Porto-sinusoidal Vascular Disease and Portal Hypertension
Porto-sinusoidal vascular disease (PSVD) is the medical diagnosis for a patient who has portal hypertension in the absence of cirrhosis on liver biopsy. There are several specific histologic findings for PSVD, including obliterative portal venopathy, nodular regenerative hyperplasia, and incomplete septal fibrosis. Epidemiologic reports vary widely among regions; PSVD comprises less than 10% of causes of portal hypertension in Western countries but incidence has been found to be as high as 48% in India. There is an expansive list of etiologies that have been reported to cause PSVD. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 30, 2024 Category: Gastroenterology Authors: Sarah Noble, Marguerite Linz, Eduardo Correia, Akram Shalaby, Leonardo Kayat Bittencourt, Seth N. Sclair Source Type: research
Pulmonary Complications of Portal Hypertension
Portopulmonary hypertension (POPH), hepatopulmonary syndrome, and hepatic hydrothorax constitute significant complications of portal hypertension, with important implications for management and liver transplantation (LT) candidacy. POPH is characterized by obstruction and remodeling of the pulmonary resistance arterial bed. Hepatopulmonary syndrome is the most common pulmonary vascular disorder, characterized by intrapulmonary vascular dilatations causing impaired gas exchange. LT may improve prognosis in select patients with POPH. LT is the only effective treatment of hepatopulmonary syndrome. Hepatic hydrothorax is defin...
Source: Clinics in Liver Disease - April 30, 2024 Category: Gastroenterology Authors: Shoma Bommena, Michael B. Fallon Source Type: research
Bleeding Complications of Portal Hypertension
In portal hypertension, acute variceal bleed is the cause of 2/3rd of all upper gastrointestinal bleeding episodes. It is a life-threatening emergency in patients with cirrhosis. Nonselective beta-blockers by decreasing the hepatic venous pressure gradient are the mainstay of medical therapy for the prevention of variceal bleeding and rebleeding. Evaluation of the severity of bleed, hemodynamic resuscitation, prophylactic antibiotic, and intravenous splanchnic vasoconstrictors should precede the endoscopy procedure. Endoscopic band ligation is the recommended endotherapy. Rescue transjugular intrahepatic port-systemic shun...
Source: Clinics in Liver Disease - April 30, 2024 Category: Gastroenterology Authors: Chitranshu Vashishtha, Shiv Kumar Sarin Source Type: research
Hepatic Venous Pressure Gradient
Measurement of hepatic venous pressure gradient (HVPG) effectively mirrors the severity of portal hypertension (PH) and offers valuable insights into prognosis of liver disease, including the risk of decompensation and mortality. Additionally, HVPG offers crucial information about treatment response to nonselective beta-blockers and other medications, with its utility demonstrated in clinical trials in patients with PH. Despite the widespread dissemination and validation of noninvasive tests, HVPG still holds a significant role in hepatology. Physicians treating patients with liver diseases should comprehend the HVPG measu...
Source: Clinics in Liver Disease - April 30, 2024 Category: Gastroenterology Authors: Susana G. Rodrigues, Maria Gabriela Delgado, Guido Stirnimann, Annalisa Berzigotti, Jaime Bosch Source Type: research
The Pathophysiology of Portal Hypertension
This article reviews the pathophysiology of portal hypertension that includes multiple mechanisms internal and external to the liver. This article starts with a review of literature describing the cellular and molecular mechanisms of portal hypertension, microvascular thrombosis, sinusoidal venous congestion, portal angiogenesis, vascular hypocontractility, and hyperdynamic circulation. Mechanotransduction and the gut –liver axis, which are newer areas of research, are reviewed. Dysfunction of this axis contributes to chronic liver injury, inflammation, fibrosis, and portal hypertension. Sequelae of portal hypertension a...
