Abstract
The aim. To assess the hemodynamic parameters of the hepatic and visceral blood flow in patients with compensated and decompensated liver cirrhosis. Materials and methods. 290 patients with liver cirrhosis were examined: 206 had gastrointestinal bleeding, 84 had diuretic-resistant ascites. Ultrasonic scanning, Doppler sonography, esophagogastroduodenoscopy, angiography, radioisotope scintigraphy were performed to assess blood flow in the portal, splenic and superior mesenteric veins and in the hepatic, splenic and superior mesenteric arteries. Results. Change in the hepatic microcirculatory blood flow in the natural course of liver cirrhosis was characterized by decreased portal and increased arterial blood flow, “arterialization” of hepatic blood flow based on scintigraphy. Decompensation of the disease was associated with progressive reduction in both portal and arterial hepatic blood flow, which were correlated with the severity of functional liver disorders regardless of the complication nature. The portal blood flow in the natural course of liver cirrhosis was characterized by 3.5–4.5 times increased volume of visceral blood. Decompensation of the disease was accompanied by a decrease in blood flow in the portal vein as compared to the splenic and superior mesenteric veins by 1.8–2.2 and 1.5–2.7 times, respectively. Arterial blood flow in the natural course of liver cirrhosis was characterized by a relatively increased hepatic arterial flow. The ultrasound criterion of hepatic blood flow “arterialization” was an increase in hepatic-splenic arterial index, which can be used as a sign to differentiate between different forms of portal hypertension. Decompensation of the disease was characterized by an average of 8.2 % decreased arterial blood flow in the hepatic artery compared to the splenic artery in dynamics. Prognostically unfavorable signs were the progression of splenomegaly degree, the increase in the portal vein diameter with the decreased velocity characterizing the increase in congestive index by 2.4–2.6 times, the decrease in the hepatic artery diameter and velocity in it over time.Conclusions. The hepatic and visceral blood flow characteristics should be considered when choosing method of conservative, surgical or minimally invasive treatment of liver cirrhosis complications. Based on the hepatic hemodynamic characteristics, the mismatch between portal perfusion (reduced) and visceral blood flow (increased) is the essence of portal hypertension in liver cirrhosis. Accordingly, the criterion of treatment effectiveness in decompensated liver cirrhosis should be improved portal liver perfusion and (or) reduced volume of visceral blood flow.
Highlights
Change in the hepatic microcirculatory blood flow in the natural course of liver cirrhosis was characterized by decreased portal and increased arterial blood flow, “arterialization” of hepatic blood flow based on scintigraphy
Decompensation of the disease was associated with progressive reduction in both portal and arterial hepatic blood flow, which were correlated with the severity of functional liver disorders regardless of the complication nature
The portal blood flow in the natural course of liver cirrhosis was characterized by 3.5–4.5 times increased volume of visceral blood
Summary
A – концепция и дизайн исследования; B – сбор данных; C – анализ и интерпретация данных; D – написание статьи; E – редактирование статьи; F – окончательное утверждение статьи. Артериальный кровоток при естественном течении ЦП характеризуется относительным увеличением артериального притока к печени. Декомпенсация заболевания характеризуется снижением артериального кровотока в печеночной артерии относительно селезеночной в динамике в среднем на 8,2 %. Особенности печеночного и висцерального кровотока необходимо учитывать при выборе метода консервативного, хирургического или малоинвазивного лечения осложнений цирроза печени. Соответственно, критерием эффективности лечения при декомпенсации цирроза должно быть улучшение портальной перфузии печени и/или уменьшение объема висцерального кровотока. Зміна печінкового кровотоку на рівні мікроциркуляторного русла при природному перебігу цирозу печінки характеризується, за даними сцинтиграфії, зниженням ворітного та збільшенням артеріального кровотоку, «артеріалізацією» печінкового кровотоку. Декомпенсація захворювання пов’язана з прогресивною редукцією ворітного й артеріального печінкового кровотоку, корелює зі ступенем тяжкості функціональних порушень печінки й не залежить від характеру ускладнень. Артеріальний кровотік при природному перебігу ЦП характеризується відносним збільшенням артеріального припливу до печінки. Ключові слова: цироз печінки, печінковий кровотік, вісцеральний кровотік, ультразвукове сканування, доплерографія, ангіографія, сцинтиграфія
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