Understanding the Pathophysiology of Portosystemic Shunt by Simulation Using an Electric Circuit

Kim, Moonhwan; Lee, Keon-Young

doi:10.1155/2016/2097363

Cited by 10 publications

(4 citation statements)

References 30 publications

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“…Kim and Lee have proposed an “electric circuit” theory for the development of SPSS based on the Ohm's law and deduced treatment options and outcomes based on the same [ 30 ]. The authors suggest two variables which are primarily responsible for the recruitment of preformed embryonic channels that eventually lead to the formation of SPSS—an increase in portal venous pressure (PVP) and the decrease in shunt resistance (SR).…”

Section: Pathophysiology and Hemodynamics Of Spss Formationmentioning

confidence: 99%

Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects

Rajesh

Philips

Ahamed

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Portal hypertension (PHT) in cirrhosis results from increased resistance to splanchnic blood flow secondary to parenchymal and vascular changes within the liver. In an attempt to counteract the increased portal pressure, two mechanisms simultaneously occur: splanchnic vasodilatation and formation of spontaneous portosystemic shunts (SPSS). Long considered to be a compensatory mechanism to decompress the portal venous system, it is now well established that SPSS are not only inefficient in decreasing the portal pressure but also contribute to reduced hepatocyte perfusion and increased splanchnic blood flow and resistance, associated with worsening PHT. Recent studies have described a high prevalence of SPSS in cirrhosis patients, increasing with liver dysfunction, and observed an association between the presence of SPSS and worse clinical outcomes. In cirrhosis patients with preserved liver functions, the presence of SPSS independently increases the risk of hepatic encephalopathy, variceal bleeding, and ascites, and reduces transplant-free survival. Moreover, the presence of SPSS in patients undergoing transjugular intrahepatic portosystemic shunting and liver transplant has been shown to variably affect the postprocedural outcome. This article provides an overview of the current understanding of the role of SPSS in the natural history of liver cirrhosis and their status as a therapeutic target and an imaging biomarker to identify patients at higher risk of developing complications of PHT.

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Section: Pathophysiology and Hemodynamics Of Spss Formationmentioning

confidence: 99%

Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects

Rajesh

Philips

Ahamed

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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show abstract

“…An explanatory model for the compensatory mechanism and development of SPSSs has been proposed, equating it to an electrical circuit. 54 The authors rely on Ohm’s law to propose two variables involved. The increase in portal venous pressure (PVP) and the decrease in shunt resistance (SR), defining the shunt flow as PVP/SR.…”

Section: Pathophysiologymentioning

confidence: 99%

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Vidal‐González

Quiroga

Simón-Talero

et al. 2020

Therap Adv Gastroenterol

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Portal hypertension is the main consequence of liver cirrhosis, leading to severe complications such as variceal hemorrhage, ascites or hepatic encephalopathy. As an attempt to decompress the portal venous system, portal flow is derived into the systemic venous system through spontaneous portosystemic shunts (SPSSs), bypassing the liver. In this review, we aim to provide an overview of the published reports in relation to the prevalence and physiopathology behind the appearance of SPSS in liver cirrhosis, as well as the complications derived from its formation and its management. The role of SPSS embolization is specifically discussed, as SPSSs have been assessed as a therapeutic target, mainly for patients with recurrent/persistent hepatic encephalopathy and preserved liver function. Furthermore, different aspects of the role of SPSS in liver transplantation, as well as in candidates for transjugular intrahepatic portosystemic shunt are reviewed. In these settings, SPSS occlusion has been proposed to minimize possible deleterious effects, but results are so far inconclusive.

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“…A portosystemic shunt is a communication between the portal vein and the systemic vein, and it is caused by a congenital malformation, liver cirrhosis or trauma. Portosystemic shunts can be found incidentally in the absence of other signs of portal hypertension[ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Autoimmune hepatitis in a patient with immunoglobulin A nephropathy: A case report

Jeon

Kim

Lee

et al. 2020

WJCC

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BACKGROUND Immunoglobulin A nephropathy (IgAN) is the most commonly encountered glomerular disease in Asian countries. It has a broad clinical presentation, and it is frequently associated with other conditions. Chronic liver disease is well recognized as the leading cause of secondary IgAN. However, cases of IgAN associated with autoimmune hepatitis (AIH) have seldom been reported. CASE SUMMARY A 63-year-old Korean woman was admitted to Pusan National University Hospital for an evaluation of abdominal pain and elevated liver enzymes. Two weeks prior, she had presented to our hospital with proteinuria of approximately 1350 mg/d and hematuria and was diagnosed with IgAN. Autoimmune profiles were highly positive for antinuclear antibodies, and symptoms related to portal hypertension including ascites and peripheral edema were present. A diagnosis of AIH was made according to the simplified scoring system of the International Autoimmune Hepatitis Group. Despite immunosuppression with prednisolone and azathioprine, rapid deterioration of liver function led to end-stage liver disease. After a living-donor liver transplantation, liver function gradually improved, and she had maintained stable liver and kidney function at the six months follow-up. CONCLUSION Cases of secondary IgAN with chronic liver disease have been frequently reported in the literature but are rarely associated with AIH. We encountered an IgAN patient with concurrent progressive liver failure due to AIH.

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Understanding the Pathophysiology of Portosystemic Shunt by Simulation Using an Electric Circuit

Cited by 10 publications

References 30 publications

Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects

Friend or Foe? Spontaneous Portosystemic Shunts in Cirrhosis—Current Understanding and Future Prospects

Spontaneous portosystemic shunts in liver cirrhosis: new approaches to an old problem

Autoimmune hepatitis in a patient with immunoglobulin A nephropathy: A case report

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