Extrahepatic Portal Obstruction Research Articles

Significance of Duodenal Deformity in Patients with Extrahepatic Portal Obstruction

Significance of Duodenal Deformity in Patients with Extrahepatic Portal Obstruction

The significance of duodenal deformity in patients with extrahepatic portal obstruction.

The study to be considered here was undertaken because of the clinical impression that a significant percentage of patients with portal venous congestion due to an extrahepatic portal obstruction are reported by the roentgenologist as having a duodenal deformity. Such a finding might be misinterpreted as a sign of duodenal ulcer, especially if the patient has presented with upper gastrointestinal bleeding and if esophagogastric varices are not demonstrable at the time of the roentgen examination. Even if varices are visualized, confusion about the source of the bleeding can occur. It is generally accepted that patients with hepatic cirrhosis have a 15 to 20 per cent incidence of duodenal ulceration (1). Hence, the clinician is not surprised when the radiologist reports esophagogastric varices and duodenal ulcer in the same case. In reviewing the records of 63 cases of portal congestion due to extrahepatic obstruction studied by Hallenbeck and Adson (2), it was noted that the roentgenologist reported a def...

Esophagogastric varices without hepatic cirrhosis. A clinical study of treatment for their bleeding in 72 cases.

Cirrhosis of the liver is the most common cause of portal venous congestion, congestive splenomegaly, and bleeding from esophagogastric varices. In some cases, however, portal venous congestion and its sequelae occur although the liver is not cirrhotic and even though the usual tests of hepatic function give normal findings. In the majority of cases without hepatic cirrhosis, some obstruction in the part of the portal venous system can be demonstrated by portal venography. The descriptive term, extrahepatic portal obstruction, is often applied to this group of lesions in contradistinction to the term, intrahepatic portal obstruction, which describes the results of the several types of cirrhosis of the liver. There remain a few patients with portal venous congestion who have neither cirrhosis of the liver nor demonstrable obstruction in the portion of the portal venous system. The cause of portal congestion in these cases is not clear. Intrahepatic portal

SPLENOPORTOGRAPHY.

HomeRadiologyVol. 71, No. 2 PreviousNext EditorialSplenoportographyPublished Online:Aug 1 1958https://doi.org/10.1148/71.2.267MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractThe need of a method of study to determine the anatomy and patency of the portal venous system is quite evident. In patients with blockage of the portal vein, varices of the esophagus and other structures frequently develop, with the ever present danger of fatal hemorrhage. In such cases demonstration of obstruction is of immense aid to the surgeon. In the presence of portal hypertension, information as to the velocity of the blood flow and the diameters of the portal and splenic veins would also be valuable. Study of the internal anatomy of the liver and of the portal venous system is useful in cases of cirrhosis. These and other conditions have motivated the search for methods of visualization of the portal vein and its branches in the living patient.Research on this subject has followed two main avenues. The first approach was that of Blakemore and Lord in 1945 (1). They injected a branch of the coronary vein at operation to determine the anatomical relation of this vein to extrahepatic portal obstruction. Child et al., also using an internal approach, in 1951 (2) worked out a successful technic on monkeys and subsequently obtained portal venograms in 21 patients. They regard the procedure as a safe and valuable method of study of the dynamics of the portal system. Moore and Bridenbaugh (3) also found it “technically feasible and relatively safe.”The second method consists in percutaneous splenoportal venography, first described by Abeatici and Campi (4) in 1951. Their experimental work was done on dogs, which recovered satisfactorily. Subcapsular hemorrhages incident to the procedure resorbed without sequelae.In 1953 Steinbach et al. (5) reported a variation of the percutaneous method in which a needle was inserted into the intrahepatic portion of the portal vein. By this method only the intrahepatic venous system is demonstrated. Numerous accounts of the clinical use of percutaneous splenoportography followed, and at the present time this appears to be the method of choice. That it is not without elements of danger, however, is attested by several reports. Reynolds, Mikkelsen, and Redeker (6) recorded 1 case in which a subcapsular hematoma, measuring 10 × 16 cm., was seen at operation one hour later. In another case intra-abdominal hemorrhage necessitated splenectomy after some hours. A number of large series have been reported, however, in which no serious complications have occurred. Thus Bergstrand and Ekman (7, 8), in a series of 175 cases, observed no untoward reactions in the absence of extrasplenic deposition of contrast medium. In patients in which this occurred, there was moderate pain in the left flank and shoulder. In 4 patients there were signs of intraperitoneal bleeding. Figley et al. (9) have employed the percutaneous method with notable success. They concluded that the technic is simple, generally successful, seldom discomforting to the patient, and reasonably safe.Article HistoryPublished in print: Aug 1958 FiguresReferencesRelatedDetailsCited ByLeberchirurgieKurtStucke1959Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 71, No. 2 Metrics Altmetric Score PDF download

