Portal Hypertention Research Articles

Study of Propranolol in Cirrhosis Patients with Portal Hypertension: Research at Sidoarjo General Hospital

Cirrhosis is the final stage of chronic liver disease caused by fibrosis which decreases the function and changes the shape and structure of the liver. Portal hypertension is an essential pathophysiology of cirrhosis, which can lead to an increased risk of death in patients resulting in very detrimental complications originating from portal obstruction of blood flow, such as cirrhosis or blockage of blood vessels. According to the EASL guidelines, non-selective β-blocker therapy such as propranolol can reduce portal pressure by reducing the portal venous flow through two mechanisms: decreased cardiac output and decreased splanchnic blood flow. This study aimed to determine the pattern of using propranolol in patients with liver cirrhosis in Sidoarjo Hospital. This was an observational study with a retrospective approach in cirrhosis patients with portal hypertension from 1st January 2021 until 31st December 2021. The Patient Medication Records (PMR) data was obtained from 15 male patients (68%), with the most age ranging from 56 to 65 years old (37%). The pattern of using single therapy was in 22 patients (100%). The highest use of single treatment was Propranolol (3×10 mg) with 12 patients (52%), Propranolol (2x10 mg) with ten patients (43%), and Propranolol (2x40 mg) with only one patient (5%). Interm of switching therapy, only one medication which is Propranolol (2x10 mg switch toPropranolol (2x40 mg).
 Keywords: Propranolol, Portal Hypertention, Cirrhosis

Hematemesis without Primary sclerosing cholangititis in a case of Ulcerative Colitis

Background: Hematemesis without Primary sclerosing cholangititis in a case of Ulcerative Colitis. Aims: We present a case of ulcerative colitis on treatment who presented with hematemesis due to an unusual complication of IBD involving liver and causing portal hypertention. Methods: A 60 years lady with Ulcerative colitis since 14 years controlled on mesalamine presented with hematemesis and ascites.On evaluation large varices were seen and hemostasis achieved with endoscopic variceal ligation. Ascites was high SAAG without spontaneous bacterial peritonitis. On evaluation for the cause of liver disease autoimmune profile,viral markers and ceruloplamin were normal. Triple phase CT evaluation revealed multiple retroperitoneal,iliac and inguinal lymph nodes. Biopsy of lymph nodes showed amyloidosis. Ascites was conservatively managed. Results: This is the first case to our knowledge where initial presentation of amyloidosis secondary to inflammatory bowel disease,which itself is very rare, presented with a portal hypertention complication. Conclusion: This case of hematemesis as the index presentation of portal hypertention due to amyloidosis secondary to IBD emphasizes the importance of routine liver evaluation in all cases of inflammatory bowel disease.

The Investigation of Gastroesophageal Reflux in Children with Portal Hypertention

The Investigation of Gastroesophageal Reflux in Children with Portal Hypertention

Clinical Manifestation of Schistosomiasis

Background: Clinical manifestations include acute (Katayama syndrome) and chronic manifestations. Katayama syndrome may include such as fever and respiratory symptoms. In Schistosoma haematobium chronic infections can cause bladder cancer. In Schistosoma japonicum and Schistosoma mansoni, chronic inflammation can cause such as ulceration and fibrosis. Objectives: In this study, the author reports the progress in a study of schistosomiasis that focused on clinical manifestations, which include acute and chronic manifestations as objectives of this study. Methodology: The author searched Google, ScisnceDirect, the PMC Database and PubMed Database for clinical manifestations of schistosomiasis between 2009 and 2019.. Articles were unrestricted open access, articles with permissions from Elsevier if required and in English. Other Relevant articles were also included. Results: Two clinical manifestations occur: Katayama syndrome and chronic manifestations. Katayama syndrome include such as fever, myalgia, and rash. In Schistosoma haematobium chronic manifestations can cause dysuria and hematuria, and can lead other infections, even to cancer. In S. japonicum and S. mansoni, chronic disease manifestations can include such as blood in the stool and diarrhea. These manifestations can cause such as fibrosis and portal hypertention. Clinical manifestation can consist of intestinal schistosomiasis and urogenital schistosomiasis. Acute infections include swimmer’s itch and Katayama syndrome. Chronic infection consists of intestinal schistosomiasis, hepatosplenic schistosomiasis, genitoirina schistosomiasis, glomerular disease, and neuroschistosomiasis. Conclusion: Clinical manifestations include Kayama syndrome and chronic diseases. Chronic diseases consist of intestinal schistosomiasis and urogenital schistosomiasis. Chronic manifestations can lead to bladder cancer in S. haematobium. In S. japonicum and S. mansoni, can lead to bowel wall ulceration and hyperplasia.