Source: Clinics in Liver Disease - April 27, 2024 Category: Gastroenterology Authors: Resham Ramkissoon, Sheng Cao, Vijay H. Shah Source Type: research
Pharmacologic Treatment of Portal Hypertension
Portal hypertension is the key mechanism driving the transition from compensated to decompensated cirrhosis. In this review, the authors described the pathophysiology of portal hypertension in cirrhosis and the rationale of pharmacologic treatment of portal hypertension. We discussed both etiologic and nonetiologic treatment of portal hypertension and the specific clinical scenarios how nonselective beta-blocker can be used in patients with cirrhosis. Finally, the authors summarized the evidence for emerging alternatives for portal hypertension in patients with cirrhosis. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 27, 2024 Category: Gastroenterology Authors: Yu Jun Wong, Juan G. Abraldes Source Type: research
Radiological and Surgical Treatments of Portal Hypertension
Interventions for portal hypertension are continuously evolving and expanding beyond the realm of medical management. When complications such as varices and ascites persist despite conservative interventions, procedures including transjugular intrahepatic portosystemic shunt creation, transvenous obliteration, portal vein recanalization, splenic artery embolization, surgical shunt creation, and devascularization are all potential interventions detailed in this article. Selection of the optimal procedure to address the underlying cause, treat symptoms, and, in some cases, bridge to liver transplantation depends on the speci...
Source: Clinics in Liver Disease - April 27, 2024 Category: Gastroenterology Authors: Charlotte Hunt, Mausam Patel, Maria del Pilar Bayona Molano, Madhukar S. Patel, Lisa B. VanWagner Source Type: research
Infectious Complications of Portal Hypertension
Patients with cirrhosis and clinically significant portal hypertension are at high risk of developing bacterial infections (BIs) that are the most common trigger of acute decompensation and acute-on-chronic liver failure. Furthermore, after decompensation, the risk of developing BIs further increases in an ominous vicious circle. BIs may be subtle, and they should be ruled out in all patients at admission and in case of deterioration. Timely administration of adequate empirical antibiotics is the cornerstone of treatment. Herein, we reviewed current evidences about pathogenesis, clinical implications and management of BIs ...
Source: Clinics in Liver Disease - April 27, 2024 Category: Gastroenterology Authors: Simone Incicco, Paolo Angeli, Salvatore Piano Source Type: research
Cerebral Aspects of Portal Hypertension
Portal hypertension has cerebral consequences via its causes and complications, namely hepatic encephalopathy (HE), a common and devastating brain disturbance caused by liver insufficiency and portosystemic shunting. The pathogenesis involves hyperammonemia and systemic inflammation. Symptoms are disturbed personality and reduced attention. HE is minimal or grades I to IV (coma). Bouts of HE are episodic and often recurrent. Initial treatment is of events that precipitated the episode and exclusion of nonhepatic causes. Specific anti-HE treatment is lactulose. By recurrence, rifaximin is add-on. Anti-HE treatment is effica...
Source: Clinics in Liver Disease - April 27, 2024 Category: Gastroenterology Authors: Karen Louise Thomsen, Michael S ørensen, Kristoffer Kjærgaard, Peter Lykke Eriksen, Mette Munk Lauridsen, Hendrik Vilstrup Source Type: research
Future Therapies of Hepatic Encephalopathy
Hepatic encephalopathy, either covert or overt, affects more than half of patients with cirrhosis and has lasting effects even after portal hypertension is corrected. Unfortunately, the current therapeutic options still result in high rates of relapse and progression, in part owing to cost barriers and side effects, leading to poor adherence. This review summarizes emerging treatment options, which could take advantage of alternative disease pathways to improve future care of those with hepatic encephalopathy. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Authors: Adam P. Buckholz, Robert S. Brown Source Type: research
Hepatic Encephalopathy
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Authors: Sammy Saab Source Type: research
Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Source Type: research
Contributors
NORMAN GITLIN, MD, FRCP (London), FRCPE (Edinburgh), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Source Type: research
Contents
Sammy Saab (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Source Type: research
Forthcoming Issues
Portal Hypertension and Its Complications (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 27, 2024 Category: Gastroenterology Source Type: research
