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Relation between liver pathology and prognosis in patients with portal hypertension

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Abstract

The most common causes of variceal bleeding are cirrhosis, schistosomiasis, and extrahepatic portal venous obstruction. The prognosis for an individual patient depends on the severity of the bleeding episode and the underlying liver function. Liver function is determined to a large extent by the underlying liver pathology. Patients with noncirrhotic portal hypertension or cirrhosis with good liver function have good short- and long-term prognoses. In patients with established cirrhosis, the presence of alcoholic hepatitis, hepatocellular carcinoma, or portal venous thrombosis may adversely affect prognosis. In addition to affecting prognosis, the underlying pathology may also influence choice of treatment. This point is particularly true for treatments such as shunt surgery, liver transplantation, or transjugular intrahepatic shunts.

Résumé

Les causes les plus fréquentes de varices oesophagiennes sont la cirrhose, la bilharziose (schistosomiase) et l'occlusion de la veine porte extrahépatique. Le pronostic pour un individu donné dépend de la sévérité de l'hémorragie et de la fonction hépatique. La fonction hépatique est elle-même déterminée par la pathologie sous-jacente. Les patients ayant une hypertension portale d'origine non cirrhotique ou une cirrhose avec une fonction hépatique conservée ont un meilleur pronostic à court et à long terme. Chez le patient ayant une cirrhose établie, la présence d'une hépatite alcoolique, d'un carcinome hépatocellulaire et/ou d'une thrombose de la veine porte sont des facteurs de mauvais pronostic. La pathologie sous-jacente peut influencer non seulement le pronostic, mais aussi le choix du traitement. Ceci est particulièrement vrai pour le traitement par anastomose portocave, la transplantation ou le shunt intrahépatique transjugulaire.

Resumen

Las causas más comunes de hemorragia varicosa son la cirrosis, la esquistosomiasis y la obstrucción portal extrahepática. El pronóstico en cada individuo depende de la severidad del' episodio de sangrado y del estado de la función hepática, estado que depende en gran parte de la patología hepática subyacente. Los pacienes con hipertensión portal de origen no cirrótico o con cirrosis y buena función hepática tienen un buen pronóstico, tanto a corto como a largo plazo. En los pacientes con cirrosis establecida, la presencia de hepatitis alcohólica, de carcinoma hepatocellular y/o de trombosis de la vena porta puede afectar el pronóstico en forma adversa. Además de afectar el pronóstico, la patología subyacente puede también influenciar la modalidad de tratamiento. Esto es particularmente cierto en modalidades terapéuticas tales como cirugía derivativa (“shunts”), trasplante hepático o “shunts” transyugulares intrahepáticos (TIPS).

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Authors and Affiliations

  1. University Department of Medicine, Hepatobiliary and Liver Transplant Unit, Royal Free Hospital School of Medicine, Pond Street, Hampstead, NW3 2QG, London, United Kingdom

    P. Aiden McCormick M.D. & Andrew K. Burroughs M.B.

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  1. P. Aiden McCormick M.D.
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  2. Andrew K. Burroughs M.B.
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Aiden McCormick, P., Burroughs, A.K. Relation between liver pathology and prognosis in patients with portal hypertension. World J. Surg. 18, 171–175 (1994). https://doi.org/10.1007/BF00294397

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