SAT-154-Acute hemodynamic response to I.V propranolol during hepatic hemodynamic study in 26 cirrhotic patients with portal hypertention and nonbleeding esophageal varices. Correlation with esophageal bleeding and survival

SAT-154-Acute hemodynamic response to I.V propranolol during hepatic hemodynamic study in 26 cirrhotic patients with portal hypertention and nonbleeding esophageal varices. Correlation with esophageal bleeding and survival

Preliminary clinical study of C-arm CT assisted transjugular intrahepatic portosystemic shunt for the treatment of portal hypertension

Objective To explore the value of C-arm CT in transjugular intrahepatic portosystemic shunt (TIPS). Methods Between June 2015 and October 2017, a total of 16 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertention in our center were retrospectively enrolled in the study. Abdominal enhanced CT was routinely performed before surgery. Postprocessing images of portal vein were used as a guidance of TIPS in real time after integrated with intraoperative c-arm CT images during selective operations. Results The success rate of C-arm CT-guided TIPS was 100%. Portal vein angiography showed the position basically consistent with CT matched images reference position. No obvious abdominal hemorrhage, injury of biliary tract and other complications occurred in all patients. The mean number of needle passes was 2.1±0.9 passes(range of 1.0-4.0 passes), the mean time of portal vein entry was 4.3±1.9 min (range of 2.0-8.0 min), the mean fluoroscopy period was 22.6±4.8 min (range of 17.0-32.0 min), DAP was (256.2±96.7)mGy/cm2. Conclusion C-arm CT-guided TIPS is technically feasible and safe. Key words: Hypertension, portal; Radiology, interventional; Portasystemic shunt, transjugular tntrahepatic; Tomography, X-Ray Computed; C-arm CT

Splenectomy plus periesophagogastric devascularization in the treatment of cirrhotic patients with portal hypertention and splentic artery steal syndrome

Objective To study the hemodynamic changes before and after splenectomy plus periesophagogastric devascularization in patients with splenic artery steal syndrome (SASS) so as to provide a theoretical basis for the treatment of portal hypertension concomitant with hypersplenism. Methods The database of 30 patients who underwent splenectomy plus devascularization from January 2015 to January 2017 was studied retrospectively. Color Doppler ultrasound was performed to detect hemodynamic changes in the hepatic artery, splenic artery, splenic vein and portal vein in patients with portal hypertension and in healthy controls. The outcomes between preoperative and postoperative biochemical indicators were compared. Results The hemodynamic indexes of splenic artery, splenic vein and portal vein in the study group were significantly higher than those in the control group (P<0.05). The peak systolic velocity [(35.3±5.1) cm/s vs. (53.1±7.0) cm/s] and blood flow [(175.9±30.5) ml/min vs. (297.0±48.3) ml/min)] of the hepatic artery were significantly lower than those of the control group (P<0.05). The peak systolic velocity [(60.7±11.9) cm/s vs. (35.3±5.1) cm/s] and blood flow [(388.8±79.6) ml/min vs. (175.86±30.46) ml/min] of the hepatic artery increased significantly after operation (P<0.05). After splenectomy, the levels of the leucocyte [(7.9±3.8)×109/L vs. (2.8±1.4)×109/L)], thrombocyte [(491.3±194.9)×109/L vs. (47.4±16.0)×109/L)], bilirubin [(15.0±10.6) μmol/L vs. (24.4±13.8) μmol/L)] and transaminase [(32.94±8.57) U/L vs. (43.37±16.59) U/L)] reco-vered when compared with the preoperative data (P<0.05). Conclusions SASS was detected in cirrhotic patients who had portal hypertension concomitant with hypersplenism. Splenectomy plus periesophagogastric devascularization were effective and safe for cirrhotic patients with hypersplenism and concomitant esophageal and gastric variceal bleeding. Key words: Cirrhosis; Portal hypertension; Hypersplenism; Hemodynamics; Devascula-rization

