Portal hypertension surgery: Difference between revisions
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=== Ascites treatment === | === Ascites treatment === | ||
* [[Refractory]] [[ascites]] that is not responsive to [[medical therapy]] | * [[Refractory]] [[ascites]] that is not responsive to [[medical therapy]] is treated with [[Transjugular intrahepatic portosystemic shunt|TIPS]]. | ||
* [[Peritoneovenous shunt|Peritoneovenous shunts]] are the basic treatment for the refractory [[ascites]]. | * [[Peritoneovenous shunt|Peritoneovenous shunts]] are the basic treatment for the refractory [[ascites]]. | ||
* [[Peritoneovenous shunt|Peritoneovenous shunts]] bypass the [[ascites]] fluid into the systemic [[veins]].<ref name="pmid1568775">{{cite journal |vauthors=Arroyo V, Ginès P, Planas R |title=Treatment of ascites in cirrhosis. Diuretics, peritoneovenous shunt, and large-volume paracentesis |journal=Gastroenterol. Clin. North Am. |volume=21 |issue=1 |pages=237–56 |year=1992 |pmid=1568775 |doi= |url=}}</ref> | * [[Peritoneovenous shunt|Peritoneovenous shunts]] bypass the [[ascites]] fluid into the systemic [[veins]].<ref name="pmid1568775">{{cite journal |vauthors=Arroyo V, Ginès P, Planas R |title=Treatment of ascites in cirrhosis. Diuretics, peritoneovenous shunt, and large-volume paracentesis |journal=Gastroenterol. Clin. North Am. |volume=21 |issue=1 |pages=237–56 |year=1992 |pmid=1568775 |doi= |url=}}</ref> | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Hepatology]] | [[Category:Hepatology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category: | [[Category:Emergency medicine]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
{{WS}} | {{WS}} | ||
{{WH}} | {{WH}} |
Latest revision as of 14:18, 7 December 2017
Portal Hypertension Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Portal hypertension surgery On the Web |
American Roentgen Ray Society Images of Portal hypertension surgery |
Risk calculators and risk factors for Portal hypertension surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Surgery is not the first-line treatment option for patients with portal hypertension. Surgery is usually reserved for patients with either severe cirrhosis, esophageal varices, splenomegaly, ascites, or liver failure.
Surgery
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Surgery is not the first-line treatment option for patients with portal hypertension. Surgery is usually reserved for patients with either:[1]
Transjugular intrahepatic portosystemic shunting
- Transjugular intrahepatic portosystemic shunting (TIPS) is bypassing the high flow rate of portal vein into the systemic veins.
- TIPS would decrease the pressure over the portal system and a decreased risk of complications, such as:[2]
Esophageal varices ligation
- Esophageal varices ligation is done through endoscopic approach.
- The procedure start with a minimal suction of the varice in a tiny endoscopic tube.
- Then when enough part of varices is been sucked into the tube, a ligation band is administered around the variceal root to block its circulation.[3]
Splenectomy
- Splenectomy is total excision of spleen after correct ligation and cutting of splenic vein and artery.
- Splenectomy is the definitive treatment for gastric variceal bleeding due to splenic vein thrombosis.[4]
Ascites treatment
- Refractory ascites that is not responsive to medical therapy is treated with TIPS.
- Peritoneovenous shunts are the basic treatment for the refractory ascites.
- Peritoneovenous shunts bypass the ascites fluid into the systemic veins.[5]
Liver transplantation
- Liver transplantation is indicated in case of liver failure.
- Liver failure may be happened due to any diseases, such as cirrhosis or chronic portal hypertension.[6]
References
- ↑ Collins JC, Sarfeh IJ (1995). "Surgical management of portal hypertension". West J Med. 162 (6): 527–35. PMC 1022831. PMID 7618313.
- ↑ Lahat E, Lim C, Bhangui P, Fuentes L, Osseis M, Moussallem T, Salloum C, Azoulay D (2017). "Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review". HPB (Oxford). doi:10.1016/j.hpb.2017.09.006. PMID 29110990.
- ↑ Poza Cordon J, Froilan Torres C, Burgos García A, Gea Rodriguez F, Suárez de Parga JM (2012). "Endoscopic management of esophageal varices". World J Gastrointest Endosc. 4 (7): 312–22. doi:10.4253/wjge.v4.i7.312. PMC 3399010. PMID 22816012.
- ↑ Bradley EL (1987). "The natural history of splenic vein thrombosis due to chronic pancreatitis: indications for surgery". Int. J. Pancreatol. 2 (2): 87–92. PMID 3500243.
- ↑ Arroyo V, Ginès P, Planas R (1992). "Treatment of ascites in cirrhosis. Diuretics, peritoneovenous shunt, and large-volume paracentesis". Gastroenterol. Clin. North Am. 21 (1): 237–56. PMID 1568775.
- ↑ Starzl TE, Van Thiel D, Tzakis AG, Iwatsuki S, Todo S, Marsh JW; et al. (1988). "Orthotopic liver transplantation for alcoholic cirrhosis". JAMA. 260 (17): 2542–4. PMC 3091380. PMID 3050180.