CONTRASTING HAEMODYNAMIC PATTERNS OF PORTAL HYPERTENSION IN HEPATOSPLENIC SCHISTOSOMIASIS

MA El-Gendi, N Gemeuh

Abstract


18 cases of hepatosplenic schistosomiasis taken at
random were studied. The transumbilical portal
pressure, the trans-splenic portal pressure, the
occluded thoracic duct pressure, and thoracic duct
lymph flow were measured simultaneously before
and after splenectomy. The findings were correlated
with the clinical data, liver pathology, and operative
findings. The transumbilical portal pressure-trans
splenic portal pressure gradient was found of
significant importance. It was considered positive
when the transumbilical portal pressure was higher
than the trans-splenic portal pressure, in such cases
the primary generating factor of portal hypertension
is most probably of hepatic origin (post or presinusoidal
obstruction; organic or functional). The gradient was
considered negative when the transumbilical portal
pressure was lower than the trans-splenic portal
pressure; in such cases the primary generating factor
of portal hypertension is most probably of splenic
origin (hyperdynamic spleen) or in the portal vein
(thrombosis). A significant correlation was found
between the type of this gradient, the thoracic duct
lymph flow and the clinico-pathological state. The
thoracic duct flow was highest in the non-bleeders.
Definite contrasting haemodynamic patterns were
found between bleeders and non-bleeders. The bearing
of these contrasting patterns on the selection of the
operative procedure in the treatment of portal
hypertension is suggested.


Full Text:

PDF