug alone, demonstrating an additive effect. However, the reduction in portal flow (−39%) under combined therapy was not significantly greater than after propranolol alone. Sorafenib, alone or in combination with propranolol, produced significant reduction in portal-systemic shunting (−25 and −33%, respectively), splanchnic vascularization (−37 and −41%, respectively), liver fibrosis (38%), and hepatic neovascularization (−42 and −51%, respectively). These effects were not observed after propranolol alone. In conclusion, the combination of propranolol+sorafenib causes a greater reduction in PP than either drug alone and decreases markedly the extent of portal-systemic shunting, splanchnic and hepatic neovascularization, and liver fibrosis, suggesting that this drug combination is a potentially useful strategy in the treatment of portal hypertension.

Multidisciplinary approach to the complex treatment for non-cirrhotic portal hypertension – case-report-based discussion

2021 ◽  
Vol 59 (01) ◽  
pp. 43-49
Author(s):  
Simon J. Gairing ◽  
Roman Kloeckner ◽  
Michael B. Pitton ◽  
Janine Baumgart ◽  
Charis von Auer-Wegener ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Rare Complication ◽  
Treatment Options ◽  
Portal Pressure ◽  
Recurrent Bleeding ◽  
Factor V ◽  
Factor X ◽  
Warren Shunt ◽  
Shunt Occlusion

AbstractNon-cirrhotic portal vein thrombosis (PVT) in patients with antiphospholipid syndrome (APS) is a rare complication, and the management has to be determined individually based on the extent and severity of the presentation. We report on a 37-year-old male patient with non-cirrhotic chronic PVT related to a severe thrombophilia, comprising APS, antithrombin-, factor V- and factor X-deficiency. Three years after the initial diagnosis of non-cirrhotic PVT, the patient presented with severe hemorrhagic shock related to acute bleeding from esophageal varices, requiring an emergency transjugular intrahepatic portosystemic stent shunt (TIPSS). TIPSS was revised after a recurrent bleeding episode due to insufficient reduction of the portal pressure. Additionally, embolization of the dilated V. coronaria ventriculi led to the regression of esophageal varices but resulted simultaneously in a left-sided portal hypertension (LSPH) with development of stomach wall and perisplenic varices. After a third episode of acute esophageal varices bleeding, a surgical distal splenorenal shunt (Warren shunt) was performed to reduce the LSPH. Despite anticoagulation with low molecular weight heparin and antithrombin substitution, endoluminal thrombosis led to a complete Warren shunt occlusion, aggravating the severe splenomegaly and pancytopenia. Finally, a partial spleen embolization (PSE) was performed. In the postinterventional course, leukocyte and platelet counts increased rapidly and the patient showed no further bleeding episodes. Overall, this complex course demonstrates the need for individual assessment of multimodal treatment options in non-cirrhotic portal hypertension. This young patient required triple modality porto-systemic pressure reduction (TIPSS, Warren shunt, PSE) and involved finely balanced anticoagulation and bleeding control.

scholarly journals PORTAL PRESSURE DECREASE AFTER ESOPHAGOGASTRIC DEVASCULARIZATION AND SPLENECTOMY IN SCHISTOSOMIASIS: LONG-TERM VARICES BEHAVIOR, REBLEEDING RATE, AND ROLE OF ENDOSCOPIC TREATMENT

2018 ◽  
Vol 55 (2) ◽  
pp. 170-174 ◽  
Author(s):  
Walter De Biase da SILVA NETO ◽  
Thiago Miranda TREDICCI ◽  
Fabricio Ferreira COELHO ◽  
Fabio Ferrari MAKDISSI ◽  
Paulo HERMAN
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Endoscopic Treatment ◽  
Portal Pressure ◽  
Postoperative Treatment ◽  
Pressure Decrease ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Pressure Fall

ABSTRACT BACKGROUND: Schistosomiasis is an endemic health problem affecting about four million people. The hepatosplenic form of the disease is characterized by periportal hepatic fibrosis, pre-sinusoidal portal hypertension and splenomegaly. Liver function is preserved, being varices bleeding the main complication of the disease. The surgical treatment used in the majority of centers for the prevention of rebleeding is esophagogastric devascularization and splenectomy. Most authors reported better results with the association of surgical and postoperative endoscopic treatment. OBJECTIVE: The aim of this study was to compare the intra operative portal pressure decrease and esophageal varices behavior and rebleeding rates in patients submitted to surgical and postoperative endoscopic treatment after long-term follow-up. METHODS: A retrospective study of 36 patients with schistosomiasis with, at least, one previous bleeding from esophageal varices rupture submitted to esophagogastric devascularization and splenectomy, added to endoscopic varices postoperative treatment was performed. Patients were stratified according to the intra operative portal pressure decrease in two groups: reduction below and above 30%. Long-term varices presence, size and bleeding recurrence were evaluated. RESULTS: Regarding varices behavior, no significant influence was observed in both groups of portal pressure fall. Regarding bleeding recurrence, despite three times more frequent in the group with lower portal pressure fall, no significant difference was observed. All patients were submitted to postoperative endoscopic treatment. CONCLUSION: Esophageal varices banding, rather than portal pressure decrease, seems to be the main responsible factor for good results after combination of two therapies (surgery and endoscopy) for patients with portal hypertension due to schistosomiasis; further studies are necessary to confirm this hypothesis.

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