Spleen Size and Portal Hypertension in Cirrhosis

Abstract

In 210 patients with cirrhosis of the liver there was no correlation between spleen size and the rise in portal pressure, whether measured directly or assessed clinically from the size of varices on barium swallow and the presence of ascites. Despite this, there was a correlation between the occurrence of bleeding as a presenting symptom and the size of varices assessed radiologically.

Portosystemic shunts in a large cohort of patients with liver cirrhosis: detection rate and clinical relevance

“…In contradiction to Westaby et al, 27 who found no correlation between spleen size and the rise in portal pressure, this study demonstrated a signifi cant positive correlation between PD and SA. In addition, significantly higher values of both SA and PD were found in patients belonging to Child's class C and in those with EVs.…”

The Complete Spleen

“…The height of the venous pressure is not itself the major determinant of the size of the spleen, which in this condition averages 900 g, but occasionally may exceed 3 kg. Venous congestion alone usually does not produce a spleen palpable below the costal margin: Westaby et al (1978) found no correlation between spleen size and portal pressure, which confirmed an earlier study by Krook (1956), showing no significant difference in hepatic wedge pressures between cirrhotic patients with and without splenomegaly. The duration of the condition is a more important determinant of spleen size than the level of venous pressure.…”

Splenic hemodynamics and decreased endothelial nitric oxide synthase in the spleen of rats with liver cirrhosis

“…Therefore, we consider, at least in part, that splenic congestion is one of the reasons for the splenic enlargement. However, such congestion cannot be considered as the only cause of the enlarged spleen in liver cirrhosis, since no relationship was found between the spleen size and PVP (Witte et al, 1974;Westaby et al, 1978;Merkel et al, 1985;Shah et al, 1996). Previous histological studies have demonstrated not only pooling of blood in the red pulp but also hyperplasia of the histiocytes with increased numbers of reticular fibers and subcapsular myofibroblasts in the spleen of portal hypertension (Manenti et al, 1993).…”

“…Splenic congestion due to portal hypertension has been reported to play a part in this increase in spleen size (Bolognesi et al, 2002). However, such congestion cannot be considered as the only cause of the enlarged spleen in liver cirrhosis, since no relationship was found between the spleen size and PVP (Witte et al, 1974;Westaby et al, 1978;Merkel et al, 1985;Shah et al, 1996). Previous reports have demonstrated that the blood flows of the splenic artery and vein are increased in patients with liver cirrhosis (Witte et al, 1974;Takagi et al, 1994;Zwiebel et al, 1995), indicating active congestion of the spleen.…”