Spleen Blood Flow and Splanchnic Haemodynamics in Blood Dyscrasia and other Splenomegalies

Abstract

1. Splenic blood flow and splanchnic haemodynamics have been studied in twenty patients with splenomegaly due to blood dyscrasia or diseases involving the reticuloendothelial system. Thirteen of these patients had portal hypertension, three had abdominal collaterals on arteriovenography and one oesophageal varices. 2. Total spleen blood flow was increased in all with values up to 1550 ml/min, and associated with this liver blood flows increased up to 2·61 1 min−1 m−2. In four patients the cardiac output was raised. 3. In five patients a raised wedged hepatic vein pressure was found which was solely related to the increase in liver blood flow, but in two others, in whom hepatic histology was abnormal, there was also an increase in postsinusoidal resistance. Nine patients had a raised hepatic pre-sinusoidal resistance. This was related to a greatly increased liver blood flow with portal tract fibrosis and cellular infiltration as possible additional factors. 4. The haemodynamic findings in these patients were similar to those found previously in patients with tropical splenomegaly. In both groups spleen blood flow in ml 100 g−1 min−1 was inversely proportional to spleen size. There were similar increases in total spleen and liver blood flows and in the percentage of patients with an increased pre-sinusoidal resistance. In contrast, in cirrhosis there was no inverse relationship between flow in 1 100 g−1 min−1, and of spleen size, and for the degree of splenomegaly total spleen blood flow was relatively greater.

Myelofibrosis, Splenomegaly, and Portal Hypertension

“…It is further more noteworthy that gastro-intestinal tract bleeding from varices may occur in these patients, as a result of which splenectomy has been advocated [Silverstein et al, 1973]. It is, however, recognised that proper as sessment of splanchnic haemodynamics and asso ciated hepatic structural changes should be carefully defined in planning the best surgical procedure to correct the portal hypertension [Blendis et al, 1970;Gomes et al, 1967], The importance of adequate pre operative investigation is illustrated by this case re port in which previously silent venous thrombosis ob structed the splenic and portal vessels and where con servative management rather than splenectomy or shunt surgery was the appropriate form of treatment.…”

Portal hypertension secondary to myelofibrosis with myeloid metaplasia: A study of 13 cases

“…The increase in portal flow itself may explain PH. In fact, few cases of PH in myelofibrosis patients secondary to increased splenic and/or portal flow with minimal hematopoiesis have been reported [20,21] . On the other hand, Sikuler et al [22] experimentally demonstrated that in the absence of structural alteration of the liver, PH does not develop as a consequence of an increased portal flow.…”

Massive Gastric Variceal Bleeding in a Patient with Chronic Pancreatitis

“…5 Splenomegaly is one of the major characteristics of long lasting portal hypertension, and in LSPH splenomegaly is more expressed than in liver cirrhosis. 6 In our paper we presented a case of a male patient with history of repetitive chronic pancreatitis exacerbations due to aethylic etiology. With continuous, long lasting alcohol consumption he developed chronic pancreatitis and consequently by repetitive exacerbations he developed fixed bulbostenosis and gastric varices due to splenic vein thrombosis.…”