[Circulatory dysfunction syndrome associated with liver cirrhosis].
Splanchnic arterial relaxation is the most important pathology in systemic circulation of portal hypertensive patients. Progressive decline of splanchnic vascular resistance is responsible for development of circulatory dysfunction syndrome (CDS), associated with reduction of effective blood volume within central vascular compartment and compensatory stimulation of vasopressor and natrium retaining hormonal mechanisms. Advanced CDS is characterized by increased cardiac output, tachycardia and low arterial pressure. Complications of CDS have functional nature and comprise: renal failure (hepatorenal syndrome), respiratory failure in context of hepatopulmonary syndrome, cardiac insufficiency produced by portopulmonary hypertension or portal cardiomyopathy, hemorrhages from digestive tract caused by hypertensive portal gastropathy or derangements of brain perfusion. The management of CDS relies on adequate filling of vascular system (albumin), constriction of arterial splanchnic vessels (beta-blocker, analogs of vasopressin and somatostatin), reduction of cardiac output (beta-blocker) and giving support to local vasoprotective mechanisms (prostaglandins, nitric oxide, blockade of ET-A receptors).
Hartleb
Marek
M
Katedra i Klinika Gastroenterologii, Slaska Akademia Medyczna w Katowicach. lakmus@poczta.wprost.pl
D001775:Blood Circulation; D002302:Cardiac Output; D009202:Cardiomyopathies / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology*; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology*; D012307:Risk Factors; D013152:Splanchnic Circulation; D014661:Vasoconstriction