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A case of a newborn with an intrahepatic congenital portosystemic venous shunt with concurrent congenital duodenal web
Domen Plut,Tamara Gorjanc
- , 2019, DOI: 10.1177/2058460119854173
Abstract: Intrahepatic congenital portosystemic venous shunts are rare vascular anomalies. We report a unique case of a neonate with an intrahepatic congenital portosystemic venous shunt with concurrent congenital duodenal web. Such association has not been previously reported to our knowledge. Interestingly, the shunt became apparent on the seventh day, after a delayed start of oral feeding due to the neonate’s recovery from the duodenal web surgery. The shunt was small and the clinical symptomatology mild. No direct treatment was required. The laboratory and the ultrasound follow-up of the child noted a spontaneous resolution of the shunt by the age of six months
肝硬化自发性门静脉分流：目前的认识和未来的展望
Spontaneous Portal Shunt in Liver Cirrhosis: Current Understanding and Future Perspectives  [PDF]
张帅, 张昕
Advances in Clinical Medicine (ACM) , 2023, DOI: 10.12677/ACM.2023.133679
Abstract: 由各种原因引起肝硬化后，肝脏内假小叶生成，肝脏实质纤维化，肝内血管阻力增加，从而引起门静脉压力升高；机体可通过2种方式代偿门静脉高压：一种为内脏血管扩张，另一种为自发性门体分流(SPSS)；长期以来，自发性门体分流被认为是一种门静脉系统减压的代偿机制，现在看来，自发性门体分流不仅在降低门静脉高压方面效率十分低下，而且还会导致肝细胞灌注减少、内脏血流量和阻力增加，从而进一步导致门静脉高压及肝功能恶化。目前，在多项研究中均发现肝硬化患者SPSS的高患病率，并观察到SPSS的存在与较差的临床结果之间有关联。SPSS可单独增加肝性脑病、静脉曲张出血和腹水的风险，并可降低患者的生存率；此外，在经颈静脉肝内门体分流术和肝移植患者中SPSS的存在对术后结果均有不同程度的影响。这篇文章概述了自发性门体分流的临床特点和对肝硬化病程的影响，以及未来对其作为治疗靶点的展望。
After liver cirrhosis caused by various reasons, pseudolobules in the liver, fibrosis in the liver pa-renchyma, and increased resistance of blood vessels in the liver, resulting in increased portal vein pressure; The body can compensate for portal hypertension in two ways: one is visceral vasodilation, the other is spontaneous portosystemic shunt (SPSS); For a long time, spontaneous portosystemic shunt has been considered as a compensatory mechanism for the decompression of the portal vein system. Now, it seems that spontaneous portosystemic shunt is not only very inefficient in reducing portal hypertension, but also leads to decreased hepatocyte perfusion, increased visceral blood flow and resistance, which further leads to portal hypertension and deterioration of liver function. At present, the high prevalence of SPSS in patients with liver cirrhosis has been found in many studies, and the association between the existence of SPSS and poor clinical results has been observed. SPSS alone can increase the risk of hepatic encephalopathy, variceal bleeding and ascites, and can reduce the survival rate of patients; In addition, the presence of SPSS in patients undergoing transjugular intrahepatic portosystemic shunt and liver transplantation has different effects on the postopera-tive results. This article summarizes the clinical characteristics of spontaneous portosystemic shunt and its impact on the course of cirrhosis, as well as the prospect of its use as a therapeutic target in the future.
Diagnosis and therapy of ascites in liver cirrhosis
Erwin Biecker
World Journal of Gastroenterology , 2011,
Abstract: Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis.
Efficacy of long-term rifaximin treatment for hepatic encephalopathy in the Japanese
Daizo Fukushima,Koichi Hamada,Noriyuki Nishino,Ryota Koyanagi,Satoshi Saitoh,Shinya Nishida,Yoshiki Shiwa,Yoshinori Horikawa
- , 2019, DOI: 10.4254/wjh.v11.i6.531
Abstract:
Temporal trends of cirrhosis associated conditions
Guangxiang Zhang,Kazuma Nakagawa,Tomoki Sempokuya
- , 2019, DOI: 10.4254/wjh.v11.i1.74
Abstract:
Novel Technique of Multislice CT Angiography for Diagnosis of Portosystemic Shunts in Sedated Dogs  [PDF]
Merja R. Laitinen, Jodi S. Matheson, Robert T. O’Brien
Open Journal of Veterinary Medicine (OJVM) , 2013, DOI: 10.4236/ojvm.2013.32019
Abstract:

Diagnosing portosystemic shunts (PSS) can be challenging in veterinary patients. Multiple imaging techniques have been described to diagnose PSS. The aim of the study was to investigate whether a novel multi-slice computed tomography (CT) angiographic protocol could be used for diagnosis of PSS in dogs utilizing only patient sedation and without the need of test injection. Independent, blinded reviewers evaluated CT studies in a randomized order for study quality, shunt presence, number, and location of shunt origin and termination. Twenty two confirmed dogs were included in the study including 16 dogs with single extrahepatic congenital PSS, one dog with single intrahepatic congenital PSS, and two dogs with multiple acquired PSS. Three of the dogs (3/22) were surgically and histologically confirmed free of shunts. Final diagnosis was confirmed by surgery or necropsy. The new CT angiography protocol was shown to be diagnostic in dogs with PSS with no need for general anesthesia, test injections, delay times or timing determinations. Specificity and sensitivity were good (100%). The quality of the studies was considered good in the majority of cases (20/22). The amount of motion artifact in the CT scans was minimal, and had no effect on the diagnostic quality. The CT protocol was found to be a useful, fast, and accurate tool for diagnosing portosystemic shunts with a 16-slice system.

