Hepatic Artery Hypertrophy and Sinusoidal Hypertension in Advanced Schistosomiasis

Alves, Carlos Alberto Paes; Alves, Álvaro; Abreu, Waldeck Neves; Andrade, Zilton A.

doi:10.1016/s0016-5085(77)80315-6

Cited by 28 publications

(5 citation statements)

References 7 publications

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“…In 16 patients with a previous history of gastrointestinal bleeding, our group measured the total liver blood flow by the method of single dose indocyanine green [23], and obtained an average of 1,408.75 +_ 537.60 ml/min. Some authors report that in patients with mansonic schistosomiasis and portal hypertension there is hypertrophy of the hepatic artery so that in these patients, similar to what is seen in patients with cirrhosis, the liver would depend more heavily on the arterial blood supply [24][25][26][27]. Our group, however, has a different opinion.…”

Section: General Considerationsmentioning

confidence: 75%

“…It should be kept in mind that most of the studies reporting arterial hypertrophy were done in cadaver livers, in which the hemodynamic interrelation between hepatic artery and portal vein blood flows is completely lacking. The study done by Paes Alves and co-workers [26], concluding that there is arterial hypertrophy and a reduced portal blood flow, based its conclusions on a reduced hepatic wedged pressure found after the hepatic artery was clamped. Their report also allows several other considerations.…”

Section: General Considerationsmentioning

confidence: 99%

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Surgical treatment of portal hypertension in schistosomiasis

1984

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Patients with mansonic schistosomiasis and portal hypertension are usually young, with good liver functional reserve, huge splenomegaly, and hypersplenism detectable only by alterations seen in laboratory tests. Patients who are not operated on do not develop portosystemic encephalopathy (PSE). Angiographic alterations are characteristic and totally different from those observed in patients with liver atrophy or cirrhosis. Digestive tract hemorrhage is the most severe complication. The patient with schistosomiasis is, therefore, a good model for the study of the consequences caused by the surgical treatment of portal hypertension. The evaluation, however, of results published in the literature regarding schistosomiasis is practically impossible. In a review of 130 publications referring to 4,516 surgically treated patients, the absence of prospective or retrospective studies with adequate controls was observed, and only 3.2% of the patients were followed for 5 years. According to available data, a total of 29 different surgical techniques has been employed, 81.6% of which are represented by simple splenectomy, esophagogastric devascularization (EGDS), and splenorenal shunt (SRS). Splenectomy was the surgical procedure showing the highest rate of recurrent hemorrhage (54.3 %), and the portocaval shunt had the highest PSE incidence (60 %). Portosystemic encephalopathy incidence after SRS was 29%.Thus, in view of a lack of objective information, in 1977 our group started a prospective, randomized study comparing the results of the surgical procedures most widely used in our country: selective portal decompression (SPD), EGDS, and SRS. The randomization was interrupted after 94 patients had been operated on (32 SRS, 30 SPD, and 32 EGDS) because of a highly significant PSE incidence in the SRS group. Preliminary results as of January, 1984, refer to an average follow-up period of 53 months (minimum 29, maximum 77 months). In the SRS group, the late mortality rate was 18.7%, and the incidence of PSE was 31.2%. Among the patients included in this group, 18.7%

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Section: General Considerationsmentioning

confidence: 75%

Section: General Considerationsmentioning

confidence: 99%

Surgical treatment of portal hypertension in schistosomiasis

1984

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“…The mean hepatic venous pressure gradient was not significantly different between patients with hepatic schistosomiasis and controls. In hepatic schistosomiasis, indexed hepatic blood flow was normal compared to normal laboratory values (0.8720.19 1min-' * m-2) (17) and azygos blood flow was increased (normal values: worms and eggs (7,9) and the latter may be a result, at least in part, of hypersplenism ( 5 , 18).…”

Section: Resultsmentioning

confidence: 99%

Systemic and splanchnic hemodynamic changes in patients with hepatic schistosomiasis

Denié¹,

Vachiéry²,

Elman³

et al. 1997

Hepatology Research

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“…130,131 This may be due to development of perisinusoidal fibrosis 132 or increased arterial supply to the liver sinusoids or focal nodulation of hepatic parenchyma. 133 For bleeding varices all forms of medical and surgical therapies have been tried. Endoscopic band ligation has shown encouraging results.…”

Section: Hepatic Schistosomiasismentioning

confidence: 99%

Intrahepatic Portal Venopathy and Related Disorders of the Liver

Chawla

Dhiman

2008

Semin Liver Dis

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Intrahepatic portal venopathy leads to various entities that are important causes of portal hypertension. Noncirrhotic portal fibrosis (NCPF) occurs in the Indian subcontinent, whereas idiopathic portal hypertension (IPH) occurs in Japan although the pathogenesis and presentation of both are similar. NCPF presents mainly with upper gastrointestinal bleeding; IPH presents with massive splenomegaly. The liver functions are preserved. Wedged hepatic venous pressure is normal, but portal venous pressure is high indicating a presinusoidal block. Patients are best managed with endoscopic therapy or surgery, with better results than in patients with cirrhosis. Nodular regenerative hyperplasia is a histological diagnosis characterized by development of nodules in the liver due to uneven perfusion of the portal venous blood. These patients may develop portal hypertension and if they bleed would require treatment as in NCPF/IPH. Schistosomiasis produces portal hypertension by the development of fibrous tissue around the portal veins as a response to schistosome eggs. Gratifying results have been reported with praziquantel therapy. Rarely sarcoidosis and chronic biliary obstruction may also produce portal venopathy.

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Hepatic Artery Hypertrophy and Sinusoidal Hypertension in Advanced Schistosomiasis

Cited by 28 publications

References 7 publications

Surgical treatment of portal hypertension in schistosomiasis

Surgical treatment of portal hypertension in schistosomiasis

Systemic and splanchnic hemodynamic changes in patients with hepatic schistosomiasis

Intrahepatic Portal Venopathy and Related Disorders of the Liver

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