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Book Details
Abstract
Dr. Herrera has created an issue that will serve as a complete update on the topic of Portal Hpertension. Content is provided from medical therapies to surgery on the patient with portal hypertension. The following important issues are addressed: Invasive and Noninvasive Methods of Measuring Portal Pressure; Primary Prophylaxis of Varceal Bleeding; Gastric and Ectopic Varices; Hepatic Hydrothorax; and Hepatopulmonary Syndrome. Readers will come away with state-of-the-art information on the topic of portal hypertension.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Portal Hypertension\r | i | ||
| copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Clinics In Liver Disease\r | xi | ||
| Preface\r | xiii | ||
| Pathophysiology of Portal Hypertension | 281 | ||
| Key points | 281 | ||
| Introduction | 281 | ||
| Intrahepatic circulation | 281 | ||
| An Overview | 281 | ||
| Endothelial cell dysfunction | 282 | ||
| Decreased vasodilators | 282 | ||
| Increased vasoconstrictors | 283 | ||
| Activated HSCs | 283 | ||
| Angiogenesis in the liver | 283 | ||
| Extrahepatic circulation | 284 | ||
| An Overview | 284 | ||
| Collateral vessel formation | 284 | ||
| Arterial vasodilation in the splanchnic and systemic circulations | 284 | ||
| Vasodilation | 284 | ||
| Hypocontractility | 285 | ||
| Neural factors | 285 | ||
| Structural changes of arteries | 285 | ||
| Future directions | 285 | ||
| An Overview | 285 | ||
| Microflora/bacterial translocation | 285 | ||
| Stem cell therapy | 286 | ||
| The lymphatic system | 286 | ||
| Splenomegaly | 286 | ||
| Summary | 286 | ||
| References | 286 | ||
| Invasive and Noninvasive Methods to Diagnose Portal Hypertension and Esophageal Varices | 293 | ||
| Key points | 293 | ||
| Introduction | 293 | ||
| Invasive methods to diagnose PH and esophageal varices | 294 | ||
| Measurement of HVPG | 294 | ||
| Endoscopic Evaluation of Esophageal Varices | 295 | ||
| Noninvasive methods proposed for the diagnosis of both PH and esophageal varices | 295 | ||
| Laboratory Tests | 296 | ||
| Abdominal Imaging (Ultrasound Scan, Magnetic Resonance Imaging, Computed Tomography) | 296 | ||
| Liver Stiffness Alone or in Combination | 296 | ||
| Spleen Stiffness | 296 | ||
| Noninvasive methods proposed for the diagnosis of esophageal varices | 297 | ||
| PSR | 297 | ||
| Liver Stiffness Platelet Spleen Index | 297 | ||
| Spleen Stiffness | 297 | ||
| Videocapsule Endoscopy | 297 | ||
| CT Esophagography | 298 | ||
| What do the clinicians really need to know? | 298 | ||
| Diagnosis of PH | 298 | ||
| Presence and Grade of Esophageal Varices | 298 | ||
| Summary | 300 | ||
| References | 300 | ||
| Pharmacologic Management of Portal Hypertension | 303 | ||
| Key points | 303 | ||
| Introduction | 303 | ||
| Drugs used in clinical practice | 304 | ||
| Vasopressin Derivatives | 304 | ||
| Somatostatin and Long-Acting Somatostatin Analogues | 305 | ||
| Nonselective β-Blockers Alone and Combined with Vasodilators | 307 | ||
| Carvedilol | 308 | ||
| Other drugs that decrease portal pressure in humans (but not routinely used) | 309 | ||
| Statins | 309 | ||
| Renin-Angiotensin-Aldosterone System Inhibitors | 309 | ||
| New drugs and strategies in the horizon (under investigation) | 310 | ||
| Etiologic Treatments | 310 | ||
| Obesity | 310 | ||
| Antifibrotic Agents | 310 | ||
| Drugs Reducing Oxidative Stress | 311 | ||
| Ascorbic acid (vitamin C) | 311 | ||
| Tetrahydrobiopterin (BH4) | 311 | ||
| Extracellular superoxide dismutase | 311 | ||
| Fenofibrate (peroxisome proliferator-activated receptor α activator) | 312 | ||
| Resveratrol | 312 | ||
| Dark chocolate | 312 | ||
| Modulation of COX-1 | 312 | ||
| Antibiotics: Rifaximin | 312 | ||
| Antiangiogenetics | 313 | ||
| References | 313 | ||
| Role of Transjugular Intrahepatic Portosystemic Shunt in the Management of Portal Hypertension | 319 | ||
| Key points | 319 | ||
| Introduction: nature of the problem | 319 | ||
| Indications/Contraindications | 321 | ||
| Esophageal Varices | 321 | ||
