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1. Introduction
2. Presentation thesis
3. Regional circulatory regulation
4. Normal liver function
5. When the liver is sick
6. Normal liver
7. Cirrhotic liver
8. Portal pressure (1)
9. Portal pressure (2)
10. Cirrhosis and portal pressure
11. Initial circulatory effects of hypertension
12. Effect of portal hypertension on regional circulation
13. Effective plasma volume
14. Effects on renal circulation
15. The arteriolar vasodilation hypothesis in cirrhosis
16. Cirrhosis and portal pressure
17. The cardiac output at rest in Laennec's cirrhosis
18. The hyperdynamic circulation
19. Shunting of portal blood flow (1)
20. Esophageal varices
21. Ascites (liver sweat)
22. Renal function and effective plasma volume
23. Mortality after decompensation
24. TIPS procedure
25. Shunting of portal blood flow (2)
26. MELD score as a predictor of death after TIPS
27. Causes of death following TIPS
28. Cardiac hemodynamics in alcoholic patients
29. Cirrhotic cardiomyopathy
30. Pulmonary hypertension
31. Portopulmonary hypertension
32. Causes of portopulmonary hypertension
33. Portopulmonary hypertension - statistics
34. Hepatopulmonary syndrome (1)
35. Hepatopulmonary syndrome (2)
36. Hepatopulmonary syndrome (3)
37. Consequences of portal hypertension
38. Orthotopic liver transplantation - the only remedy
39. Thanks

Topics Covered

• Portal hypertension causes regional circulatory derangements that result in extra- and intra-vascular volume overload and organ dysfunction
• Vascular tone is mediated by autonomic input and chemical mediators many of which are released by local vascular endothelium
• Intrahepatic portal hypertension develops as a result of anatomic changes in the cirrhotic liver that cause sinusoidal narrowing and loss of compliance
• Reflex SMA vasoconstriction and portosystemic shunting up-regulate VEGF eNOS and iNOS with resultant vasodilation
• There is secondary: ADH secretion with retention of free water; renal salt retention; renal afferent arteriolar vasoconstriction
• Affected individuals develop progressive volume overload with associated afterload reduction and increases in cardiac output (hyperdynamic circulation)
• Fluid is forced off the surface of the liver and accumulates in the abdominal cavity as ascites
• Blood is shunted around the liver through latent venous connections that become varices
• Renal function is impaired (hepatorenal syndrome)
• Volume overload may cause secondary pulmonary hypertension
• Affected individuals may also develop primary pulmonary hypertension due to anatomic alterations of pulmonary microvasculature (porto-pulmonary hypertension)
• The ability of the heart to respond to stress is impaired
• Patients develop intrapulmonary shunts that cause hypoxemia (hepatopulmonary syndrome)
• The only real remedy for these problems is orthotopic liver transplantation

Links

Series:

• Gastroenterology and Hepatology

Categories:

• Diseases, Disorders & Treatments
• Metabolism & Nutrition

Talk Citation

Publication History

• Published on January 11, 2011
• Reviewed on June 15, 2018