Surgical Intervention for Portal Hypertension
In 2010, surgery for complications of portal hypertension is largely limited to liver transplantation. The use of surgical shunts and devascularization procedures for variceal bleeding is now limited to unusual patients who have bleeding refractory to me
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Laurie D. DeLeve Guadalupe Garcia-Tsao Editors
Vascular Liver Disease Mechanisms and Management
Editors Laurie D. DeLeve Division of Gastrointestinal and Liver Diseases University of Southern California Keck School of Medicine Los Angeles, CA 90033, USA [email protected]
Guadalupe Garcia-Tsao Section of Digestive Diseases Yale University School of Medicine New Haven, CT 06520, USA [email protected]
ISBN 978-1-4419-8326-8 e-ISBN 978-1-4419-8327-5 DOI 10.1007/978-1-4419-8327-5 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011922497 © Springer Science+Business Media, LLC 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com)
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Preface
Functions of the liver are highly dependent on its vascular connections to the “outside world” (the gut and the splanchnic circulation) and the “inside world” (the heart and the systemic circulation). These connections not only allow the liver to process nutrients and store vitamins that are absorbed from the gut, but also permit removal of bacteria that come from the gut before they reach the systemic circulation. The liver detoxifies and metabolizes endogenous toxins (e.g., ammonia) and, importantly, exogenous substances such as alcohol and most medications that arrive to the liver via the systemic or splanchnic circulations. Additionally, the liver synthesizes substances such as albumin and clotting factors that are secreted into the systemic circulation and produces bile acids that are secreted through the biliary ducts into the gut, facilitating fat absorption. It follows that abnormalities that directly or indirectly affect the hepatic vasculature will lead to significant disease. These abnormalities can be microscopic, at the level of the hepatic sinusoids, or can affect the larger afferent or efferent vessels. T
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