Collateral Circulation of the Splenoportal System in Portal Hypertension

  • H.-J. Maurer
Conference paper

Abstract

The main cause of portal hypertension is liver cirrhosis (LC) (Brick and Palmer; Gütgemann and Schreiber; Kalk 1958; Schreiber 1962; Zimmerman et al). In Western countries this is commonly due to alcohol (De la Hall); in India and southeastern Asia most cases are attributable to hepatitis B which is less common in Europe and North America; other, less frequent causes of LC are discussed by Zimmerman et al. and by Okuda and Benhamou (1991, part IV). Thrombosis in the splenoportal system may complicate LC or appear alone. Due to localization of the barrier in the splenoportal circulation Whipple (1945) proposed the concept of intra- and prehepatic block and Kalk (1953) that of posthepatic block, i. e., obstruction of the hepatic venous outflow, caused mostly by thrombosis (Budd-Chiari syndrome) and sometimes connected with thrombosis in the splenoportal system. The most important complication is bleeding of esophageal or/and stomach varices, entailing a high mortality rate (first bleeding, 50%; generally, 38.2%). In 10% of cases this bleeding is the first symptom of LC.

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© Springer-Verlag Berlin Heidelberg 1993

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  • H.-J. Maurer

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