Abstract
In order to examine the relationship of various haemodynamic parameters in two different liver diseases, 10 patients with cirrhosis of liver and 14 patients with non-cirrhotic portal fibrosis were studied. In cirrhotics, mean (+/- SD) wedged hepatic (25.8 +/- 6.4 mmHg), intrahepatic (24.5 +/- 6.2 mmHg) and intrasplenic (25.0 +/- 5.6 mmHg) pressures correlated significantly (p less than 0.001) with intravariceal (25.2 +/- 6.7) pressure measurements. In patients with NCPF, mean (+/- SD) wedged hepatic (9.1 +/- 3.7 mmHg) and intraphepatic (15.4 +/- 5.8 mmHg) pressures were significantly (p less than 0.01) lower than the intrasplenic (24.5 +/- 4.2 mmHg) and intravariceal (23.96 +/- 5.6 mmHg) pressures. Two independent pressure gradients, one between intrasplenic and intrahepatic pressure (8.9 +/- 6.5 mmHg) and another between intrahepatic and wedged hepatic venous pressure (6.2 +/- 5.6 mmHg) were seen in non-cirrhotic portal fibrosis patients, indicating the likelihood of both pre- and perisinusoidal resistance to flow of portal venous blood in these patients. A highly significant (p less than 0.001) correlation between intravariceal and intrasplenic pressures was found in patients with cirrhosis of liver (r = 0.93), as well as in patients with non-cirrhotic portal fibrosis (r = 0.85). No correlation was found between the size of oesophageal varices and wedged hepatic and intrahepatic pressures. Patients with grade 4 varices had significantly higher intravariceal (p less than 0.01) and intrasplenic (p less than 0.05) pressure than patients with grade 2 varices. It can be concluded that intravariceal pressure is representative of portal pressure in patients with cirrhosis of liver as well as in non-cirrhotic portal fibrosis patients and it can be recommended as the single haemodynamic investigation in patients with portal hypertension and oesophageal varices.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- ATKINSON M., SHERLOCK S. Intrasplenic pressure as index of portal venous pressure. Lancet. 1954 Jun 26;266(6826):1325–1327. doi: 10.1016/s0140-6736(54)92212-6. [DOI] [PubMed] [Google Scholar]
- Anand C. S., Tandon B. N., Nundy S. The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital. Br J Surg. 1983 Apr;70(4):209–211. doi: 10.1002/bjs.1800700407. [DOI] [PubMed] [Google Scholar]
- Boyer J. L., Sen Gupta K. P., Biswas S. K., Pal N. C., Basu Mallick K. C., Iber F. L., Basu A. K. Idiopathic portal hypertension. Comparison with the portal hypertension of cirrhosis and extrahepatic portal vein obstruction. Ann Intern Med. 1967 Jan;66(1):41–68. doi: 10.7326/0003-4819-66-1-41. [DOI] [PubMed] [Google Scholar]
- Conn H. O. Ammonia tolerance in the diagnosis of esophageal varices. A comparison of endoscopic, radiologic, and biochemical techniques. J Lab Clin Med. 1967 Sep;70(3):442–451. [PubMed] [Google Scholar]
- Dawson J., Gertsch P., Mosimann F., West R., Elias E. Endoscopic variceal pressure measurements: response to isosorbide dinitrate. Gut. 1985 Aug;26(8):843–847. doi: 10.1136/gut.26.8.843. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Garcia-Tsao G., Groszmann R. J., Fisher R. L., Conn H. O., Atterbury C. E., Glickman M. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology. 1985 May-Jun;5(3):419–424. doi: 10.1002/hep.1840050313. [DOI] [PubMed] [Google Scholar]
- Groszmann R. J. Reassessing portal venous pressure measurements. Gastroenterology. 1984 Jun;86(6):1611–1614. [PubMed] [Google Scholar]
- Iber F. L. Obliterative portal venopathy of the liver and "idiopathic portal hypertension". Ann Intern Med. 1969 Sep;71(3):660–661. doi: 10.7326/0003-4819-71-3-660. [DOI] [PubMed] [Google Scholar]
- Iber F. L. The cause of portal hypertension. Am J Med Sci. 1968 Apr;255:217–220. doi: 10.1097/00000441-196804000-00001. [DOI] [PubMed] [Google Scholar]