Critical analysis of Jalodara (Ascites) - A Review

Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity that exceeds 25ml. Ascitic fluid can accumulate as a transudate or an exudate, this is secondary diseases to such as portal hypertention, spontaneous bacterial peritonitis and liver cirrhosis. Hence it is considered as one of the leading cause of death in the developing countries. Here Ascites has been understood as Jalodara. Udara is manifested because of Rasa Dhatu portion which gets extravesated from Kosta, Grahanyadi gets collected in Udara being influenced by Prakupita Vata the disease is called as Jalodara. For Dosha Nirharana Nitya Virechana, and other oral Ayurvedic medications are used as a mode of treatment. This paper throws an insight to the understanding and management of Ascites under the heading of Jalodara and also highlights the role of Nitya Virechana in the management of Jalodara.

Risk factors of hepatic myelopathy after transjugular intrahepatic portosystem stent-shunt

Objective To investigate risk factors of hepatic myelopathy (HM) after transjugular intrahepatic portosystem stent-shunt (TIPS), and to explore the correlation between HM after TIPS and long term survival. Methods From January 2005 to September 2014, patients with liver cirrhosis received TIPS treatment because of complications associated with portal hypertention were collected. After operation, all patients were followed up by telephone at one, three, six months and later every six months, and the follow-up stopped until death or September 2015. Univariate and multivariate Logistic regression analysis was performed to screen risk factors of HM, and the survival of patients was compared and analyzed. Results A total of 1 101 patients with liver cirrhosis and successfully treated by TIPS were enrolled, and they were divided into HM group (n=80) and non-HM group (n=1 021). The median follow-up time was 44.77 months (range, 2.87-129.80 months). Male (hazard ratio (HR)=2.825, 95%CI:1.454-5.179), splenectomy history (HR=1.829, 95%CI:1.024-3.265) and post-TIPS hepatic encephalopathy (HE) (HR=5.057, 95%CI:2.824-9.055) were risk factors of HM by multivariate Logistic regression analysis (all P<0.05). The median survival time of HM group and non-HM group was 69.93 and 58.43 months, respectively. There was no statistically significant difference in survival time between two groups (P=0.208). The one, three and five years cumulative survival rates of the above two groups were 96.25%, 73.28%, 61.13% and 81.36%, 64.28%, 49.11%, respectively. Conclusion The risk of HM after TIPS is increased in male liver cirrhosis patients with splenectomy. To reduce the risk of HM, a positive prevention of HE after TIPS is recommended. Key words: Portasystemic shunt, transjugular intrahepatic; Hepatic encephalopathy; Spinal cord diseases; Risk factor

Safety management of portal hypertention

Safety management of portal hypertention

How to proceed with RCT in portal hypertention

How to proceed with RCT in portal hypertention

Clinical significance of splenic artery steal syndrome in patients with cirrhotic portal hypertention

Clinical significance of splenic artery steal syndrome in patients with cirrhotic portal hypertention

