Splanchnic and systemic hemodynamics in portal hypertensive rats during hemorrhage and blood volume restitution

Kravetz, David; Sikuler, Emanuel; Groszmann, Roberto J.

doi:10.1016/0016-5085(86)90390-2

Cited by 161 publications

(111 citation statements)

References 27 publications

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“…7 This recommendation is based on experimental studies that show that restitution of all lost blood leads to increases in portal pressure to levels higher than baseline, 87 and to more rebleeding and mortality. 88 Similarly, vigorous resuscitation with saline solution should generally be avoided because, in addition to possibly precipitating recurrent variceal hemorrhage, this can worsen or precipitate the accumulation of ascites or fluid at other extravascular sites.…”

Section: D1 General Measuresmentioning

confidence: 99%

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

et al. 2007

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Section: D1 General Measuresmentioning

confidence: 99%

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

et al. 2007

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“…General measures for patients presenting with acute bleeding from PHG include volume resuscitation and cautious transfusion of packed erythrocytes, as necessary, to maintain the hemoglobin level at 8 g/dL [192,259,260] . Over-transfusion to a higher hemoglobin level could promote bleeding from PHG by raising portal pressure, as reported for bleeding from esophageal varices [261,262] . However, patients with cardiopulmonary disease or severe other comorbidities may require a hemoglobin level of 9-10 g/dL [263] .…”

Section: Summary Of Clinical Treatmentmentioning

confidence: 82%

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

Gjeorgjievski¹

2016

WJH

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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. Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy 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 chemicals and poor wound healing. Nitrous oxide, free radicals, tumor necrosis factor-alpha, and glucagon may contribute to PHG development. Acute and chronic gastrointestinal bleeding are the only clinical complications. Bleeding is typically mild-to-moderate. Endoscopic therapy is rarely useful because the bleeding is typically diffuse. Acute bleeding is primarily treated with octreotide, often with concomitant proton pump inhibitor therapy, or secondarily treated with vasopressin or terlipressin. Nonselective β-adrenergic receptor antagonists, particularly propranolol, are used to prevent bleeding after an acute episode or for chronic bleeding. Iron deficiency anemia from chronic bleeding may require iron replacement therapy. Transjugular-intrahepaticportosystemic-shunt and liver transplantation are highly successful ultimate therapies because they reduce the underlying portal hypertension. SYSTEMA...

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“…Blood volume resuscitation should be undertaken promptly but with caution, with the goals of maintaining hemodynamic stability and a hemoglobin of approximately 8 g/dL (7). This recommendation is based on experimental studies that show that restitution of all lost blood leads to increases in portal pressure to levels higher than baseline (87), and to more rebleeding and mortality (88). Similarly, vigorous resuscitation with saline solution should generally be avoided because, in addition to possibly precipitating recurrent variceal hemorrhage, this can worsen or precipitate the accumulation of ascites or fluid at other extravascular sites.…”

Section: D1 General Measuresmentioning

confidence: 99%

Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis

García–Tsao

Sanyal

Grace

et al. 2007

Am J Gastroenterology

628

753

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Splanchnic and systemic hemodynamics in portal hypertensive rats during hemorrhage and blood volume restitution

Cited by 161 publications

References 27 publications

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis

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

Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis

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