Portal Hypertension In The 21st Century

Portal hypertension is the most important complication of a great variety of both acute and chronic liver diseases. Nevertheless, hepatic cirrhosis is the most frequent cause of portal hypertension. Gastrointestinal bleeding due to rupture of oesophageal varices is, without doubt, the most severe complication of portal hypertension. At present, great advances are being made in the pathophysiology and in the development of new therapeutic tools for controlling and preventing this severe clinical event. This book contains the papers presented and discussed during the Symposium on 'Portal Hypertension in the 21st Century', held in Montréal, Canada, in April 2004, and sponsored by Axcan Pharma Inc. and NicOx S.A. There are eight sections covering basic mechanisms, new drugs, prevention and current treatment of variceal bleeding, prevention of recurrent bleeding and hepatic hemodynamic monitoring. An international faculty of authors have contributed chapters at an outstanding scientific level which will be vital reading for scientists and clinicians alike.

A cutting-edge review of the latest findings on key scientific topics and the best strategies for evaluation and management of portal hypertension in the clinic. Writing in an easy-to-read style, the authors review its pathobiology, the progress being made in its experimental understanding, the methodologies to assess it in humans, the treatment of its complications (esophageal varices, ascites, and hepatorenal syndrome), and its treatment in special circumstances (during pregnancy, in children, or when the portal vein is blocked). They also provide in-depth coverage of the pros and cons of the various therapeutic choices available to the clinician managing patients with complicated portal hypertension.

Portal hypertension is a clinical syndrome defined by a portal venous pressure gradient, exceeding 5 mm Hg. In this book the causes of its development and complications are described. Authors have presented personal experiences on conducting patients with various displays of portal hypertension. Moreover, the book presents modern data about molecular mechanisms of pathogenesis of portal hypertension in liver cirrhosis, the information about the original predictor of risk of bleeding from gastro-esophageal varices and new methods for their conservative treatment.

Book Description:The cirrhotic liver is significantly more vulnerable to injury. This vulnerability is particularly evident after the advent of portal hypertension. In the normal liver, up to 75 percent can be resected without decompensation. By contrast, in the cirrhotic liver with portal hypertension, liver decompensation can occur even after less than 50 percent of the liver is resected.This book, "Portal Hypertension: New Insights" begins with an attempt to provide insights into this unanswered puzzle. The normal liver is soft and elastic. By contrast, the cirrhotic liver is inelastic and rigid. Flow in rigid tubes is governed by the Hagen-Poiseuille law. The law dictates that pressure gradient increases exponentially by the fourth power of the radius of the rigid sinusoid. This makes the cirrhotic liver virtually incapable of accommodating any increase in flow. The increase in pressure gradient is equivalent to the fourth power of the vessel radius.The first chapter explores the major new insight that decompensation in the cirrhotic liver is related to the loss of elasticity and the development of vessel wall rigidity, which thereafter subjects flow in the hepatic sinusoids to the Hagen-Poiseuille law.The rest of the book addresses portal hypertension in its clinical context. It invites the reader to survey multiple avenues associated with portal hypertension, including idiopathic non-cirrhotic portal hypertension, INCPH and non-alcoholic fatty liver disease, NAFLD. It also includes chapters on relationships between portal hypertension, the gastrointestinal system and the renal system. In general, the book provides several new insights into portal hypertension.