| Rescue Treatment of Acute Variceal Hemorrhage | 321 | ||
| Preemptive TIPS | 321 | ||
| Secondary Prophylaxis: Prevention of Late Rebleeding | 322 | ||
| Treatment of Gastric Varices | 322 | ||
| Clinical Outcomes: Portal Hypertensive Gastropathy | 322 | ||
| Clinical Outcomes: Gastric Antral Vascular Ectasia | 323 | ||
| Clinical Outcomes: Treatment of Ascites | 323 | ||
| Clinical Outcomes: Hepatic Hydrothorax | 323 | ||
| Clinical Outcomes: Hepatorenal Syndrome | 323 | ||
| Clinical Outcomes: Budd-Chiari | 325 | ||
| Clinical Outcomes: Pulmonary Complications of Portal Hypertension | 325 | ||
| Contraindications | 325 | ||
| Technique/Procedure | 325 | ||
| Assessment | 325 | ||
| Procedure | 326 | ||
| Postoperative Care | 327 | ||
| Complications and management | 328 | ||
| Encephalopathy | 328 | ||
| Cardiac Complications | 328 | ||
| TIPS Dysfunction | 328 | ||
| TIPS-itis | 329 | ||
| Liver Transplantation | 329 | ||
| Summary | 329 | ||
| References | 329 | ||
| Primary Prophylaxis of Variceal Bleeding | 335 | ||
| Key points | 335 | ||
| Introduction | 335 | ||
| Risk for esophageal variceal bleeding | 336 | ||
| Preprimary prophylaxis | 337 | ||
| Prevention of variceal growth | 337 | ||
| Pharmacologic prophylaxis of variceal bleeding | 337 | ||
| Endoscopic prophylaxis | 339 | ||
| Summary | 341 | ||
| References | 341 | ||
| Management of Acute Variceal Bleeding | 347 | ||
| Key points | 347 | ||
| Introduction | 347 | ||
| Airway management | 348 | ||
| Volume resuscitation | 348 | ||
| Vasoactive therapy | 349 | ||
| Antibiotic prophylaxis | 350 | ||
| Endoscopic therapy | 350 | ||
| Rescue therapies | 351 | ||
| Risk stratification to tailor therapy | 353 | ||
| Summary | 355 | ||
| Supplementary data | 355 | ||
| References | 355 | ||
| Secondary Prophylaxis for Esophageal Variceal Bleeding | 359 | ||
| Key points | 359 | ||
| Current recommendations for the prevention of esophageal variceal rebleeding | 360 | ||
| Critical appraisal of current recommendations to prevent esophageal variceal rebleeding | 362 | ||
| Stratification of patients according to their risk of variceal rebleeding | 364 | ||
| Stratification by Hemodynamic Criteria | 364 | ||
| Stratification by Clinical Criteria | 365 | ||
| The TIPS choice | 366 | ||
| References | 367 | ||
| Gastric and Ectopic Varices | 371 | ||
| Key points | 371 | ||
| Embryologic development of the portal venous system | 371 | ||
| GV in cirrhosis | 373 | ||
| Endoscopic Treatment of GV | 377 | ||
| TIPS Treatment of GV | 377 | ||
| Balloon-Occluded Retrograde Transvenous Obliteration Treatment of GV | 378 | ||
| Medical Prophylaxis for GV | 378 | ||
| Duodenal varices | 378 | ||
| Colorectal varices | 379 | ||
| GV and ECV in portal vein thrombosis | 379 | ||
| Cirrhotic PVT and GV/ECV Bleeding | 379 | ||
| Noncirrhotic PVT and GV/ECV Bleeding | 380 | ||
| Noncirrhotic SVT and GV/ECV Bleeding | 381 | ||
| Summary | 381 | ||
| References | 383 | ||
| Portal Hypertensive Gastropathy and Colopathy | 389 | ||
| Key points | 389 | ||
| Introduction | 389 | ||
| Portal hypertensive gastropathy | 390 | ||
| Epidemiology | 390 | ||
| Clinical Findings | 390 | ||
| Diagnostic Modalities | 391 | ||
| Classification | 391 | ||
| Other Diagnostic Modalities | 391 | ||
| Pathogenesis | 392 | ||
| Diagnostic Dilemmas | 393 | ||
| Treatment Options | 394 | ||
| Primary Prophylaxis | 395 | ||
| Chronic Bleeding | 395 | ||
| Acute Bleeding | 395 | ||
| Refractory Bleeding | 396 | ||
| Secondary Prevention | 397 | ||
| Portal hypertensive colopathy | 397 | ||
| Introduction and Definition | 397 | ||
| Epidemiology | 397 | ||
| Clinical Findings | 397 | ||
| Diagnostic Modalities | 398 | ||
| Classification | 398 | ||
| Pathology | 399 | ||
| Diagnostic Dilemmas | 400 | ||
| Treatment Options | 400 | ||
| Prophylaxis | 401 | ||
| Summary | 401 | ||
| References | 401 | ||
| Hepatopulmonary Syndrome | 407 | ||
| Key points | 407 | ||
| Historical perspective | 407 | ||
| Pathophysiology | 408 | ||
| Animal Model of HPS | 408 | ||
| Human Disease | 408 | ||
| Clinical manifestations | 409 | ||
| Diagnosis | 410 | ||