Wedged hepatic venous pressure: A clinical evaluation

The measurement of wedged hepatic venous pressure can be accomplished in approximately 90 per cent of patients and is without danger in experienced hands. From it a reliable estimate of portal vein pressure can be made. If inferior vena caval pressure is used as a zero reference point, non-cirrhotic ascites and right heart failure do not cause elevations of wedge pressure. Moderate and marked elevations are seen only in fibrotic liver disease, although mild elevations have been found in patients with no evidence of liver disease. In the earlier stages of cirrhosis wedge pressure may be normal, therefore in the lower pressure ranges neither the presence or absence of elevated wedge pressure can be considered diagnostic with respect to cirrhosis. The chief technical problem in wedge pressure measurement is that there is no safeguard in inexperienced hands against the recording of a falsely low pressure when the catheter is caught at a venous bifurcation and incompletely wedged. Therefore it is recommended that wedge pressure be recorded in at least two areas in the liver. There are rare instances (in our experience always in patients with complicated intra-abdominal circulatory problems) where wedge pressures may be difficult or impossible to interpret properly. Wedge pressure determination has proved to be of practical clinical value in several circumstances. It may establish a definite diagnosis of cirrhosis in problem cases in which liver biopsy is hazardous or technically not satisfactory. In patients with known cirrhosis who have had gastrointestinal bleeding from an unknown source it will provide important evidence in favor of or against construction of a portacaval shunt. It will differentiate reliably between intrahepatic and extrahepatic portal obstruction in patients with known esophageal varices.

Extrahepatic Portal Obstruction

Extrahepatic Portal Obstruction

Total hepatectomy in the rat.

ArticleTotal Hepatectomy in the RatFrances Pauls MeehanFrances Pauls MeehanFrom the Department of Physiology, School of Medicine, University of Southern California, Los Angeles, and Scripps Metabolic Clinic, La Jolla, CaliforniaPublished Online:31 Oct 1954https://doi.org/10.1152/ajplegacy.1954.179.2.282MoreSectionsPDF (451 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformation Cited ByNephrectomized and Hepatectomized Animal Models as Tools in Preclinical Pharmacokinetics20 May 2013 | Basic & Clinical Pharmacology & Toxicology, Vol. 113, No. 2Autonomic nerve system responses for normal and slow rewarmers after hand cold provocation: effects of long-term cold climate training17 April 2012 | International Archives of Occupational and Environmental Health, Vol. 86, No. 3Improved survival and ammonia metabolism by intraperitoneal transplantation of microencapsulated hepatocytes in totally hepatectomized ratsSurgery, Vol. 130, No. 3Animal Models of Liver FailureIntrasplenic transplantation of allogeneic hepatocytes prolongs survival in anhepatic ratsHepatology, Vol. 28, No. 5A new technique of one-stage total hepatectomy in the ratSurgery, Vol. 121, No. 2Changes in cold tolerance due to a 14-day stay in the Canadian ArcticInternational Journal of Biometeorology, Vol. 39, No. 4Biometrical characteristics and physiological responses to a local cold exposure of the extremitiesEuropean Journal of Applied Physiology and Occupational Physiology, Vol. 74, No. 1-2Technique of total hepatectomy in the ratMicrosurgery, Vol. 16, No. 7Fluctuation of pancreatic peptide hormones in total-hepatectomy model in the ratResearch in Experimental Medicine, Vol. 193, No. 1A simple two-stage technique of total hepatectomy in the ratJournal of Surgical Research, Vol. 52, No. 1A simple experimental model of total hepatectomy, hepatic ischemia and extrahepatic portal obstruction in rats using splenic transpositionThe Japanese Journal of Surgery, Vol. 21, No. 1A simplified single stage total hepatectomy in the rat with maintenance of gastrointestinal absorptive functionHepatology, Vol. 9, No. 1Benefit-risk Assessment of Investigational Drugs: Current Methodology, Limitations, and Alternative Approaches24 January 2012 | Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, Vol. 6, No. 6Hyperammonemic coma after hepatectomy in germ-free ratsGastroenterology, Vol. 77, No. 2Portal-systemic anastomosis in the ratJournal of Surgical Research, Vol. 17, No. 1Extrahepatic creatine synthesis in the ratArchives of Biochemistry and Biophysics, Vol. 122, No. 2The Study of Carbohydrate Metabolism More from this issue > Volume 179Issue 2October 1954Pages 282-284 Copyright & PermissionsCopyright © 1954 by American Physiological Societyhttps://doi.org/10.1152/ajplegacy.1954.179.2.282PubMed13218159History Received 14 January 1954 Published online 31 October 1954 Published in print 31 October 1954 Metrics

Patterns of Collateral Circulation in the Portal System Following Extrahepatic Inflammatory Processes

Summary Two cases, showing different patterns of collateral circulation in the portal systems following extrahepatic inflammatory processes have been presented. Both of these cases had massive gastrointestinal hemorrhage. Case No. I presents an unusual pattern which is not commonly demonstrated in extrahepatic portal obstruction; one in which sodium morrhuate had been used as a sclerosing agent in treating the pancreatic fistula. Case No. II represents another pattern of collateral portal circulation. The extrahepatic portal obstruction produced by the fibrosing peripancreatitis involved the superior mesenteric vein as it passed beneath the pancreas.

Haematemesis due to extrahepatic portal obstruction.

Haematemesis due to extrahepatic portal obstruction.

Venous shunts in portal hypertension.

THE USE of shunts between the portal venous system and the vena cava or its branches has become a well-established method of combating the complications of portal hypertension.1The impetus of a reasonable surgical treatment has resulted in an improved understanding of the modes of production of portal hypertension. The frequent disproportion between the level of the portal pressure in intrahepatic disease and the degree of hepatic damage has been studied by Kelty and others.2These workers find that the regeneration of liver cells which improves hepatocellular function adds to the interference with portal blood flow. In cases of extrahepatic portal obstruction, the causes are narrowing down to those of congenital nature and those resulting from inflammation and thrombosis of the portal vein with subsequent organization along various lines. This organization may take the form of a single, extremely thick-walled vessel with small lumen, met with in one