Extrahepatic complications to cirrhosis and portal hypertension: haemodynamic and homeostatic aspects.
In addition to complications relating to the liver, patients with cirrhosis and portal hypertension develop extrahepatic functional disturbances of multiple organ systems. This can be considered a multiple organ failure that involves the heart, lungs, kidneys, the immune systems, and other organ systems. Progressive fibrosis of the liver and subsequent metabolic impairment leads to a systemic and splanchnic arteriolar vasodilatation. This affects both the haemodynamic and functional homeostasis of many organs and largely determines the course of the disease. With the progression of the disease, the circulation becomes hyperdynamic with cardiac, pulmonary as well as renal consequences for dysfunction and reduced survival. Infections and a changed cardiac function known as cirrhotic cardiomyopathy may be involved in further aggravation of other complications such as renal failure precipitating the hepatorenal syndrome. Patients with end-stage liver disease and related complications as for example the hepatopulmonary syndrome can only radically be treated by liver transplantation. As a bridge to this treatment, knowledge on the mechanisms of the pathophysiology of complications is essential for the choice of vasoactive drugs, antibiotics, drugs with specific effects on fibrogenesis and inflammation, and drugs that target specific receptors.
Søren Møller, Jens H Henriksen, Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, University of Copenhagen, DK.2650 Hvidovre, Denmark.
Søren
S
Møller
Søren Møller, Jens H Henriksen, Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, University of Copenhagen, DK.2650 Hvidovre, Denmark.
Jens H
JH
Henriksen
Søren Møller, Jens H Henriksen, Department of Clinical Physiology and Nuclear Medicine, Center for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, University of Copenhagen, DK.2650 Hvidovre, Denmark.
Flemming
F
Bendtsen
D000818:Animals; D018450:Disease Progression; D006439:Hemodynamics; D006706:Homeostasis; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008099:Liver / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D015398:Signal Transduction
Ascites; Bacterial translocation; Cirrhotic cardiomyopathy; Fibrogenesis; Hepatopulmonary syndrome; Hepatorenal syndrome; Infections; Inflammation; Portopulmonary hypertension; Splanchnic haemodynamics; Systemic circulation