| Screening for HPS | 412 | ||
| Therapeutic options | 412 | ||
| Pharmacologic Treatment | 412 | ||
| Transjugular Intrahepatic Portosystemic Shunt | 413 | ||
| LT | 413 | ||
| Summary | 414 | ||
| References | 414 | ||
| Portopulmonary Hypertension | 421 | ||
| Key points | 421 | ||
| Introduction | 421 | ||
| POPH definition and general characteristics | 422 | ||
| Pathophysiology | 423 | ||
| Epidemiology and main outcomes | 424 | ||
| Screening for POPH | 426 | ||
| Clinical manifestations | 426 | ||
| Management and medical treatment of POPH | 427 | ||
| Prostanoids | 428 | ||
| Endothelin Receptor Antagonists | 428 | ||
| Phosphodiesterase-5 Inhibitors | 430 | ||
| Other Therapies | 430 | ||
| LT | 430 | ||
| Practice guidelines | 433 | ||
| Summary | 433 | ||
| References | 433 | ||
| Hepatic Hydrothorax | 439 | ||
| Key points | 439 | ||
| Introduction: hepatic hydrothorax | 439 | ||
| Clinical features | 440 | ||
| Epidemiology | 440 | ||
| Clinical Manifestations and Complications | 440 | ||
| Presentation | 440 | ||
| Spontaneous bacterial empyema | 440 | ||
| Pathophysiology | 442 | ||
| Diagnosis | 442 | ||
| Treatment options/management/outcomes | 444 | ||
| Medical Management | 444 | ||
| Thoracentesis | 444 | ||
| Transjugular Intrahepatic Portosystemic Shunt | 445 | ||
| Liver Transplantation | 445 | ||
| Other Surgical Interventions | 445 | ||
| Future Directions | 446 | ||
| Summary | 446 | ||
| References | 446 | ||
| Non-cirrhotic Portal Hypertension | 451 | ||
| Key points | 451 | ||
| Non-cirrhotic portal fibrosis | 454 | ||
| Etiopathogenesis | 455 | ||
| Etiologic factors | 455 | ||
| Pathology | 455 | ||
| Immunologic and cellular changes | 455 | ||
| Spleen | 455 | ||
| Diagnosis | 456 | ||
| Clinical Presentation | 456 | ||
| Laboratory Evaluation | 457 | ||
| Hemodynamics | 457 | ||
| Endoscopic Findings | 457 | ||
| Radiological Features | 457 | ||
| Role of Liver Biopsy | 457 | ||
| HIV and NCPF/IPH | 457 | ||
| Natural History and Prognosis of NCPF | 458 | ||
| PVT in NCPF/IPH | 458 | ||
| EHPVO | 458 | ||
| Definition | 458 | ||
| Etiopathogenesis | 459 | ||
| Etiologic factors | 459 | ||
| Pathogenesis | 459 | ||
| Pathology | 459 | ||
| Diagnosis | 459 | ||
| Clinical Features | 460 | ||
| Laboratory Findings | 460 | ||
| Hemodynamics | 460 | ||
| Endoscopic Findings | 460 | ||
| Radiological Features | 460 | ||
| Role of Liver Biopsy | 461 | ||
| Natural History and Prognosis of EHPVO | 461 | ||
| Growth retardation | 461 | ||
| Impaired QoL | 461 | ||
| Portal biliopathy | 461 | ||
| MHE | 462 | ||
| Liver dysfunction | 462 | ||
| Hepatic schistosomiasis | 462 | ||
| Congenital hepatic fibrosis | 462 | ||
| Nodular regenerative hyperplasia | 463 | ||
| Management | 463 | ||
| Medical and Endoscopic Management: Control and Prophylaxis of Variceal Bleeding | 463 | ||
| Role of Surgery | 465 | ||
| Management of Portal Biliopathy | 465 | ||
| Surveillance | 469 | ||
| Management of Schistosomiasis, CHF, and NRH | 469 | ||
| Summary | 470 | ||
| References | 470 | ||
| Surgery in Patients with Portal Hypertension | 477 | ||
| Key points | 477 | ||
| Introduction | 477 | ||
| Pathophysiology | 478 | ||
| Preoperative screening for liver disease | 478 | ||
| Estimating surgical risk | 479 | ||
| Timing of Surgery | 479 | ||
| Contraindications to Elective Surgery | 480 | ||
| Prediction Models of Surgical Risk | 480 | ||
| Prediction Models: CTP | 481 | ||
| Prediction Models: MELD | 482 | ||
| Type of surgery | 486 | ||
| Laparoscopic Versus Open Cholecystectomy | 486 | ||
| Herniorrhaphy | 487 | ||
| Colorectal Surgery | 488 | ||
| Thoracic Procedures | 488 | ||
| Bariatric Surgery | 489 | ||
| Cardiac Surgery | 489 | ||
| Liver Resection | 490 | ||
| Strategies for attenuating perioperative risk | 491 | ||
| Preoperative Strategies | 491 | ||
| Preoperative checklist in patients with cirrhosis or portal hypertension | 491 | ||
| Optimizing medical therapy: compensate the decompensated | 491 | ||
| Intraoperative strategies | 495 | ||
| Postoperative Strategies | 496 | ||
| Summary | 496 | ||
| References | 497 | ||
| Index | 507 |