PORTAL HYPERTENSION – CAUSES AND COMPLICATIONS Edited by Dmitry V. Garbuzenko Portal Hypertension – Causes and Complications Edited by Dmitry V. Garbuzenko Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Sandra Bakic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Portal Hypertension – Causes and Complications, Edited by Dmitry V. Garbuzenko p. cm. ISBN 978-953-51-0251-9 Contents Preface IX Chapter 1 The Molecules: Abnormal Vasculatures in the Splanchnic and Systemic Circulation in Portal Hypertension 1 Yasuko Iwakiri Chapter 2 Cystic Fibrosis Liver Disease 27 Andrew Low and Nabil A. Jarad Chapter 3 Extra Hepatic Portal Venous Obstruction in Children 41 Narendra K. Arora and Manoja K. Das Chapter 4 Portal Vein Thrombosis with Cavernous Transformation in Myeloproliferative Disorders: Review Update 65 Anca Rosu, Cristian Searpe and Mihai Popescu Chapter 5 The Bacterial Endotoxins Levels in the Blood of Cirrhotic Patients as Predictor of the Risk of Esophageal Varices Bleeding 85 Dmitry Garbuzenko, Alexandr Mikurov and Dmitry Smirnov Chapter 6 Traditional Chinese Medicine Can Improve Liver Microcirculation and Reduce Portal Hypertension in Liver Cirrhosis 93 Xu Lieming, Gu Jie, Lu Xiong, Zhou Yang, Tian Tian, Zhang Jie and Xu Hong Chapter 7 Role of Manganese as Mediator of Central Nervous System: Alteration in Experimental Portal Hypertension 121 Juan Pablo Prestifilippo, Silvina Tallis, Amalia Delfante, Pablo Souto, Juan Carlos Perazzo and Gabriela Beatriz Acosta VI Contents Chapter 8 Changes of Peripheral Blood Cells in Patients with Cirrhotic Portal Hypertension 133 Lv Yunfu Preface Portal hypertension is a clinical syndrome defined by a portal venous pressure gradient exceeding 5 mm Hg. It is initiated by increased outflow resistance, and can occur at a presinusoidal (intra- or extrahepatic), sinusoidal, or postsinusoidal level. As the condition progresses, there is a rise in portal blood flow, a combination that mains and worsens the portal hypertension. Cirrhosis is the most common cause of portal hypertension in the Western world. There are more rare intrahepatic causes of portal hypertension, such as cystic fibrosis liver disease. Extra hepatic portal venous obstruction is found mainly at children, and it can also be caused by myeloproliferative diseases. In cirrhosis, the principal site of increased resistance to outflow of portal venous blood is within the liver itself. Mesenteric arterial vasodilation is hallmark of cirrhosis and contributes to both increased portal venous inflow and a systemic hyperdinamic circulatory state. Arterial vasodilatation is regulated by a complex interplay of various vasodilator molecules and factors that influence the production of those vasodilator molecules. Portal hypertension is associated with severe complications, including ascites, hepatic encephalopathy, hypersplenism, bleeding from gastro-esophageal varices. Despite the progress achieved over last decades, the 6-week mortality associated with variceal bleeding is still in the order of 10-20%. Endoscopic assessment of esophageal varices and the state of esophageal and stomach mucosa at the esophagogastroduodenoscopy, presents high importance for the assessment of risk of their development. However, invasiveness as well as discomfort that are tolerated by patients during the given procedure, lead to the rejection from it and therefore they can’t be subjected to examination in a number of cases. Beside that, the research might be impossible to carry out in case if the state of patient is grave. The investigation of hepatic venous pressure gradient, that reflects the portal hypertension intensity best of all, haven`t been realized in the clinical practice up to now. Considering the above mentioned disadvantages of main methods, the development of additional prognostic criteria of the risk of esophageal varices bleeding remains the urgent problem of the internal medicine. X Preface Current methods of treatments in portal hypertension include farmacologic therapy by vasoactive drugs, endoscopic therapy, portosystemic shunt surgery and transjugular intrahepatic portosystemic shunts (TIPS). Expansion in the knowledge of pathophysiology of portal hypertension is need as this might provide new and useful strategies for the future. The described problems above associated mainly with portal hypertension are presented in this book. Dmitry V. Garbuzenko Department of Surgical Diseases and Urology, Chelyabinsk State Medical Academy, Chelyabinsk, Russia . PORTAL HYPERTENSION – CAUSES AND COMPLICATIONS Edited by Dmitry V. Garbuzenko Portal Hypertension – Causes and Complications Edited by Dmitry. vessels in the splanchnic and systemic circulation in cirrhosis and portal Portal Hypertension – Causes and Complications 2 hypertension. The chapter concludes with a brief discussion about. (bovine) and activates eNOS, leading to NO production (Dimmeler, et al. 1999; Fulton, et al. 1999). We have shown that portal hypertension increases eNOS Portal Hypertension – Causes and Complications