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Pathophysiology of portal hypertension and variceal bleeding.
Surg Clin North Am. 1990 Apr; 70(2):251-66.SC

Abstract

Portal hypertension results from an interaction of abnormal intrahepatic resistance and increases in portal blood flow. Intrahepatic resistance is probably multifactorial in nature and may include compression of hepatic veins by regenerating nodules, collagen deposition in sinusoids and venules, hepatocyte enlargement, and constriction of sinusoids by contractile myofibroblasts. The increase in splanchnic blood flow observed is incompletely understood, but it may involve circulating vasodilators and alteration in volume and sodium balance. The end result of these interactions is the development of increased portal pressure and portosystemic collaterals, the most important of which are esophageal varices. The rupture of esophageal varices is a devastating complication of portal hypertension. Increased portal pressure is necessary for the development and rupture of varices but apparently not sufficient, because many patients with elevated portal pressures never bleed. Presumably, local factors must be involved. Variceal wall tension is probably the best single descriptor of risk from variceal hemorrhage. The wall-tension formula unites the contributions of portal pressure, varix size, and wall thickness to variceal rupture. Lowering portal pressure, reducing varix size, and supporting varices in scar tissue may all lower the risk of hemorrhage.

Authors+Show Affiliations

Division of Digestive Diseases, Yale University School of Medicine, New Haven, Connecticut.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

2181704

Citation

Mahl, T C., and R J. Groszmann. "Pathophysiology of Portal Hypertension and Variceal Bleeding." The Surgical Clinics of North America, vol. 70, no. 2, 1990, pp. 251-66.
Mahl TC, Groszmann RJ. Pathophysiology of portal hypertension and variceal bleeding. Surg Clin North Am. 1990;70(2):251-66.
Mahl, T. C., & Groszmann, R. J. (1990). Pathophysiology of portal hypertension and variceal bleeding. The Surgical Clinics of North America, 70(2), 251-66.
Mahl TC, Groszmann RJ. Pathophysiology of Portal Hypertension and Variceal Bleeding. Surg Clin North Am. 1990;70(2):251-66. PubMed PMID: 2181704.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pathophysiology of portal hypertension and variceal bleeding. AU - Mahl,T C, AU - Groszmann,R J, PY - 1990/4/1/pubmed PY - 1990/4/1/medline PY - 1990/4/1/entrez SP - 251 EP - 66 JF - The Surgical clinics of North America JO - Surg Clin North Am VL - 70 IS - 2 N2 - Portal hypertension results from an interaction of abnormal intrahepatic resistance and increases in portal blood flow. Intrahepatic resistance is probably multifactorial in nature and may include compression of hepatic veins by regenerating nodules, collagen deposition in sinusoids and venules, hepatocyte enlargement, and constriction of sinusoids by contractile myofibroblasts. The increase in splanchnic blood flow observed is incompletely understood, but it may involve circulating vasodilators and alteration in volume and sodium balance. The end result of these interactions is the development of increased portal pressure and portosystemic collaterals, the most important of which are esophageal varices. The rupture of esophageal varices is a devastating complication of portal hypertension. Increased portal pressure is necessary for the development and rupture of varices but apparently not sufficient, because many patients with elevated portal pressures never bleed. Presumably, local factors must be involved. Variceal wall tension is probably the best single descriptor of risk from variceal hemorrhage. The wall-tension formula unites the contributions of portal pressure, varix size, and wall thickness to variceal rupture. Lowering portal pressure, reducing varix size, and supporting varices in scar tissue may all lower the risk of hemorrhage. SN - 0039-6109 UR - https://www.unboundmedicine.com/medline/citation/2181704/Pathophysiology_of_portal_hypertension_and_variceal_bleeding_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6109(16)45080-2 DB - PRIME DP - Unbound Medicine ER -