A New Approach to Evaluating Hepatic Blood Flow in the Presence of Intrahepatic Portal Systemic Shunting

Gross, Gilbert; Goldberg, Henry I.; Shames, David M.

doi:10.1097/00004424-197603000-00010

Cited by 7 publications

(3 citation statements)

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“…Obstruction of the portal venous flow produces portal hypertension that eventually leads to both intra· 19 and extrahepatic portosystemic anastomoses. The cardiac region of the stomach is a frequent area of compensation (coronary vein/right gastric vein ; gastroesophageal veins; azygoslhemi- azygos veins ; splenic vein/intrasplenic vessels ; vein of gastric fundus ; periesophageal veins}.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound detection of unusual spontaneous portosystemic shunts associated with uncomplicated portal hypertension.

Candio¹,

Campatelli²,

Mosca³

et al. 1985

Journal of Ultrasound in Medicine

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Seven cases of unusual spontaneous portosystemic shunts observed by ultrasonography in the last 8 months are reported, including mses of coronary vein varicocele and patent umbilical vein; two cases of spleno-retroperitoneal anastomosis. ; omphalo-ilio-caval anastomosis; superior mesenteric vein-inferior vena cava anastomosis~ spleno-renal anastomosis; and spleno-portal anastomosis and anastomosis from the splenic vein to the abdominal wall. One of these collateral vessels was also analyzed by pulsed Doppler flowmetry. The patients were either cirrhotic or had pre-hepatic portal hypertension (resulting from chronic pancreatitis) and gave no history of gastrointestinal bleeding or ascites. Two of these patients had previously undergone surgery for problems associated with cholestasis. In both cases, presurgical sonogmphic studies were used to guide the surgical procedures in the hope of preserving the anomalous connections. Furthermore, ultrasound detection of spontaneous portosystemic shunts was an important factor in interpreting the clinical symptoms of these patients. (Key words: portal hypertension ; portosystemic shunts, spontaneous)Real-time ultrasonography allows visualization of splanchnic vessels in patients with portal hypertension even though they may be asymptomatic and, therefore. not candidates for more invasive techniques. Only 15 per cent of patients with cirrhosis and 18 per cent of those with esophageal varices present with a gastrointestinal hemorrhage that would justify the use of arteriography, splenoportography, and/or percutaneous transhepatic portography prior to establishing the surgical approach. 1Collateral circulation via the umbilical vein, 2 -5 dilatation of the portal vein and its tributaries, and the absence of respiratory caliber variation in the splenic and/or superior mesenteric vein, 6 ·i with or without dilatation, are signs of portal hypertension that are routinely detected by ultrasonography. Promising findings have also been obtained by the analysis of portal vein flow with the echo-Doppler method. 8 Many authors have also reported signs of altemtion of the portal trunk, such as aneurysm 9 and thrombosis 10 with cavernous transformation 11 and neoplastic invasion, t 2 • 13 that confirm the ability of ultrasonography to furnish a preliminary diagnosis of the location and cause of obstruction. Reports on spontaneous collateral venous circulation are less common. 1 " -18 The frequency of these anomalies is still uncertain and some doubts exist as to their efficiency in decreasing pressure within the portal venous system. In order to further clarify the ultrasound appearances of spontaneous portosystemic connections and to stress the importance of visualization of these vessels prior to abdominal surgery, we report seven cases of spontaneous portosystemic shunts presenting peculiar morphologic and/or clinical characteristics observed by ultrasonography in the last 8 months.

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Section: Discussionmentioning

confidence: 99%

Ultrasound detection of unusual spontaneous portosystemic shunts associated with uncomplicated portal hypertension.

Candio¹,

Campatelli²,

Mosca³

et al. 1985

Journal of Ultrasound in Medicine

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“…However, these studies [4,9,17] have only taken clinical signs of portal-systemic shunting or the ammonia tolerance test [18] into consideration, and have ignored the presence of intrahepatic shunts [19] which may be extensive [14]. Furthermore, ammonia tolerance may be normal in the presence of extensive portal-systemic shunting when hepatocellular function is well preserved [20], but becomes abnormal when hepatocellular function declines [21].…”

Section: Discussionmentioning

confidence: 99%

“…Aspartate transaminase, albumin, bilirubin, plasma urea and electrolytes, creatinine and haematology values were performed in the routine hospital laboratory. In the 5 cirrhotic subjects without surgical shunts the degree of portal systemic shunting was measured during transhepatic portography by the method of Gross et al [14]. In the surgically shunted patients complete diversion was assumed for the patients with end to side portacaval anastomoses and follow up portography in the patient with a mesocaval shunt showed complete diversion of splanchnic blood into the systemic circulation.…”

Section: Protocol and Methodsmentioning

confidence: 99%

Hyperglucagonaemia in cirrhosis

et al. 1980

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Plasma glucagon and growth hormone concentrations were measured fasting and after oral glucose in 19 patients with portal vein block with extensive portal-systemic shunting but minimal liver cell damage, 11 cirrhotic patients and 12 matched control subjects. Portal vein block patients and controls had similar fasting glucose and glucagon levels (glucose 3.8 +/- 0.1 mmol/l VS control 3.4 +/- 0.1 mmol/l (mean +/- SEM); glucagon 57.5 +/- 9.1 pg/ml VS control 51.3 +/- 7.8 pg/ml). Cirrhotic patients were hyperglycaemic (cirrhosis 4.3 +/- 0.2 mmol/l VS control 3.4 +/- 0.1 mmol/l, p < 0.01) with significantly elevated glucagon levels (167.3 +/- 61.1 pg/ml VS control 51.3 +/- 7.8 pg/ml, p < 0.05), which suppressed towards control values after oral glucose. There was no correlation between fasting plasma glucagon levels and the degree of portal-systemic shunting in cirrhotic patients. There was a strong correlation between fasting plasma glucagon concentrations and aspartate transaminase levels (r = 0.68; p < 0.01) in cirrhotic and portal vein block patients. Significant elevations of growth hormone were seen only in cirrhotic patients. It is concluded that hyperglucagonaemia is a feature of hepatocellular damage rather than portal-systemic shunting but the relationship between elevated glucagon and growth hormone concentrations and carbohydrate intolerance in cirrhosis remains unclear.

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Measurements of liver haemodynamics

Ackery¹

1991

Nuclear Medicine in Gastroenterology

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A New Approach to Evaluating Hepatic Blood Flow in the Presence of Intrahepatic Portal Systemic Shunting

Cited by 7 publications

References 0 publications

Ultrasound detection of unusual spontaneous portosystemic shunts associated with uncomplicated portal hypertension.

Ultrasound detection of unusual spontaneous portosystemic shunts associated with uncomplicated portal hypertension.

Hyperglucagonaemia in cirrhosis

Measurements of liver haemodynamics

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