LDRf classification for ectopic varices in gastrointestinal tract

Objective To study the feasibility of LDRf classification for gastrointestinal tract ec- topic varices （EcV） outside the esophagus. Methods Data of 914 patients with gastrointestinal EcV were classified by LDRf and analyzed for EeV location （ L）, vascular diameter （D） , and risk factor （Rf）. The etiology of the portal hypertension （PH） was determined, and the patients were treated and followed up. Results The EeVs were located in duodenum of 198 cases, in jejunum and ileum of 93, in bile duct of 105, in colon of 65, and in rectum of 453. Diameters of blood vessels of EcV varied from 0. 3 to 3.5 cm. PH causes were cirrhosis with portal hypertention in 630 patients （68. 9% ）, in which 3 were autoimmune cirrhosis and 3 were portal spongiform fiver disease （0. 6% ）. Combined esophageal and gastric varices were found in 252 cases （27.6 % ） , including 4 cases （0. 5% ） of splenectomy. Various treatments were applied in 315 patients, including endoscopic tissue adhesive injection in 43, endoscopic sclerotherapy in 76, endo- scopic ligation in 74, interventional treatment in 52, and surgical laparotomy in 70. A total of 19 patients died of variceal bleeding. The patients were followed up for 13 to 36 months, no varices relapsed, and 1-year survival rate was 100%. Conclusion LDRf classification, simple, applicable, standardized, is suitable for the whole gastrointestinal varicose veins. Key words: Varicose veins, heterotopic ; Endoscopy; Hypertension, portal; LDRf typing

Peliosis hepatis: seltene Differenzialdiagnose der Leberraumforderung und interdisziplinäre Herausforderung für Diagnostik und Therapie

A 42-year-old woman presented at our hospital, because of a non-specific hepatic tumor. She complained of dull pain in the right upper abdomen. Physical examination did not reveal any pathology, especially there was no evidence of an infection. Abuse of drugs, alcohol or anticontraceptives was also denied. INVESTIGATIONS UND THERAPY: Even though fine needle biopsy and extensive radiological examination were performed a malignant nature of the liver tumor could not be excluded. Therefore a hemihepatectomy was performed. The postoperative course was normal and the patient was released from hospital after 11 days. The histological examination revealed an incidental finding of an extended peliosis hepatis. Peliosis hepatis is a rare disease of the liver, histologically characterized by blood filled cavities. The clinical picture of this disease is mostly asymptomatic, but it may also lead to liver failure, portal hypertention and massive intrahepatic bleeding. The preoperative differentiation is an interdisciplinary challenge, especially in terms of radiological examination (chemical shift MRI; liver specific radiocontrast). If the distinction to a malignancy cannot be excluded operative resection is indicated.

Platelet count/spleen diameter ratio for non-invasive diagnosis of oesophageal varices: Is it useful in compensated cirrhosis?

AimTo assess the diagnostic accuracy of the platelet count/spleen diameter ratio for identification of oesophageal varices and/or hypertensive gastropathy in patients with compensated cirrhosis. MethodsPlatelet count/spleen diameter ratio was calculated in 87 consecutive patients with compensated cirrhosis. A new cut-off with the highest sensitivity and specificity for the presence/absence of oesophageal varices and/or hypertensive gastropathy was identified. Performance of the platelet count/spleen diameter ratio considering previously reported cut-off values were then tested in our population. ResultsA platelet count/spleen diameter ratio <936.4 had the best sensitivity and specificity for the diagnosis of oesophageal varices and for all endoscopic findings of portal hypertension. A value lower than 936.4 allowed identification of 64.5% of patients with oesophageal varices and 66.7% of patients with any sign of portal hypertension; a value higher than 936.4 excluded oesophageal varices in 64.3% of patients and any sign of portal hypertention in 68.6% of patients. ConclusionsIn patients with compensated cirrhosis, the platelet count/spleen diameter ratio is not a useful parameter to avoid unnecessary upper endoscopy, independently of the cut-off.