- Lebrec D., De Fleury P., Rueff B., Nahum H., Benhamou J. P. Portal hypertension, size of esophageal varices, and risk of gastrointestinal bleeding in alcoholic cirrhosis. Gastroenterology. 1980 Dec;79(6):1139–1144. [PubMed] [Google Scholar]
- Mosimann R. Nonaggressive assessment of portal hypertension using endoscopic measurement of variceal pressure. Preliminary report. Am J Surg. 1982 Feb;143(2):212–214. doi: 10.1016/0002-9610(82)90070-8. [DOI] [PubMed] [Google Scholar]
- Nayak N. C., Ramalingaswami V. Obliterative portal venopathy of the liver. Associated with so-called idiopathic portal hypertension or tropical splenomegaly. Arch Pathol. 1969 Apr;87(4):359–369. [PubMed] [Google Scholar]
- ORREGO-MATTE H., AMENABAR E., LARA G., BARAONA E., PALMA R., MASSAD F. MEASUREMENT OF INTRAHEPATIC PRESSURE AS INDEX OF PORTAL PRESSURE. Am J Med Sci. 1964 Mar;247:278–282. doi: 10.1097/00000441-196403000-00005. [DOI] [PubMed] [Google Scholar]
- Orrego H., Blendis L. M., Crossley I. R., Medline A., Macdonald A., Ritchie S., Israel Y. Correlation of intrahepatic pressure with collagen in the Disse space and hepatomegaly in humans and in the rat. Gastroenterology. 1981 Mar;80(3):546–556. [PubMed] [Google Scholar]
- Pomier-Layrargues G., Kusielewicz D., Willems B., Villeneuve J. P., Marleau D., Côté J., Huet P. M. Presinusoidal portal hypertension in non-alcoholic cirrhosis. Hepatology. 1985 May-Jun;5(3):415–418. doi: 10.1002/hep.1840050312. [DOI] [PubMed] [Google Scholar]
- Reynolds T. B., Ito S., Iwatsuki S. Measurement of portal pressure and its clinical application. Am J Med. 1970 Nov;49:649–657. doi: 10.1016/s0002-9343(70)80131-0. [DOI] [PubMed] [Google Scholar]
- Sama S. K., Bhargava S., Nath N. G., Talwar J. R., Nayak N. C., Tandon B. N., Wig K. L. Noncirrhotic portal fibrosis. Am J Med. 1971 Aug;51(2):160–169. doi: 10.1016/0002-9343(71)90234-8. [DOI] [PubMed] [Google Scholar]
- Sarin S. K., Nanda R., Vij J. C., Anand B. S. Oesophageal ulceration after sclerotherapy--a complication or an accompaniment? Endoscopy. 1986 Mar;18(2):44–45. doi: 10.1055/s-2007-1018323. [DOI] [PubMed] [Google Scholar]
- Sarin S. K., Nundy S. Subclinical encephalopathy after portosystemic shunts in patients with non-cirrhotic portal fibrosis. Liver. 1985 Jun;5(3):142–146. doi: 10.1111/j.1600-0676.1985.tb00229.x. [DOI] [PubMed] [Google Scholar]
- Sarin S. K., Sachdev G., Nanda R., Batra S. K., Anand B. S. Comparison of the two time schedules for endoscopic sclerotherapy: a prospective randomised controlled study. Gut. 1986 Jun;27(6):710–713. doi: 10.1136/gut.27.6.710. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sarin S. K., Sachdeva G. K., Nanda R., Vij J. C., Anand B. S. Endoscopic sclerotherapy using absolute alcohol. Gut. 1985 Feb;26(2):120–124. doi: 10.1136/gut.26.2.120. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shibayama Y., Nakata K. Localization of increased hepatic vascular resistance in liver cirrhosis. Hepatology. 1985 Jul-Aug;5(4):643–648. doi: 10.1002/hep.1840050421. [DOI] [PubMed] [Google Scholar]
- Tandon B. N., Lakshminarayanan R., Bhargava S., Nayak N. C., Sama S. K. Ultrastructure of the liver in non-cirrhotic portal fibrosis with portal hypertension. Gut. 1970 Nov;11(11):905–910. doi: 10.1136/gut.11.11.905. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Valla D., Bercoff E., Menu Y., Bataille C., Lebrec D. Discrepancy between wedged hepatic venous pressure and portal venous pressure after acute propranolol administration in patients with alcoholic cirrhosis. Gastroenterology. 1984 Jun;86(6):1400–1403. [PubMed] [Google Scholar]
- Williams R. Portal hypertension in idiopathic tropical splenomegaly. Lancet. 1966 Feb 12;1(7433):329–333. doi: 10.1016/s0140-6736(66)91319-5. [DOI] [PubMed] [Google Scholar]