[Column] Portosystemic Shuntopathy: This Column Is the Postscript to Chap. 5
Portosystemic shunts including esophagogastric varices are formed in patients with portal hypertension. Esophageal varices do not serve as major shunts, while isolated gastric fundal varices (IGFVs) become major splenorenal shunts. A major shunt is particularly large and has a high shunt ratio. A major splenorenal shunt causes various disease states including classic portosystemic encephalopathy, in other words recurrent hepatic encephalopathy. Although a portosystemic shunt develops as a biological adaptation, excessive portal steal results in liver failure or variceal rupture/bleeding and significantly worsens the prognosis.