Management of Variceal Hemorrhage in Children with Extrahepatic Portal Venous Obstruction-Shunt Surgery Versus Endoscopic Sclerotherapy

Extrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertention in children. Esophageal variceal hemorrhage is a major cause of morbidity and mortality in these patients. For many decades, portal systemic shunts were considered as the most effective treatment of variceal hemorrhage. Endoscopic injection sclerotherapy (EIS) was first introduced for emergency management of bleeding varices and subsequently as definitive treatment to prevent recurrent hemorrhage. The purpose of the study was to compare the safety and efficacy of shunt surgery and endoscopic sclerotherapy for patients with proven esophageal variceal bleeding due to EHPVO. The study was a prospective randomized study of 61 children with bleeding esophageal varices due to EHPVO carried out jointly by the department of General Surgery and Gastroenterology at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, between March 2001 and September 2003. Thirty patients received surgery and other 31 patients received EIS. Overall incidence of rebleeding was 22.6% in sclerotherapy group and 3.3% in shunt surgery group. Treatment failure occurred in 19.4% patients in sclerotherapy group and 6.7% in shunt surgery group. The rebleeding rate of sclerotherapy is significantly higher than that of shunt surgery. However, the therapy failure rate of sclerotherapy is not significantly different from that of shunt surgery.

Transjugular intrahepatic portosystemic shunt: contraindications and complications

门静脉高压症(portal hypertention,PH)是由门静脉压力增高引起的一组症候群,主要临床表现有脾脏肿大、门腔侧支循环形成及腹水.各种原因引起的肝硬化是PH最主要的病因,约占PH病因的90%以上。

Splenic artery embolisation for portal hypertention in children

Bleeding from esophageal varices is one of the most common causes of serious gastrointestinal haemorrhage in children. We analysed our experience with the use of splenic artery embolisation and variceal sclerotherapy for bleeding oesophageal varices. Records of all patients treated for bleeding oesophageal varices caused by portal hypertension from 1998 to 2004 were retrospectively analysed. Patients were followed up for five years. Out of 25 patients treated, ten belonged to sclerotherapy (group A), eight to combined sclerotherapy and embolisation (group B), and seven to only embolisation (group C). The patients were selected randomly, only two patients who had active bleed recently were directly sclerosed. The splenic artery was embolised at the hilum using steel coils in 15 patients with portal hypertension and hypersplenism. Follow-up findings showed decrease in splenic mass, varices, and hyperdynamic flow. In spite of few patients and a short period of follow-up, our results pointed out that a serious consideration should be given to this procedure, as it slowed the sequel of portal hypertension and the complications associated with it. Patients who were embolised and followed up for five years had lesser rebleeds and complications than sclerotherapy patients.

Management practices for gastrointestinal hemorrhage related to portal hypertention in cirrhotic patients: evaluation of the impact of the Paris consensus workshop

The purpose of this before-after observational survey was to evaluate compliance with good clinical practice guidelines for gastrointestinal hemorrhage related to portal hypertension and the impact of the French Consensus Workshop held in Paris in 2003. Data were recorded concerning episodes of gastrointestinal hemorrhage occurring in cirrhotic patients using a survey questionnaire in 2003 before the workshop and again in 2004. Seventy-six index episodes were included in 2003 and 84 in 2004 in patients attending French hospitals. Before hospital admission, primary prophylaxis was similar in 2003 and 2004, but beta blockers were used alone more often in 2004 for secondary prophylaxis (42% vs 19%, P=0.018). The time from onset of bleeding to hospital admission was greater than 12 hours for 43 and 42% of patients and was not shorter in the event of recurrent hemorrhage. At admission, vasoactive drugs were given earlier in 2004 (<2h: 68% vs 35%, P<0.001). Use of antibiotic prophylaxis was similar in 2003 and 2004 (70% vs 61%, P=0.098), and was more common for Child-Pugh B or C patients (P=0.044). The Paris Consensus Workshop enabled improved clinical practices. Weak points were insufficient screening for cirrhosis, long delay before admission, insufficient use of antibiotic prophylaxis which should be systematic.

PD-050 Clinical study of cases with idiopathic prehepatic portal hypertention(Prehepatic portal hypertention, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)

PD-050 Clinical study of cases with idiopathic prehepatic portal hypertention(Prehepatic portal hypertention, the 44th Annual Meeting of Japanese Society of Pediatric Surgeons)