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PORTAL HYPERTENSION
– CAUSES AND
COMPLICATIONS
Edited by Dmitry V. Garbuzenko
Portal Hypertension – Causes and Complications
Edited by Dmitry V. Garbuzenko
Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia
Copyright © 2012 InTech
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Technical Editor Teodora Smiljanic
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First published March, 2012
Printed in Croatia
A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from orders@intechweb.org
Portal Hypertension – Causes and Complications, Edited by Dmitry V. Garbuzenko
p. cm.
ISBN 978-953-51-0251-9
Contents
Preface IX
Chapter 1 The Molecules: Abnormal
Vasculatures in the Splanchnic
and Systemic Circulation in Portal Hypertension 1
Yasuko Iwakiri
Chapter 2 Cystic Fibrosis Liver Disease 27
Andrew Low and Nabil A. Jarad
Chapter 3 Extra Hepatic Portal
Venous Obstruction in Children 41
Narendra K. Arora and Manoja K. Das
Chapter 4 Portal Vein Thrombosis
with Cavernous Transformation
in Myeloproliferative Disorders: Review Update 65
Anca Rosu, Cristian Searpe and Mihai Popescu
Chapter 5 The Bacterial Endotoxins Levels
in the Blood of Cirrhotic Patients as Predictor
of the Risk of Esophageal Varices Bleeding 85
Dmitry Garbuzenko, Alexandr Mikurov and Dmitry Smirnov
Chapter 6 Traditional Chinese Medicine
Can Improve Liver Microcirculation
and Reduce Portal Hypertension in Liver Cirrhosis 93
Xu Lieming, Gu Jie, Lu Xiong, Zhou Yang,
Tian Tian, Zhang Jie and Xu Hong
Chapter 7 Role of Manganese as Mediator
of Central Nervous System:
Alteration in Experimental Portal Hypertension 121
Juan Pablo Prestifilippo, Silvina Tallis,
Amalia Delfante, Pablo Souto,
Juan Carlos Perazzo and Gabriela Beatriz Acosta
VI Contents
Chapter 8 Changes of Peripheral Blood Cells
in Patients with Cirrhotic Portal Hypertension 133
Lv Yunfu
Preface
Portal hypertension is a clinical syndrome defined by a portal venous pressure
gradient exceeding 5 mm Hg. It is initiated by increased outflow resistance, and can
occur at a presinusoidal (intra- or extrahepatic), sinusoidal, or postsinusoidal level. As
the condition progresses, there is a rise in portal blood flow, a combination that mains
and worsens the portal hypertension.
Cirrhosis is the most common cause of portal hypertension in the Western world.
There are more rare intrahepatic causes of portal hypertension, such as cystic fibrosis
liver disease. Extra hepatic portal venous obstruction is found mainly at children, and
it can also be caused by myeloproliferative diseases.
In cirrhosis, the principal site of increased resistance to outflow of portal venous blood
is within the liver itself. Mesenteric arterial vasodilation is hallmark of cirrhosis and
contributes to both increased portal venous inflow and a systemic hyperdinamic
circulatory state. Arterial vasodilatation is regulated by a complex interplay of various
vasodilator molecules and factors that influence the production of those vasodilator
molecules.
Portal hypertension is associated with severe complications, including ascites, hepatic
encephalopathy, hypersplenism, bleeding from gastro-esophageal varices. Despite the
progress achieved over last decades, the 6-week mortality associated with variceal
bleeding is still in the order of 10-20%. Endoscopic assessment of esophageal varices
and the state of esophageal and stomach mucosa at the esophagogastroduodenoscopy,
presents high importance for the assessment of risk of their development. However,
invasiveness as well as discomfort that are tolerated by patients during the given
procedure, lead to the rejection from it and therefore they can’t be subjected to
examination in a number of cases. Beside that, the research might be impossible to
carry out in case if the state of patient is grave. The investigation of hepatic venous
pressure gradient, that reflects the portal hypertension intensity best of all, haven`t
been realized in the clinical practice up to now. Considering the above mentioned
disadvantages of main methods, the development of additional prognostic criteria of
the risk of esophageal varices bleeding remains the urgent problem of the internal
medicine.
X Preface
Current methods of treatments in portal hypertension include farmacologic therapy by
vasoactive drugs, endoscopic therapy, portosystemic shunt surgery and transjugular
intrahepatic portosystemic shunts (TIPS). Expansion in the knowledge of
pathophysiology of portal hypertension is need as this might provide new and useful
strategies for the future. The described problems above associated mainly with portal
hypertension are presented in this book.
Dmitry V. Garbuzenko
Department of Surgical Diseases and Urology,
Chelyabinsk State Medical Academy, Chelyabinsk,
Russia
. PORTAL HYPERTENSION
– CAUSES AND
COMPLICATIONS
Edited by Dmitry V. Garbuzenko
Portal Hypertension – Causes and Complications. Esophageal Varices Bleeding 85
Dmitry Garbuzenko, Alexandr Mikurov and Dmitry Smirnov
Chapter 6 Traditional Chinese Medicine
Can Improve Liver Microcirculation
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