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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Taking into account 6 own cases and 51 cases reported in the literature the question is asked, whether pregnancy influences portal hypertension due to extrahepatic block and vice-versa. Complications arise in about 50% of the patients, hemorrhage from esophageal varices making up to 40%, as the most common complication. Most esophageal bleedings occur in the second of third trimenon. The physiological changes of the circulatory system during pregnancy are held to be responsible for these complications; especially temporary increase of portal pressure tend to aggravate the preexisting extrahepatic portal hypertension. The prognosis for mother and child in these cases is less severe than in patients with portal hypertension due to liver cirrhosis. Therapeutic procedures which have to be adapted to the individual case are discussed.
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PMID:[Extrahepatic portal hypertension and pregnancy (author's transl)]. 121 66

Surgical procedures concerning the portal vein in liver cirrhosis must be carefully planned preoperatively. If there is still a residual blood supply of the liver through the portal vein it should be preserved. This can be done best by establishing a pressure-adapted arterialisation of the liver plus portacaval end-to-side anastomosis. The portacaval shunt is the method of choice if there is no residual blood flow through the portal vein. A spleno-renal venous anastomosis is to be performed, if there is a total or partial thrombosis of the stem of the portal vein. Treatment of acute bleeding from esophageal varices is still a problem unresolved. The pathophysiology of this situation is considered; a method is proposed which combines a quick stop of bleeding and relief of the detoxfying function of the liver.
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PMID:[The present status of portal vein surgery in liver cirrhosis (author's transl)]. 121 67

1. An infusion of 3 gamma/kg/min dopamine causes a significant increase in the renal plasma flow and the glomerulum filtration rate. This dosage does not cause a change of the mean systolic and arterial pressure. This effect may also be observed in patients with hepatic cirrhosis. 2. The wedged hepatic vein pressure, an indicator for the portal pressure, only shows a slight increase (9,46 +/- 9,41%) as compared to the initial pressure produced by the mentioned dose. Measurements of the spleen pulpa pressure, which likewise indicates the portal pressure, showed an increase of pressure up to 100% due to pressing or coughing. 3. If in the case of bleeding oesophageal varices acute renal failure might develop, the advantage of the effect of dopamine in stimulating the blood flow through the kidneys may be considered more important than the minute danger of a slight increase of the portal pressure, which might provoke haemorrhage.
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PMID:[Effect of dopamine on the portal pressure]. 122 May 17

Upper gastrointestinal bleeding from isolated duodenal varices is a rare occurrence. We report the case of a patient with idiopathic duodenal varices in whom the diagnosis was established preoperatively by endoscopy. The patient did not have esophageal varices or portal hypertension, and he was treated by exicising the varix with a full thickness of duodenal wall. Bleeding has not recurred. Duodenal varices as well as duodenal ulcer and gastritis must be considered in evaluating a patient with cirrhosis and upper gastrointestinal bleeding.
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PMID:Duodenal varices. 125 52

To clarify the effect of splenomegaly on portal hemodynamics in patients with portal hypertension and esophageal varices, manometric studies were carried out before and after splenectomy during an operation for esophageal varices. The 118 patients evaluated retrospectively had underlying liver cirrhosis (LC) (62), idiopathic portal hypertension (IPH) (42), and extrahepatic portal occlusion (EHO) (14). The weight of the spleen did not differ significantly among the three diagnostic groups: 640 +/- 473.5 g for LC, 780 +/- 414.6 g for IPH, and 683 +/- 457.2 g for EHO. Before splenectomy, portal pressure was significantly elevated in the patients with EHO (410 +/- 85.2 mm H2O) as compared to either the LC or IPH groups (348 +/- 64.1 and 348 +/- 73.5 mm H2O). Following splenectomy the reduction of portal pressure was significantly greater in the EHO group (29 +/- 15.5%) than in either the LC (18 +/- 17.4%) or IPH (19 +/- 17.0%) groups. Each group was subdivided according to severity of splenomegaly: marked (spleen weight > or = 500 g) or slight (spleen weight < 500 g). Patients with LC and marked splenomegaly showed a reduction in liver function parameters as shown by the prolongation of indocyanine retention rate at 15 min as compared to those with slight splenomegaly. Though it is not statistically significant, the average portal pressure tended to be higher among those with marked splenomegaly.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Portal venous pressure following splenectomy in patients with portal hypertension of differing etiology. 129 40

Interrelationships between quantitative assessment of portal (%Qp) and arterial (%Qa) components of hepatic blood supply obtained by dynamic hepatoscintigraphy, and clinical variables characterizing the severity of liver cirrhosis and portal hypertension were studied in 25 cirrhotic patients. The variables, clinical state, size of oesophageal varices, ascites accumulation, sonographic stigmata of portal hypertension, liver mass and elimination rate of lidocaine and antipyrine were studied. The %Qa rose in proportion to the severity of liver injury estimated from the Child-Turcotte and McCormick grading scores. The mean %Qa for patients with Child A cirrhosis was significantly higher than that for 8 healthy subjects (34.8 +/- 7.9% vs 18.1 +/- 4.0; P < 0.01). The %Qp values showed relationship with the size of esophageal varices, provided discriminatory data with respect to the ascitic fluid accumulation and the development of intraabdominal collateral circulation. The liver mass had no impact on hepatic dual blood supply pattern, but was linked with the rate of antipyrine clearance. Neither antipyrine clearance nor lidocaine elimination rate corresponded to alterations of hepatic dual blood supply. The %Qp showed a negative correlation with the initial half-life of lidocaine, which was referred to lowered hepatic uptake of the drug. It is concluded that the quantitative assessment of %Qp and %Qa reflect the advancement of portal hypertension better than liver function failure does.
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PMID:Clinical utility of quantitative assessment of liver haemodynamics in cirrhosis provided by dynamic hepatoscintigraphy. 129 83

