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.

Preface

v

Color Plates

xi

Contributors

xiii

Part I. Historical Perspective

Portal Hypertension: A History

3

(12)

Adrian Reuben

Roberto J. Groszmann

Part II. Pathobiology and Experimental Progress in Portal Hypertension

Anatomy and Vascular Biology of the Cells in the Portal Circulation

15

(22)

Massimo Pinzani

Francesco Vizzutti

Cell and Molecular Mechanisms of Increased Intrahepatic Resistance and Hemodynamic Correlates

37

(14)

Don C. Rockey

Molecular Mechanisms of Systemic Vasodilation and Hyperdynamic Circulatory State of Cirrhosis

51

(14)

Richard Moreau

Didier Lebrec

Mechanisms of Sodium Retention, Ascites Formation, and Renal Dysfunction in Cirrhosis

65

(20)

Andres Cardenas

Pere Gines

Hepatic Hemodynamics in Portal Hypertension: Compliance, Hepatic Arterial Buffer Response, Hepatorenal Syndrome, and Liver Regeneration

85

(14)

W. Wayne Lautt

Zhi Ming

Neovascularization, Angiogenesis, and Vascular Remodeling in Portal Hypertension

99

(14)

Manuel Morales-Ruiz

Wladimiro Jimenez

Mechanisms of Cardiopulmonary Hemodynamics and Dysfunction in Portal Hypertension

113

(16)

Michael B. Fallon

Part III: Methodology to Assess Portal Hypertension in Humans

Measurement of Hepatic Venous Pressure Gradient: Methods, Interpretation, and Pitfalls

129

(16)

G. Pomier-Layrargues

P. Michel Huet

Evaluation of Portal Hemodynamics Using Indicator Dilution and Noninvasive Techniques

145

(10)

Juerg Reichen

Endoscopic Assessment of Portal Hypertension Including Variceal Pressure Measurements: Methods, Interpretation, and Pitfalls

155

(12)

Angels Escorsell

Jaime Bosch

Part IV: Natural History and Treatment of Esophageal Varices

Clinical Features and Natural History of Variceal Hemorrhage: Implications for Surveillance and Screening

167

(16)

Juan G. Abraldes

Jaime Bosch

Management Strategies for the Prophylaxis and Treatment of Esophageal Variceal Rupture: An Overview

183

(16)

Roberto de Franchis

Pharmacologic Therapy for the Management of Esophageal Varices: Biology and Utility of Available Agents

199

(22)

Norman D. Grace

Richard S. Tilson

Endoscopic Treatment for Bleeding Esophageal Varices

221

(14)

John P. Cello

Surgical Therapies for Management: Surgical Shunts and Liver Transplantation

235

(12)

J. Michael Henderson

Transjugular Intrahepatic Portosystemic Stent-Shunt: Technical Considerations and Clinical Utility in the Management of Variceal Hemorrhage

247

(20)

Dhiraj Tripathi

Peter C. Hayes

Doris N. Redhead

Rajiv Jalan

Clinical Features and Management of Gastric Varices, Portal Hypertensive Gastropathy, and Ectopic Varices

267

(18)

Charmaine A. Stewart

Patrick S. Kamath

Part V: Natural History and Treatment of Ascites and Hepatorenal Syndrome

Ascites: Clinical Features, Diagnosis, and Natural History

285

(16)

Sakib Karim Khalid

Guadalupe Garcia-Tsao

Management of Ascites

301

(18)

Florence Wong

Spontaneous Bacterial Peritonitis and Other Infections in Cirrhosis

319

(24)

Rosa Maria Morillas

Romon Planas

Diagnosis and Management of the Hepatorenal Syndrome

343

(22)

Kevin Moore

Part V: Evaluation and Treatment in Special Circumstances of Portal Hypertension

Pregnancy and Portal Hypertension

365

(18)

Bimaljit Sandhu

Arun J. Sanyal

Causes and Management of Portal Hypertension in the Pediatric Population

383

(28)

Frederick C. Ryckman

Maria H. Alonso

Greg Tiao

Noncirrhotic Portal Hypertension and Portal Vein Thrombosis

411

(22)

Shiv K. Sarin

Manav Wadhawan

Hepatic Venous Outflow Obstruction: Budd--Chiari Syndrome and Veno-Occlusive Disease (Sinusoidal Obstruction Syndrome)

433

(22)

Hugo E. Vargas

Thomas D. Boyer

Pulmonary Complications Associated with Portal Hypertension

455

(14)

Karen L. Swanson

Michael J. Krowka

Health Status Assessment and Economic Analyses in Cirrhosis and Portal Hypertension

469

(16)

Jayant A. Talwalkar

W. Ray Kim

Future Treatments: Antifibrotic Agents, Nitric Oxide Donors, and Gene Therapy in the Treatment of Portal Hypertension

485

(20)

Meena B. Bansal

Scott L. Friedman

Index

505

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Portal Hypertension

9781588293862

1588293866

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