Hemodynamic studies of portal hypertension in schistosomiasis

Abstract

The principal hemodynamic alterations observed in hepatosplenic Schistosomiasis are reviewed. The following studies were performed: (1) transparietal splenic manometry, (2) direct portal vein manometry, (3) splenoportography, (4) hepatic vein catheterization for estimation of free hepatic vein pressure and occluded hepatic vein pressure and (5) transparietal hepatic manometry. Studies of pressure relationships in different areas of the portal system reveal hypertension in the spleen and prehepatic venous circulation and normal or slightly elevated occluded hepatic vein pressure and transparietal hepatic pressure. In Schistosomiasis, an increased gradient is observed in (1) intrasplenic/intrahepatic pressure; and (2) portal venous/occluded hepatic vein pressure. These hemodynamic alterations are similar to those observed in extrahepatic portal obstruction and differ from those found in cirrhosis in which both splenic and hepatic pressures are similarly elevated. Splenoportography revealed accentuated prehepatic alterations, sudden stopping of flow in main portal venous branches and perivascular angiomatoid formation. These aspects help in differentiating this condition from cirrhosis. Estimates of hepatic blood flow are normal in schistosomiasis and reduced in cirrhosis. Those findings are consistent with the observed structural and functional changes in the hepatic vessels in schistosomiasis.