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At least 613 records · Page 34Linked to original sources

PubMed1996

Is portal hypertension due to liver cirrhosis a major factor in the development of portal hypertensive gastropathy?

OBJECTIVES: The gastric mucosa of patients with portal hypertension frequently manifests changes in its appearance that are readily identifiable by endoscopy. Many of these can be sources of bleeding, and some imply the presence of systemic disease. Although portal hypertension is critical in development of portal hypertensive gastropathy (PHG), the role that other factors might play in its pathogenesis is uncertain. METHODS: Four groups of subjects were studied prospectively: 37 with portal hypertension due to cirrhosis, 26 noncirrhotic subjects with portal hypertension due to extrahepatic portal vein obstruction (PVO), nine cirrhotic patients with extrahepatic PVO, and 57 control subjects. The diagnosis in each case was based on a combination of clinical data, needle liver biopsy, ultrasonography, splenoportography, and upper GI endoscopy. RESULTS: Snake skin, scarlatina rash, diffuse hyperemia, and diffuse bleeding were frequent endoscopic gastric findings in cirrhotic patients. These findings were seen less frequently in noncirrhotic patients with portal hypertension due to PVO than in cirrhotic patients (p< 0.0001). The highest incidence was seen in cirrhotic patients with PVO (P< 0.001). Positive correlations existed among the endoscopic findings, the clinical estimate of the cirrhosis severity (Child-Pugh grade), and the size and appearance of esophageal varices (Beppu score). No endoscopic findings of the gastric mucosa enabled one to distinguish between groups. Hypergastrinemia was present in cirrhotics with and without PVO but not in noncirrhotic patients with portal hypertension resulting from isolated PVO. CONCLUSION: These findings suggest that the endoscopic findings of PHG are affected by the severity of the underlying liver disease and the presence or absence of coexisting PVO. There is no association between PHG and the presence of gastric varices. Thus, the development of the gastric lesions characteristic of PHG requires not only portal hypertension but also some other consequence of parenchymal liver disease.

Adult↗

PubMed1995

Significance of isolated gastric varices among Chinese patients.

BACKGROUND: Isolated gastric varices rarely occurs, and was considered as a hint of pancreatic disease rather than liver cirrhosis. Recently, the frequency of acute gastrointestinal bleeding secondary to isolated gastric varices tended to increase among cirrhotic patients. We therefore conducted this retrospective study to analyze its possible etiologies. METHODS: Thirty-six cases of isolated gastric varices were found in an extensive review of the endoscopic records at our hospital from 1984 to 1993. Gastric varices developed after injection sclerotherapy of esophageal varices were excluded. Medical records were reviewed to determine their etiologies. RESULTS: The underlying disorders of these 36 patients included liver cirrhosis in 26 patients (72.2%), pancreatic diseases in 7 patients (19.4%), myelofibrosis in 1 patient (2.7%), and unknown cause in 2 patients (5.5%). Among those with liver cirrhosis, portal hemodynamic study conducted in 5 patients to find all with a high level of portal venous pressure; angiography conducted in 5 patients also found all with gastric varices. Among those with pancreatic diseases, angiography and/or splenoportography was conducted in 5 patients to evidence all with gastric varices, splenic vein obstruction and splenomegaly. CONCLUSIONS: Isolated gastric varices identified in endoscopy can first strongly suggests the presence of liver cirrhosis with portal hypertension. Pancreatic diseases complicating with splenic vein obstruction is the second possible underlying etiology.

Adult↗

PubMed1977

Pre-operative angiographic assessment of portal venous hypertension.

Fifty-three patients with portal venous hypertension underwent angiographic evaluation of the portal venous system. Arteriography was found to provide adequate opacification of the portal system in 52 patients. Arterial portography is a safer method than splenoportography and provides informaiton not obtainable by the latter method. Thus, hepatic arteriography demonstrated 2 unsuspected hepatomas in the present series. Catheterization of the hepatic veins and measurement of the wedged hepatic venous pressure provide a reliable estimate of the total portal pressure and of the severity of the portal venous hypertension. Vena caval pressure measurements and inferior vena cavography are helpful in the diagnosis of surprahepatic causes of portal hypertension, such as constrictive pericarditis and inferior vena caval diaphragm, and are also useful in the diagnosis of vena caval hypertension due to caudate lobe enlargement. Combined arteriography and venous studies are recommended as the initial radiological approach in all patients with portal hypertension who are being considered for portal-systemic shunt surgery.

Adolescent↗

PubMedDate not supplied

[Transitory hepatic peliosis in a child].

A case of hepatic peliosis in a 4 year old child is reported. The exceptional character of such a presentation in a child, along with its reversibility, are emphasized. The hepatogram performed during splenoportography showed numerous little granular pictures, which probably corresponded to the opacification of "peliotic" cavities. The mechanism of hepatic peliosis remains unknown in this case, except that it occurred in a child with poor general condition.

Child, Preschool↗

PubMed1976

Portal vein thrombosis resulting in portal hypertension in adults.

Attempting to elucidate the best way to treat adult patients with extrahepatic portal vein occlusive thrombosis, the experience with six such patients is analyzed. Portal vein thrombosis rarely occurs in adults but when it does, it frequently results in portal hypertension with its concomitant complications. Five patients had bleeding esophageal varices, two had massive refractory ascites. Their conventional liver function tests were not greatly altered. Thrombocytosis and history of thrombophlebitis were encountered in over half of the patients. Splenoportography is the best method to confirm the diagnosis preoperatively. In none of the six patients a decompressive portal systemic shunt could be performed although, it was attempted in five. Three patients survived. It appears that nonoperative management is the treatment of choice in these patients who can remain well for several years, however, when bleeding recurs gastric devascularization or even resective procedures are acceptable therapeutic alternatives.

Adult↗

PubMed1976

[Radiological diagnosis of echinococcus disease in man (author's transl)].

The position of radiological diagnostics in the context of the diagnosis of echinococcosis was discussed on the basis of 11 examined cases of Echinococcus cysticus (9) and Echinococcus alveolaris (2). General thoracic x-rays as well as radiological examination of the gastrointestinal track and the kidneys were used to establish the extent of echinococcosis and to determine the involvement of neighboring organs. Diagnosis of the liver is generally of major interest diagnostically. With a scintigram of the liver, parenchymatous lesions of 2-4 cm and larger can be diagnosed with an optimal examination technique. The scintigram used in connection with the arteriogram can clarify the extent of the parenchymatous lesions. The celiacogram is the most important of the morphological liver diagnostic methods. It can be augmented by the selective hepaticogramm. An exact localization and the relationship of the process to the vessels is possible only with the celiacogram. In addition, the exclusion of other liver processes for the differential diagnosis is possible with the angiogram. The direct splenoportography is for the most part, replaced today by the indirect splenoportogram, it is only used now for special problems.

Celiac Artery↗

PubMed1965