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1、Surgical Complication of Cirrhosis and Portal Hypertension,Surgical Complication of Cirrh, Mechanism ,Some causes,Hepatocellular injury,Necrosis fibrosis nodular regeneration,cirrhosis, Mechanism Some Hepatocellul,altered hepatic architecture perisinusoidal fibrosis,Increased hepatic vasecular resis
2、tance,portal hypertension,altered hepaticIncreasedportal, Some causes ,Toxins: alcoholViruses: hepatitis B,hepatitis CProlonged cholestasis: extrahepatic, intrahepaticAutoimmunity: lupoid hepatitisMetabolic disorders: hemochromatosis, Wilsons disease alpha1-antitrypsin deficiency, Some causes Toxins
3、: alcohol,Anatomy,Anatomy,门静脉高压症治疗英文课件, Classification of portal hypertension ,Prehepatic portal hypertension Intrahepatic portal hypertension Posthepatic portal hypertension, Classification of portal hyp,Prehepatic portal hypertension,Isolated splenic vein thrombosis,Left sided portal hypertension,
4、Pancreatic inflammation or neoplasm,The most common cause is portal vein thrombosis.( Half in children ),Prehepatic portal hypertension,Intrahepatic portal hypentension,Presinusoidal lever schistomiasis posthepatitisSinusoidal lever alcoholic posthepatitisPostsinusoidal lever alcoholic, Budd-chiaris
5、 syndrome,rare,Intrahepatic portal hypentensi,Posthepatic portal hypertension,Budd-Chiaris syndrome: hepatic vein thrombosis, obstruction of vena cavaConstrictive pericarditisHeart failure,Posthepatic portal hypertensio, Pathophysiology of portal hypertension ,A portal pressure above the normal leve
6、r of 5 to 8 mmHg stimulates portosystemic collateraligation.Coronary vein Esophagogastric Short gastric vein varices,Azygos vein, Pathophysiology of portal hy, Evaluation of the patient with cirrhosis ,Diagnosis of the underlying liver disease Estimations of functional hepatic reserve Identification
7、 of the site of upper GI hemorrhage, if present (esophageal varices, gastric varices, ectopic varices, portal hypertensive gastropathy) Definition of portal venous anatomy and hepatic hemadynamic evaluation, Evaluation of the patient wi, Measurement of Hepatic Functional Reserve ,Child-Pugh Criteria
8、 for Hepatic Functional ReserveMeasure A B CSerum bulirubin 3 ( mg per 100 ml ) Serum albumin 3.5 2.8-3.5 6Ascites None Slight ModerateNeurologic disorder None Minimal Advanced,”coma”, Measurement of Hepatic Funct, Other Laboratory Tests ,Anemia ( bleeding, nutritional deficiency, hemolysis, or bone
9、 marrow depressing )LeukopeniaThromhocytopenia Prothrombin timeAlpha-fetoprotein leverLiver biopsy(cause of cirrhosis, activity of the liver disease), Other Laboratory Tests Ane, Hepatic Hemodynamic Assessment ,PresinusodalSinusodialPostsinusoidal,Portal Hypertension,Hepatic venous wedge pressureTra
10、nshepatic venous cannulationUmbilical venous cannulationPercutaneou spleen puncure, Hepatic Hemodynamic Assessme,Cases to do shunt operation,Selective visceral angiography Duplex ultrasonographyPortal venous systemRenal veinHepatic portal perfusion,Cases to do shunt operationSe, Treatment ,Nonoperat
11、ive ColchicinePenicillamine,Definitive treatment,OperativeLiver Transplantation, Treatment Nonoperative Defi,PharmacotherapyEndoscopic therapy TIPS,Palliativetreatment,Portosystemic shunt (nonselective, selective, partial)Nonshunt operation,PharmacotherapyPalliativePorto,Historically, the treatment
12、of cirrhosis has been the treatment of the complications of portal hypertension.A major challenge is to determine when definitive treatment rather than palliative treatment shoud be applied.No single therapy is entirely satisfactory for all patients or clinical situations.,Historically, the treatmen
13、t of, Treatment of Acute Bleeding Episode ,Decompensated hepatic functionEncephalopathyAscitesCoagulopathyMalnutrition,High risk,Nonoperative treatment whenever possible, Treatment of Acute Bleeding,Resuscitation and Diagnosis,Pharmacotherapy: Vasopressin+ nitroglycerin, somatostatin/octreotideBallo
14、on tamponade: Sengstaken-Blackmore tubeEndoscopic treatment: variceal sclerosis or ligationTransjugular intrahepatic portosystemic shunt(TIPS),Resuscitation and DiagnosisPha,门静脉高压症治疗英文课件,门静脉高压症治疗英文课件,门静脉高压症治疗英文课件,Emergency Surgery,Failure of,Acute endoscopic treatmentLong-term endoscopic treatmentTI
15、PS,Hemorrhage from gastric varicesPortal hypertensive gastropathy(PHG),Emergency operation,Emergency SurgeryFailure ofAcu, Treating for Prevention of Recurrent Hemorrhage ,First-linetreatment,PharmacotherapyEndoscopicTIPS,( Satisfactory hepatic function ), Treating for Prevention of R, Portosystemic
16、 shunts ,Advantages: the most effective decompression low rebleeding rate.Shortages:high encephalopathy accelerated hepatic failure, Portosystemic shunts Advan,Nonselective shunts,End-to-side portacaval shunt(Eckfistula)Side-to-side portacaval shuntLarge diameter interposition shuntConventional sple
17、enorenal shunt,Nonselective shuntsEnd-to-sid,门静脉高压症治疗英文课件,Selective shunts,Warren (1967) Distal splenorenal shuntInokuchu (1984) Left gastric renacaval shuntLeft gastic(coronary) vein vein graft inferior vena cava,Selective shuntsWarren (1967),门静脉高压症治疗英文课件,Patial Shunts,Small-diameter vein-to-vein a
18、nastomosesSmall-diameter interposition proacaval shunt,Patial Shunts Small-diameter v,门静脉高压症治疗英文课件,The objective of partial selective shunts,Effective decompression of varicesPreservation of hepatic portal perfusionMaintenance of some residual portal hypertension,The objective of partial selec, Nons
19、hunt Operation ,Objectives: extensive esophagogastric devasculrigation splenectomy transection of the distal esophagus, Nonshunt Operation Objecti,门静脉高压症治疗英文课件, Liver Transplantantion ,A definitive treatmentEnd-stage hepatic failureNot indicated for schistosomiasisNot indicated for active alcoholism (noncompliance), Liver Transplantantion A de, Overall treatment Plan , Overall treatment Plan ,门静脉高压症治疗英文课件,
