Pregnancy with extrahepatic portal venous hypertension

We are reporting a case of pregnancy with extrahepatic portal venous hypertension. Portal hypertension in pregnancy is an uncommon event. It presents a challenge to the obstetrician in management as physiological hemodynamic changes associated with pregnancy worsen with portal hypertension. Thus, increasing risk of life threatening complications like variceal haemorrhage and hepatic decompensation to many folds during pregnancy. Management requires knowledge of effects of portal hypertension on maternal and fetal outcome and vice-versa.

Diagnosis and management of portal vein thrombosis in patients with cirrhosis of liver

Portal vein thrombosis (PVT) is an occlusion of the portal venous system and is a common complication of liver cirrhosis. It can present as either an acute or chronic complication. Acute PVT can present with abdominal pain, diarrhea, ileus, and bleeding. Chronic PVT is often asymptomatic; however, it can be discovered in cases of worsening portal hypertension. Portal vein thrombosis is diagnosed by imaging modalities, such as ultrasound and computed tomography. Contrast-enhanced imaging can be used in cases with difficult visualization. Despite the hemostatic imbalance in cirrhosis, anticoagulants can be safely used to recanalize the vein. Transjugular intrahepatic portosystemic shunt procedures are also an effective method for recanalization.

Gastrointestinal Bleeding Secondary to Portal Hypertensive Duodenopathy in a Patient with Decompensated Liver Cirrhosis

With alcoholic cirrhosis and nonalcoholic fatty liver disease continuously on the rise in the United States, there is also a corresponding rise in portal hypertension. Portal hypertensive duodenopathy (PHD) is a complication of portal hypertension not commonly seen in cirrhotic patients. We present a case of a 46-year-old man who presented with decompensated liver cirrhosis secondary to gastrointestinal bleed. The patient underwent esophagogastroduodenoscopy (EGD) with findings indicative of PHD. Patient subsequently underwent transjugular intrahepatic portosystemic shunt (TIPS) with resolution of gastrointestinal bleed. We highlight TIPS as a management strategy in patients with PHD for whom less invasive measures are not effective.

Endoscopic Ultrasound for the Hepatologist: A Comprehensive Review

In the last few years, the diagnostic and therapeutic utilization of endoscopic ultrasound (EUS) for a variety of liver conditions has exponentially grown. We performed a thorough search for all available studies on the performance of diagnostic and therapeutic EUS in the field of hepatology. This article reviews the indication of EUS in the evaluation and treatment of portal hypertension, portal vein pressure measurement, focal liver lesions, and parenchymal liver diseases, and presents all the clinical evidences available so far in this regard. All the review data suggest that EUS is becoming an increasingly important tool in the armamentarium of the hepatologists for the management of certain liver-related conditions. Implementation in the education of the hepatologists of means to become more familiar with both diagnostic and therapeutic capabilities of EUS is warranted.

Refractory Hepatic Hydrothorax: A Rare Complication of Systemic Sclerosis and Presinusoidal Portal Hypertension

We report on a rare case of refractory hepatic hydrothorax in an individual with Scleroderma/CREST syndrome and noncirrhotic portal hypertension. Portal pressure measurements revealed a normal transjugular hepatic venous portal pressure gradient, mild pulmonary hypertension, and an unremarkable liver biopsy except for mild sinusoidal dilation. Pulmonary hypertension, cardiac diastolic dysfunction, and chronic kidney disease were determined to be the causes of his refractory pleural effusions and ascites. Over the year, he underwent 50 thoracenteses and 20 paracenteses averaging 10–12 liters/week. Repeat pulmonary evaluation determined his pulmonary pressures to be normal and a secondary review of the “unremarkable” liver biopsy noted mild venous outflow obstruction and possibly Nodular Regenerative Hyperplasia (NRH). Repeat portal pressures indirectly and directly confirmed the existence of presinusoidal portal hypertension that has been associated with NRH. A transjugular intrahepatic portal systemic shunt (TIPS) was placed and he has not required thoracentesis or paracentesis over the past 18 months.

The Liver and Portal System

Understanding of the anatomy and physiology of the liver and techniques for safe anatomic and nonanatomic liver resections has evolved over the past several decades. The liver is composed of a complex arterial and portal venous inflow, which has several important variants that are crucial for the surgeon to understand when planning hepatic resections, both anatomic and nonanatomic. In addition, intra- and extrahepatic biliary configurations may be encountered, and variants must be recognized to prevent complications during common surgical procedures, such as cholecystectomy and liver resection. The liver is responsible for numerous metabolic, homeostatic, and immunologic processes throughout the body. It is crucial for the practicing physician and surgeon to have a fundamental understanding of hepatic anatomy and physiology when treating patients with derangements in liver structure and function. Key words: bile duct, bilirubin, bilirubin metabolism, hepatic artery, hepatic blood flow, hepatic parenchyma microstructure, liver anatomy, portal hypertension, portal vein

The Liver and Portal System

Understanding of the anatomy and physiology of the liver and techniques for safe anatomic and nonanatomic liver resections has evolved over the past several decades. The liver is composed of a complex arterial and portal venous inflow, which has several important variants that are crucial for the surgeon to understand when planning hepatic resections, both anatomic and nonanatomic. In addition, intra- and extrahepatic biliary configurations may be encountered, and variants must be recognized to prevent complications during common surgical procedures, such as cholecystectomy and liver resection. The liver is responsible for numerous metabolic, homeostatic, and immunologic processes throughout the body. It is crucial for the practicing physician and surgeon to have a fundamental understanding of hepatic anatomy and physiology when treating patients with derangements in liver structure and function. Key words: bile duct, bilirubin, bilirubin metabolism, hepatic artery, hepatic blood flow, hepatic parenchyma microstructure, liver anatomy, portal hypertension, portal vein