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Neural Control of the Intestinal Circulation and its Interaction With Autoregulation
Published in Irving H. Zucker, Joseph P. Gilmore, Reflex Control of the Circulation, 2020
Gerald A. Meininger, Harris J. Granger
Splanchnic Afferents. In addition to the efferent sympathetic and parasympathetic supply, the autonomic nerves distributing to the digestive organs also contain a considerable number of afferent nerve fibers (Longhurst, 1984). For example, the composition of the vagus has been estimated to contain 80% afferent nerve fibers and the composition of the sympathetic nerves comprise 50% afferent fibers (Granger et al., 1985). These nerve fibers arise from a variety of sensory receptor types identified as mechanoreceptors and chemoreceptors located throughout the digestive tract. Stimulation of these receptors typically results in cardiovascular excitation manifested as an elevation in systemic blood pressure, peripheral resistance, heart rate, and myocardial contractility (Longhurst, 1984). The physiological role and adequate stimuli for these afferent reflexes is not entirely clear. A speculative view is that they play a homeostatic role in governing the cardiovascular system by influencing control of vascular resistance, fluid and osmotic balance, and metabolic balance.
Intra-Abdominal Hypertension after Life-Threatening Penetrating Abdominal Trauma: Prophylaxis, Incidence, and Clinical Relevance to Gastric Mucosal pH and Abdominal Compartment Syndrome
Published in Stephen M Cohn, Ara J. Feinstein, 50 Landmark Papers every Trauma Surgeon Should Know, 2019
RR Ivatury, JM Porter, RJ Simon, S Islam, R John, WM. Stahl, J Trauma
Conclusions IAH is frequent after major abdominal trauma. It may cause gut mucosal acidosis at lower bladder pressures, long before the onset of clinical ACS. Uncorrected, it may lead to splanchnic hypoperfusion, ACS, distant organ failure, and death. Prophylactic mesh closure of the abdomen may facilitate the prevention and bedside treatment of IAH and reduce these complications.
Shunts in the Portal Area of the Rat
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
The shunts and transpositions provide suitable experimental models for studies concerning liver and portal blood flow, liver metabolism, liver regeneration, and biochemically induced neurological complications. The interrelation between liver and the diverse splanchnic organs can be studied by these models also. Immediately after shunt and transposition operations, no fatal complications occur provided no stenosed anastomoses are present.
Effect of terlipressin on systemic and hepatic hemodynamics in patients undergoing liver transplantation
Published in Egyptian Journal of Anaesthesia, 2023
Reham Mustafa Hashim, Nada Mohamed Radwan, Omar Mohamed Taha Elsafty, Waleed Abdalla Ibrahim, Tarek Samir Shabana
Liver transplantation is linked to hemodynamic instability induced by comorbidities, an inherent hemorrhagic tendency, and surgical technique. It involves a complete porto-systemic collateral vessels dissection as well as great vessel clamping or nclamping with ischemia – reperfusion damage as a consequence. Therefore, vasopressor administration as well as, rational fluid significantly contribute to maintaining hemodynamic stability in liver transplant recepients [1]. Systemic and splanchnic circulation closely interacts with one another. In individuals with portal hypertension and liver cirrhosis, splanchnic circulation is principally responsible for maintaining the pressure and volume of the systemic blood pressure. Portal hypertension is linked to decline central blood volume, vasodilatory molecules overproduction, and consequent arterial vasodilatation along with declined arterial blood pressure as well as elevated heart rate (HR) and cardiac output (COP [2]. Therefore, splanchnic circulation’s pharmacologic modulation using vasoconstrictors such as terlipressin can alleviate venous congestion, and maintain central blood flow, thereby optimizing control of blood volume during liver transplant surgeries [3]. Terlipressin decreases splanchnic blood flow and reduces portal hypertension in cirrhotic patients. Moreover, it transfers blood from the splanchnic to the systemic circulation, improving systemic hemodynamics [4]. The present study attempted to examine intra operative terlipressin`s impact on systemic and hepatic hemodynamics in (LDLT) recipients.
Pharmacological management of portal hypertension and its complications in children: lessons from adults and opportunities for the future
Published in Expert Opinion on Pharmacotherapy, 2021
Sarah Henkel, Carol Vetterly, Robert Squires, Patrick McKiernan, James Squires
Another vasoactive agent that can also be used for gastrointestinal variceal bleeding is vasopressin, or its analogue terlipressin. In splanchnic circulation, it acts on arterial smooth muscle V1 receptors to induce vasoconstriction, and as a result lowers splanchnic blood flow and portal pressure [17]. Vasopressin is often compared to octreotide, and both have been found to be effective in adults. In one meta-analysis, octreotide imparted better control of bleeding compared to vasopressin, but no significant difference was found between vasopressin/terlipressin compared to octreotide for prevention of re-bleeding episodes in a second meta-analysis analyzing 6 RCTs [18,19]. In contrast to octreotide, terlipressin side effects, such as reduced cardiac output, bradycardia, and systemic vasoconstriction may preclude its use in clinical practice [2]; however, when comparing side effect profiles of terlipressin to vasopressin, a recent meta-analysis suggested terlipressin did have a significantly lower risk of complications [19]. Importantly, for patients with acute upper GI bleeding in the setting of hepatorenal syndrome, terlipressin may prevent worsening of renal function compared to octreotide/somatostatin, suggesting its use in this particular population [20]. In neonates and children, vasopressin has been used as a rescue vasoactive agent in refractory shock [21], though it has not been well studied for the management of GI bleeding secondary to portal hypertension.
Spinal cord involvement in Lewy body-related α-synucleinopathies
Published in The Journal of Spinal Cord Medicine, 2020
Raffaele Nardone, Yvonne Höller, Francesco Brigo, Viviana Versace, Luca Sebastianelli, Cristina Florea, Kerstin Schwenker, Stefan Golaszewski, Leopold Saltuari, Eugen Trinka
Fibers originating in the rostroventral nucleus of the medulla that traveling in the Th/IML provide the efferent innervation. Of great importance is also the capacitance of the splanchnic-mesenteric bed. This region is supplied by the splanchnic nerve with cell bodies at the thoracic level and synapses at the celiac ganglion.91 Orthostatic hypotension is a chief complaint in the pure autonomic failure, in LBD and in MSA. Some cases starting as isolated autonomic failure and subsequently developing PD or LBD features were described.71,92,93 Moreover, dysfunctions of cardiac sympathetic and parasympathetic neurons were observed in the initial stages of PD.93 Even is also the genesis of orthostatic hypotension is likely to be multifactorial, the pathology of the dorsal motor nucleus of the vagus may explain the early occurrence of orthostatic hypotension.