Copyright
©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Nov 14, 2014; 20(42): 15499-15517
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15499
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15499
Table 1 Vasodilating and vasoconstricting forces involved in disturbed haemodynamics in cirrhosis (Alphabetic order)
| Vasodilator systems |
| Adenosine |
| Adrenomedullin |
| Atrial natriuretic peptide |
| Bradykinin |
| Brain natriuretic peptide |
| Calcitonin gene-related peptide |
| Carbon monoxide |
| Endocannabinoids |
| Endothelin-3 |
| Endotoxin |
| Enkephalins |
| Glucagon |
| Histamine |
| Hydrogen sulphide |
| Interleukins |
| Natriuretic peptide of type C |
| Nitric oxide |
| Prostacyclin (PGI2) |
| Substance P |
| Tumour necrosis factor-α |
| Vasoactive intestinal polypeptide |
| Vasoconstrictor systems |
| Angiotensin II |
| Adrenaline and noradrenaline |
| Endothelin-1 |
| Neuropeptide Y |
| Renin-angiotensin-aldosterone system |
| Sympathetic nervous system |
| Vasopressin |
Table 2 Circulatory changes in specific vascular beds in cirrhosis
| Systemic circulation |
| Plasma volume ↑ |
| Total blood volume ↑ |
| Non-central blood volume ↑ |
| Central and arterial blood volume ↓ (→) |
| Cardiac output ↑ |
| Arterial blood pressure ↓ (→) |
| Heart rate ↑ |
| Systemic vascular resistance ↓ |
| Arterial and total vascular compliance ↑ |
| Heart |
| Left atrial volume ↑ |
| Left ventricular volume → (↑) |
| Right atrial volume →↑↓ |
| Right ventricular volume →↑↓ |
| Right atrial pressure →↑ |
| Right ventricular end diastolic pressure → |
| Pulmonary artery pressure →↑ |
| Left ventricular end diastolic pressure → |
| Hepatic and splanchnic circulation |
| Hepatic blood flow ↓→ (↑) |
| Hepatic venous pressure gradient ↑ |
| Postsinusoidal resistance ↑ |
| Renal circulation |
| Renal blood flow ↓ |
| Glomerular filtration rate ↓→ |
| Pulmonary circulation |
| Pulmonary blood flow ↑ |
| Pulmonary vascular resistance ↓ (↑)1 |
| Cutaneous and skeletal muscle circulation |
| Skeletal muscular blood flow ↑→↓ |
| Cutaneous blood flow ↑→↓ |
Table 3 Characterization of cirrhotic cardiomyopathy
| Definition |
| A cardiac dysfunction in patients with cirrhosis characterised by impaired contractile responsiveness to stress and/or altered diastolic relaxation with electrophysiological abnormalities in the absence of other known cardiac disease |
| Diagnostic criteria |
| Systolic dysfunction |
| Blunted increase in cardiac output with exercise, volume challenge or pharmacological stimuli |
| Resting EF < 55% |
| Diastolic dysfunction |
| E/A ratio < 1.0 (age-corrected) |
| Prolonged deceleration time (> 200 ms) |
| Prolonged isovolumetric relaxation time (> 80 ms) |
| Supportive criteria |
| Electrophysiological abnormalities |
| Abnormal chronotropic response |
| Electromechanical uncoupling/dyssynchrony |
| Prolonged Q-T interval |
| Enlarged left atrium |
| Increased myocardial mass |
| Increased BNP and pro-BNP |
| Increased troponin I |
Table 4 Diagnostic criteria for the hepatopulmonary syndrome and portopulmonary hypertension
| HPS | PoPH |
| Presence of liver disease | Presence of liver disease and portal hypertension |
| PA-aO2 > 15 mmHg (> 2 kPa) | Mean pulmonary arterial pressure > 25 mmHg |
| Positive contrast enhanced echocardiography1 | Pulmonary vascular resistance > 240 dyn·s·cm-5 left atrial pressure < 15 mmHg |
Table 5 New diagnostic criteria for the hepatorenal syndrome from the International Ascites Club (2013)[192]
| Cirrhosis with ascites |
| Serum creatinine > 133 μmol/L (1.5 mg/dL) |
| No improvement of serum creatinine (decrease to a level of < 133 μmol/L) after at least 2 d with diuretic withdrawal and volume expansion with albumin. 1 g/kg of body weight per day up to a maximum of 100 g/d |
| Absence of shock |
| No current treatment with nephrotoxic drugs |
| Absence of parenchymal kidney disease as indicated by proteinuria > 500 mg/d, or microhaematuria, (> 50 red blood cells per high power field) and /or a normal renal ultrasonography |
- Citation: Møller S, Henriksen JH, Bendtsen F. Extrahepatic complications to cirrhosis and portal hypertension: Haemodynamic and homeostatic aspects. World J Gastroenterol 2014; 20(42): 15499-15517
- URL: https://www.wjgnet.com/1007-9327/full/v20/i42/15499.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i42.15499