Asymptomatic Intrahepatic Portosystemic Venous Shunt: Case Report and Review of Literature  [PDF]
Huylmer Lucena Chaves, Mayanna Pinho Batista, Germana Bastos Pontes, Lia Pontes de Melo, José Carlos Godeiro Junior
Open Journal of Radiology (OJRad) , 2019, DOI: 10.4236/ojrad.2019.91001
Abstract: A spontaneous portosystemic shunt is a rare malformation of the liver vessels. The etiology of these shunts is controversial. They can be divided into acquired (most commonly associated with liver cirrhosis) and congenital. Vascular shunts are asymptomatic in the majority of the patients, and when symptomatic were presented by severe complications. The specific way of management can be selected depended on whether the patient was symptomatic or not, and also on the size of the shunt, shunt ratio and whether it was associated with cancer. We will present a clinical case and discuss the importance of the radiological imaging in the screening, diagnosis and follow up of these anomalies.
Optimal management of hepatorenal syndrome in patients with cirrhosis
Paolo Angeli, Filippo Morando
Hepatic Medicine: Evidence and Research , 2010, DOI: http://dx.doi.org/10.2147/HMER.S6918
Abstract: imal management of hepatorenal syndrome in patients with cirrhosis Review (4764) Total Article Views Authors: Paolo Angeli, Filippo Morando Published Date June 2010 Volume 2010:2 Pages 87 - 98 DOI: http://dx.doi.org/10.2147/HMER.S6918 Paolo Angeli, Filippo Morando Department of Clinical and Experimental Medicine, University of Padova, Italy Abstract: Hepatorenal syndrome (HRS) is a functional renal failure that often occurs in patients with cirrhosis and ascites. HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. There are 2 different types of HRS. Type 1 HRS, which is often precipitated by a bacterial infection, especially spontaneous bacterial peritonitis, is characterized by a rapidly progressive impairment of renal function. Despite its functional origin, the prognosis of type 1 HRS is very poor. Type 2 HRS is characterized by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure but refractory ascites and its impact on prognosis is less negative. New treatments (vasoconstrictors plus albumin, transjugular portosystemic shunt, and molecular adsorbent recirculating system), which were introduced in the past 10 years, are effective in improving renal function in patients with HRS. Among these treatments vasoconstrictors plus albumin can also improve survival in patients with type 1 HRS. Thus, this therapeutic approach has changed the management of this severe complication in patients with advanced cirrhosis.
Progress and Prospects of Surgical Treatment of Portal Hypertension  [PDF]
Linjun Ruan, Buqiang Wu
Journal of Biosciences and Medicines (JBM) , 2023, DOI: 10.4236/jbm.2023.1111015
Abstract: Portal hypertension is a group of syndrome characterized by splenic hyperfunction, esophageal and gastric varices and ascites caused by abnormal portal vein hemodynamics. Among them, upper gastrointestinal bleeding caused by esophageal and gastric varices is the most dangerous complication, which often threatens the lives of patients. After half a century of development, the treatment of portal hypertension is divided into two categories: medical drug therapy, endoscopic therapy and surgical treatment. With the understanding of portal hypertension and the continuous development of medical technology, the surgical operation of portal hypertension has also been greatly improved, reducing postoperative complications and improving the quality of life of patients after operation. However, at present, there is no surgical method that can completely cure portal hypertension. This article reviews the progress of surgical treatment of portal hypertension in recent years, in order to provide reference for the surgical treatment of portal hypertension.
Uso do ultra-som dúplex Doppler no diagnóstico de shunt portossistêmico em gatos
Carvalho, C.F.;Chammas, M.C.;
Arquivo Brasileiro de Medicina Veterinária e Zootecnia , 2008, DOI: 10.1590/S0102-09352008000100016
Abstract: abdominal duplex doppler ultrasonography was used in two cats with hepatic encephalopathy clinical signs. the main ultrasonographic findings were: identification of a tortuous strange vessel shunting portal flow; elevated portal flow velocity; turbulence in the caudal vena cava, and reduced size of liver and hepatic portal branches. necropsy findings were similar to that found at ultrasonographic and clinical exams. it is concluded that portosystemic shunt diagnosis may be a real hypothesis to be considered in cats with clinical signs of hepatic encephalopathy.
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