Flow Rate and Composition of Thoracic-Duct Lymph in Patients with Cirrhosis

Dumont, Allan E.; Mulholland, John H.

doi:10.1056/nejm196009082631001

Cited by 190 publications

(78 citation statements)

References 8 publications

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“…In patients with portal hypertension, hepatic hilar lymphatics become distended and obstruct the hepatic venules. This phenomenon of increased lymph production in patients with advanced liver diseases is caused by disturbance in the drainage of vascular flow from the sinusoid to the central or terminal hepatic veins associated with lobular distortion [7,19,20].…”

Section: Discussionmentioning

confidence: 99%

Dilated cisternae chyli: a sign of uncompensated cirrhosis at MR imaging

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Dilated cisternae chyli: a sign of uncompensated cirrhosis at MR imaging

et al. 2008

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“…[16][17][18] Other proposed mechanisms, which are mostly speculative, include an increase in azygous vein pressure and flow leading to leakage of plasma, 19 fluid traversing from the abdominal cavity to pleural space across transdiaphragmatic lymphatics, 20 hypoalbuminaemia with decreased colloid osmotic pressure 21 and leakage of the thoracic duct. 22 Although not specifically addressed in hepatic hydrothorax, the rate of reabsorption of ascites back into the intravascular compartment could also play an important role in the pathogenesis of hepatic hydrothorax. 23 …”

Section: 12mentioning

confidence: 99%

Hepatic hydrothorax

Cárdenas

Kelleher

Chopra

2004

Aliment Pharmacol Ther

149

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SUMMARYPatients with cirrhosis and portal hypertension often have abnormal extracellular fluid volume regulation, resulting in accumulation of fluid as ascites, oedema or pleural effusion. These complications carry a poor prognosis with nearly half of the patients with ascites dying in the ensuing 2-3 years. In contrast to what happens in the abdominal cavity where large amounts of fluid (5-8 L) accumulate with the patient only experiencing only mild symptoms, in the thoracic cavity smaller amounts of fluid (1-2 L) cause severe symptoms such as shortness of breath, cough and hypoxaemia. Hepatic hydrothorax is defined as a pleural effusion, usually >500 mL, in patients with cirrhosis without cardiopulmonary disease. The pathophysiology involves the direct movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. The estimated prevalence among cirrhotic patients is 5-10%. The effusion, which is a transudate, most commonly occurs in the right hemithorax. The mainstay of therapy is similar to that of portal hypertensive ascites and includes sodium restriction and administration of diuretics. Refractory hydrothorax can be managed with transjugular intrahepatic portosystemic shunt in selected cases. Pleurodesis is not routinely recommended. Suitable patients with hepatic hydrothorax should be considered candidates for liver transplantation.

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“…It is a relatively uncommon complication of end-stage liver disease, with an estimated prevalence among cirrhotic patients of 5% to 10% [1,[3][4][5] . Although the exact mechanisms involved in the development of HH have not been completely elucidated, the most widely accepted mechanism is the passage of fluid from the peritoneal to the pleural cavity through diaphragmatic defects, usually less than 1 cm in diameter [6][7][8][9] . The one way flow of the ascitic fluid into the pleural cavity is also thought to be influenced by the negative intrathoracic pressure.…”

Section: Introductionmentioning

confidence: 99%

“…The treatment strategies for RHH are similar but not identical to those for refractory ascites. In patients with prerenal azotemia, therapeutic thoracentesis as a longterm regular treatment is not recommended because of the risk for bleeding and pneumothorax [6] . Transjugular intrahepatic portosystemic stent shunt (TIPSS) is a nonsurgical, angiographic technique of reducing hepatic sinusoidal pressure, which then results in a reduction in the accumulation of fluid in the peritoneal and pleural space.…”

Section: Introductionmentioning

confidence: 99%

Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

Ditah¹

2015

WJH

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AIM:To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis. METHODS:A comprehensive literature search was conducted on MEDLINE, EMBASE, and PubMed covering the period from January 1970 to August 2014. Two authors independently selected and abstracted data from eligible studies. Data were summarized using a random-effects model. Heterogeneity was assessed using the I 2 test. RESULTS:Six studies involving a total of 198 patients were included in the analysis. The mean (SD) age of patients was 56 (1.8) years. Most patients (56.9%) had Child-Turcott-Pugh class C disease. The mean duration of follow-up was 10 mo (range, 5.7-16 mo). Response to TIPSS was complete in 55.8% (95%CI: 44.7%-66.9%), partial in 17.6% (95%CI: 10.9%-24.2%), and absent in 21.2% (95%CI: 14.2%-28.3%). The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mmHg. The incidence of TIPSS-related encephalopathy was 11.7% (95%CI: 6.3%-17.2%), and the 45-d mortality was 17.7% (95%CI: 11.34%-24.13%). CONCLUSION:TIPSS is associated with a clinically relevant response in RHH. TIPSS should be considered early in these patients, given its poor prognosis. Core tip: Evidence on the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in patients with refractory hepatic hydrothorax (RHH) is scarce and variable. This paper summarizes available data on the effectiveness of TIPSS in RHH in a cumulative meta-analysis. The sum total of the evidence shows that TIPSS is associated with a clinically relevant response in three-quarters of patients with medically RHH. We suggest that TIPSS be considered early in patients with RHH, given its impact on quality of life and prognosis. However, caution should be exercised in older patients and those with severe underlying liver or renal dysfunction.Ditah IC, Al Bawardy BF, Saberi B, Ditah C, Kamath PS. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis. World

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Flow Rate and Composition of Thoracic-Duct Lymph in Patients with Cirrhosis

Cited by 190 publications

References 8 publications

Dilated cisternae chyli: a sign of uncompensated cirrhosis at MR imaging

Dilated cisternae chyli: a sign of uncompensated cirrhosis at MR imaging

Hepatic hydrothorax

Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

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