Portal Hypertension V

Every five years, hepatologists with an interest in portal hypertension (high blood pressure in the portal vein), gather in Baveno, Italy, for the Baveno International Consensus Workshop on Portal Hypertension, attending workshops and examining the latest in clinical data and research on this condition. This book documents the contents of the meeting so that practitioners who could not be present at the conference still have access to the proceedings.

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.

This book provides a comprehensive account on individually rare, but collectively frequent diseases of the liver. In the first part, conditions such as hepatic vascular malformations, ischemic cholangiopathy, hepatic artery occlusion, sinusoidal conditions and Budd-Chiari syndrome are discussed among others. The second part examines the causes of vascular liver disease namely, coagulation disorders, neoplasm disorders, non-malignant blood disorders, systemic diseases and toxins, among others. The unique expertise of the authors, who are all members of the Vascular Liver Disease Disorders Group, an independent network of researchers with a common interest in Vascular Liver Diseases, are merged for an optimal pragmatic and individualized approach. This book is of interest to a broad range of experts, such as hepatologists, internists, radiologists and angiologists.

Portal hypertension is causally related to major complications of chronic liver disease like upper GI tract bleeding, ascites formation, portosystemic encephalopathy and bacterial infections. In recent years, new approaches have increased our knowledge of the underlying pathobiological events of these complications. Accordingly, new promising treatment modalities have been developed and introduced into clinical trials. This book, the proceedings of the 79th Falk Symposium in Freiburg-im-Breisgau, Germany, 17--19 June 1994, presents the latest developments in the field, including a section which describes the role of portal hypertension in the pathogenesis of complications of chronic liver disease. Also covered is the therapeutic management of portal hypertension and its consequences as well as the latest endoscopic, interventional and surgical treatment options. This book is essential reading for those whose interests range from anatomy and pathobiology through to practical recommendations for treatment of 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.

Current recommendations for diagnosis and management of portal hypertension This book presents the proceedings from the 'Baveno IV International Consensus Workshop: Methodology of diagnosis and treatment in portal hypertension' which was held on April 28-29, 2005 in Baveno, Italy. These meetings are important to raise awareness of difficulties and defining some key events related to portal hypertension and variceal bleeding. They also help to produce guidelines aimed at improving trials conducted in this field. Since the Baveno III meeting, new diagnostic tools, new drugs and new treatment strategies for portal hypertension have been developed. Therefore this book updates recommendations for diagnosis and management. It includes evidence from the workshop on pathophysiology, natural history, methods of evaluation and established treatments of portal hypertension. In addition, this books looks at important emerging topics such as the role of coagulation disturbances, portopulmonary hypertension and the hepatopulmonary syndrome, hepato-renal syndrome, spontaneous bacterial peritonitis, and infections. This gives clinicians and investigators current evidence and helps to inform treatment decisions.

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.