Portal Hypertension and Its Complications

Sanyal, Arun J.; Bosch, Jaime; Blei, Andrés T.; Arroyo, Vicente

doi:10.1053/j.gastro.2008.03.007

Cited by 311 publications

(328 citation statements)

References 187 publications

(183 reference statements)

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“…Particularly, chronic liver disease and cirrhosis aggravate this syndrome exceedingly [80]. Hepatic dysfunction related to fibrosis or cirrhosis would aggravate the grade of systemic inflammation characteristic of the chronic portal hypertensive syndrome.…”

Section: High-grade Inflammatory Portal Hypertension: the Amniotic Comentioning

confidence: 99%

“…During cirrhotic portal hypertension dilation of esophageal and gastric lymph vessels may be related to the absorption of excess interstitial fluid [84]. However, the main features of liver decompensation in cirrhosis are ascites [85], hepatorenal syndrome [80,86] and hepatic encephalopathy [80]. Ascites and hepatorenal syndrome are the major challenging complications of cirrhosis and portal hypertension that significantly affect the course of the disease [87].…”

Section: Ascites: the Portal Hypertensive Peritoneummentioning

confidence: 99%

“…The hemodynamic alterations that portal hypertension imposes on the splanchnic circulation [16,80] allows considering that changes in the mesenteric lymph flow and composition are also produced [9]. Therefore, the mesenteric lymph could play an etiopathogenic role in the multiple organ dysfunction developed in the portal hypertensive syndrome [16].…”

Section: Splanchnic Interstitium Mesenteric Lymphatics and Peritoneamentioning

confidence: 99%

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Portal hypertension-related inflammatory phenotypes: From a vitelline and amniotic point of view

Aller¹,

Arias²,

Prieto³

et al. 2012

ABB

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Prehepatic portal hypertension induces a splanchnic low-grade inflammatory response that could switch to high-grade inflammation with the development of severe and life-threatening complications when associated with chronic liver disease. The extraembryonic origin of the portal system maybe determines the regression to an extraembryonic phenotype, i.e., vitellogenic and amniotic, during the evolution of both types of portal hypertension. Thus, prehepatic portal hypertension, or compensated hypertension by portal vein ligation in the rat, is associated with molecular mechanisms related to vitellogenesis, where hepatic steatosis and splanchnic angiogenesis stand out. In turn, extrahepatic cholestasis in the rat induces intrahepatic portal hypertension, or decompensated hypertension, with ascites and hepatorenal syndrome. The splanchnic interstitium, the mesenteric lymphatic system, and the peritoneal mesothelium seem to create an inflammatory pathway that could have a key pathophysiological relevance in the production of ascites. The hypothetical comparison between the ascitic and the amniotic fluid also allows for translational investtigation. The induced regression of the splanchnic system to extraembryonic functions by portal hypertension highlights the great relevance of the extraembryonic structures even during post-natal life.

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Section: High-grade Inflammatory Portal Hypertension: the Amniotic Comentioning

confidence: 99%

Section: Ascites: the Portal Hypertensive Peritoneummentioning

confidence: 99%

Section: Splanchnic Interstitium Mesenteric Lymphatics and Peritoneamentioning

confidence: 99%

See 1 more Smart Citation

Portal hypertension-related inflammatory phenotypes: From a vitelline and amniotic point of view

Aller¹,

Arias²,

Prieto³

et al. 2012

ABB

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“…Artificial porto-systemic shunts can be created by various techniques and localizations in case of underlying portal hypertension when other therapeutical ways are not effective [1][2][3][4][5] , but these shunts may act as supportive tools in other surgical procedures (liver transplantation, small-for-size grafting) 6,7 . So these shunts still have important clinical relevance.…”

Section: Introductionmentioning

confidence: 99%

A modified microsurgical model for end-to-side selective portacaval shunt in the rat: intraoperative microcirculatory investigations

et al. 2013

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PURPOSE:To investigate the intraoperative microcirculatory changes of the affected organs (small bowel, liver and kidney) during the making of a modified selective portacaval (PC) shunt. METHODS:On ten anaesthetized Sprague-Dawley rats the selective end-to-side mesocaval anastomosis was performed, where only the rostral mesenteric vein is utilized and the portal vein with the splenic vein are left intact. Morphometric and microcirculatory investigations using a LDF device determining flux units (BFU) were carried out. RESULTS:After completing the shunts the microcirculatory flux values did not recover in the same manner on the surface of the small intestine, the liver or the kidney. BFU values showed deterioration in the small intestine and in the liver (p<0.001). During the reperfusion the BFU values improved, but not in the same manner. The small intestine values left behind the kidney and liver data. CONCLUSIONS:Technically, the advantages of the models include the selective characteristic, the mesocaval localization and the relatively easy access to those vessels. However, its major disadvantage is the time needed for positioning the vessels without coiling or definitive stretching. Intraoperative LDF may provide useful data on the microcirculatory affection of the organs suffering from hypoperfusion or ischemia during creating the shunts.

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“…1 NCPH, due to intrahepatic or extrahepatic etiologies, is a fairly common cause of portal hypertension in India. NCPH can be classified based on the site of resistance to blood flow as "prehepatic," "hepatic," and "posthepatic."…”

mentioning

confidence: 99%

Noncirrhotic Portal Hypertension

Rajekar¹,

Vasishta²,

Chawla³

et al. 2011

Journal of Clinical and Experimental Hepatology

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Portal hypertension is characterized by an increase in portal pressure (> 10 mmHg) and could be a result of cirrhosis of the liver or of noncirrhotic diseases. When portal hypertension occurs in the absence of liver cirrhosis, noncirrhotic portal hypertension (NCPH) must be considered. The prognosis of this disease is much better than that of cirrhosis. Noncirrhotic diseases are the common cause of portal hypertension in developing countries, especially in Asia. NCPH is a heterogeneous group of diseases that is due to intrahepatic or extrahepatic etiologies. In general, the lesions in NCPH are vascular in nature and can be classified based on the site of resistance to blood flow. In most cases, these disorders can be explained

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Portal Hypertension and Its Complications

Cited by 311 publications

References 187 publications

Portal hypertension-related inflammatory phenotypes: From a vitelline and amniotic point of view

Portal hypertension-related inflammatory phenotypes: From a vitelline and amniotic point of view

A modified microsurgical model for end-to-side selective portacaval shunt in the rat: intraoperative microcirculatory investigations

Noncirrhotic Portal Hypertension

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