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Treatment of Variceal Bleeding in Cirrhotic Patients
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Urgent pharmacologic intervention for emergency treatment includes the administration of splanchnic vasoconstrictors that will reduce blood flow through the portal venous system. Vasoactive agents such as octreotide and terlipressin are associated with lower 7-day all-cause mortality, improved control of acute hemorrhage, and lower transfusion requirements [5]. These medications should be administered as soon as possible. In fact, Levacher and colleagues advocate for terlipressin administration to patients by emergency medical personnel before transfer to the hospital [6].
The liver, gallbladder and pancreas
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Dina G. Tiniakos, Alastair D. Burt
The liver is an important, multifunctional organ with major roles in the synthesis of plasma proteins, in detoxification and excretion of potentially harmful exogenous and endogenous substances, and in digestion and absorption through the secretion of bile. It receives dual blood supply from the hepatic artery and portal vein, and drains through the sinusoids via the hepatic veins to the inferior vena cava. The portal venous system draws blood from the intestine and therefore almost everything that is absorbed from the gut passes through the liver before entering the systemic circulation. Failure of this metabolic guardian function in liver disease is an important determinant of clinical symptoms.
Neonatal and General paediatric Surgery
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
The hallmark of the diagnosis is the finding of pneumatosis intestinalis on plain abdominal x-ray. Free air (pneumoperitoneum) is indicative of perforation. Gas in the portal venous system may be a sign of advanced disease (Figs 18.33–18.35).
Anticoagulant therapy for splanchnic vein thrombosis: recent updates for patients with liver cirrhosis
Published in Expert Review of Hematology, 2023
Lucia M. Caiano, Nicoletta Riva, Walter Ageno
Thrombosis of the portal venous system is common in patients with liver cirrhosis. The prevalence of ultrasound-detected PVT in patients with liver cirrhosis can range from 17% [20] to 26% in liver transplantation candidates [21]. The portal circulation seems to be particularly susceptible to the development of venous thrombosis, due to its unique characteristics. The portal vein does not have venous valves and drains blood from the abdominal viscera, in particular the small and large intestines and, since cirrhotic patients have impaired intestinal barrier, bacterial translocation and endotoxemia are common [22]. In certain studies, a local prothrombotic state has been described in the portal circulation, with lower levels of proteins C and S and higher levels of factor VIII and platelet activation, compared to peripheral circulation [15]. Finally, the presence of portal hypertension may lead to endothelial damage and may reduce the blood flow velocity in the portal vein [22]. Significant alterations of the endothelium have been highlighted in the portal veins of cirrhotic patients with portal hypertension compared to other peripheral veins [23].
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
Portal hypertension (PHT) occurs when there is elevated pressure within the portal venous system, including the main portal vein and the many tributary veins that drain into it. PHT is defined as a portal pressure greater than 10 mmHg or as elevation of the hepatic venous pressure gradient to >4 mmHg. In children, diagnosis and management decisions are challenging due to the breadth and complexity of etiopathogenic conditions, many of which are rare and unique to pediatrics. Decompression of the portal venous system using a shunt connecting the portal and systemic venous system performed surgically or by interventional radiographic procedures is the mainstay for non-transplant intervention when complications arise in young patients with PHT; however, the use of pharmacotherapy as an adjunctive intervention remains an area of intense interest given their non-invasive nature and effectiveness in adults.
Multifocal gastrointestinal varices: a rare manifestation of immunoglobulin G4-related disease
Published in Postgraduate Medicine, 2019
Gastroesophageal varices are often caused by liver cirrhosis-related intrahepatic PH. EcV can be caused by PH or segmental blockages of the portal venous system [1,3,4]. For example, many patients with isolated duodenal varices have extrahepatic PH caused by thrombosis of the portal or splenic vein [2,3]. Similarly, colonic varices in patients without PH are either idiopathic or secondary to other diseases such as congenital or iatrogenic anomalies in portal venous outflow [2,5]. Idiopathic colonic varices usually occur throughout the whole colon, whereas colonic varices caused by anomalies in the portal venous outflow tend to be located at the draining areas of either the superior or inferior mesenteric vein [5]. Our case exhibited both duodenal and transverse colonic varices but not liver cirrhosis. Obliteration of the splenic and superior mesenteric veins caused by IgG4-related disease was confirmed through a CT scan, pancreatic biopsy, and surgical findings.