Bleeding gastroesophageal varices is associated with a high morbidity and mortality. Forty-four cases of bleeding gastroesophageal varices were treated at the Department of Surgery, Universiti Kebangsaan Malaysia, General Hospital, Kuala Lumpur over four and a half years. Thirty-two of them had liver cirrhosis. Hepatitis B infection was noted in 13 and alcoholic abuse was present in 14 patients. Five patients had associated hepatoma. Thirty-four percent had gastric fundal varices and a third of these bled from them. A total of 179 endoscopic injection sclerotherapy sessions were performed averaging 4 per person. Rebleeding rate was 4% and mortality was high (50%) in these cases. It was concluded that injection sclerotherapy is a safe and effective means of controlling bleeding oesophageal varices. Operative surgery was employed in those who rebled after injection and would be considered in those in Child's A.
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PMID:Treatment of bleeding gastroesophageal varices: a report of forty-four cases. 818 58

Endoscopic sclerotherapy was performed for esophageal variceal sclerosis in 7 children, aged 18 months to 11 years. Five of them had cavernomatous portal degeneration and the other two hepatic cirrhosis. The technique used was intra- and perivariceal with ethanolamine oleate in order to get the decrease or disappearance of the variceal veins. Two of the patients showed retrosternal pain and fever after the sclerosis procedure. This preliminary report shows that endoscopic sclerosis of esophageal varices is a good procedure to control acute bleeding and to prevent its onset in children.
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PMID:[Endoscopic sclerotherapy of esophageal varices in pediatric patients]. 130 11

Haemorrhage from oesophageal varices is one of the most common reason of death of patients with liver cirrhosis. The possibility of treatment and prevention of the haemorrhage by endoscopic sclerotherapy (ES) has become one of the achievements of contemporary medicine. Nevertheless there are some complications described after this procedure, the most severe being the pulmonary embolia. In our study we analyzed the pulmonary circulation by perfusion scintigraphy after ES. Among twelve patients treated by ES we found two cases of disturbed pulmonary perfusion. We did not find clinical or gasometric changes in these patients. We suggest there should be done pulmonary perfusion monitoring after ES.
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PMID:Disturbances of the pulmonary perfusion after endoscopic sclerotherapy of oesophageal varices. 130 44

Between July 1986 and April 1989, 334 hospitalized adult Ethiopian patients with chronic liver disease were studied according to a protocol to define their clinical features and to identify risk factors with the aim of preventive intervention. Of these, 14 had chronic hepatitis, 208 cirrhosis and 112 hepatocellular carcinoma (HCC). Both clinical and histological diagnostic criteria were employed. A detailed questionnaire was used to document demographic and clinical data. A common clinical presentation among patients with chronic hepatitis was darkening of the face and hands with or without hypertrichosis of the face and blisters over the dorsi of the hands. This overt or latent form of porphyrea cutanea tarda (PCT) responds to chloroquine. Patients with cirrhosis of the liver commonly present for the first time with ascites, splenomegaly, haematemesis and/or melena from oesophageal varices, and mental changes due to hepatic encephalopathy. Overt or latent forms of PCT are also common features. Peculiar to these cirrhotics is the rarity of spider naevi, gynaecomastia, testicular atrophy, Dupuytren's contracture, parotid gland enlargement and clubbing of the fingers. Exhaustion, loss of appetite, rapid loss of weight, right upper quadrant and/or epigastric pain (all often of less than 6 months' duration, a big, hard, tender and grossly nodular liver with bruit, signs of portal hypertension, and/or hepatic encephalopathy, in a young male with a rapid down hill course characterize the Ethiopian patient with HCC. Serum anti-nuclear factor, anti-mitochondrial anti-bodies and anti-smooth muscle anti-bodies were absent in those with chronic hepatitis and were uncommon in the cirrhotics and HCC cases. One or more hepatitis B virus markers were found in 86% of chronic hepatitis, 88% cirrhosis and 78% HCC and the HBsAg carrier state was found in 36%, 29% and 23%, respectively. Among the HBsAg carriers, HBeAg positivity was less common than anti-HBe but anti-HDV was significantly higher than in the healthy general population. Alphafetoprotein (AFP) levels greater than 500 mg/ml were present in 16 (8%) cirrhotics and 58 (52%) patients with HCC. Histologically, 3 of the chronic hepatitis patients had progressed to cirrhosis, 8 of the cirrhotic patients had chronic active hepatitis and 85% of HCC cases occurred in a background of macronodular cirrhosis. Three cirrhotics developed HCC during follow-up.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Chronic liver disease in Ethiopia: a clinical study with emphasis on identifying common causes. 131


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