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Gastrointestinal and Hepatic Physiology in Liver Disease

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Hepatic Critical Care

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Abstract

Portal hypertension develops as a consequence of increased resistance to portal blood flow as well as increased portal blood flow due to splanchnic vasodilation. Increased resistance due to cirrhosis is due to both structural changes from increased vascular resistance as well as dynamic variables due to release of endothelial vasodilators (such as nitrous oxide) and increased production of vasoconstrictors (such as endothelin 1). While portal hypertension is initially asymptomatic, its development is a necessary precursor for many of the potentially lethal complications related to liver disease. Portosystemic collateral vessels, or varices, develop as an inefficient means to decompress the portal system and can result in esophageal or gastric hemorrhage associated with high morbidity and mortality. A compensatory activation of neurohormonal mechanism to reduced effective circulating volume leads to sodium and water retention results in ascites and eventually to hepatorenal syndrome. Acute liver failure is characterized as the acute development of liver injury, hepatic encephalopathy, and impaired synthetic dysfunction and leads to hemodynamic instability and multi-organ system failure. Acute on chronic liver failure is a recently defined syndrome characterized by hemodynamic abnormalities with complications resulting from portal hypertension.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Colorado, Anschutz Medical Campus, 1635 Aurora Ct./Mail Stop B154, Aurora, CO, 80045, USA

    J. P. Norvell M.D. (Assitant Professor of Medicine)

  2. The University of Chicago Medical Center and Biological Sciences, 5841 S. Maryland Ave/MC 7120, Chicago, IL, 60637, USA

    Anjana A. Pillai M.D. (Associate Professor of Medicine)

  3. Gastroenterology Fellow, Division of Digestive Diseases, Emory University School of Medicine, 1365 Clifton Rd, Suite B6100, Atlanta, GA, 30322, USA

    Mary M. Flynn M.D.

Authors
  1. J. P. Norvell M.D.
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  2. Anjana A. Pillai M.D.
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  3. Mary M. Flynn M.D.
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Correspondence to J. P. Norvell M.D. or Anjana A. Pillai M.D. .

Editor information

Editors and Affiliations

  1. Medical Intensive Care Unit, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Rahul Nanchal

  2. Emory University, Atlanta, Georgia, USA

    Ram Subramanian

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Norvell, J.P., Pillai, A.A., Flynn, M.M. (2018). Gastrointestinal and Hepatic Physiology in Liver Disease. In: Nanchal, R., Subramanian, R. (eds) Hepatic Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-319-66432-3_4

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  • DOI: https://doi.org/10.1007/978-3-319-66432-3_4

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-66431-6

  • Online ISBN: 978-3-319-66432-3

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