WordNet

turn or go to the port or left side, of a ship; "The big ship was slowly porting"
an opening (in a wall or ship or armored vehicle) for firing through (同)embrasure, porthole
sweet dark-red dessert wine originally from Portugal (同)port wine
a place (seaport or airport) where people and merchandise can enter or leave a country
located on the left side of a ship or aircraft (同)larboard
bring to port; "the captain ported the ship at night"
carry or hold with both hands diagonally across the body, especially of weapons; "port a rifle"
carry, bear, convey, or bring; "The small canoe could be ported easily"
drink port; "We were porting all in the club after dinner"
land at or reach a port; "The ship finally ported"
modify (software) for use on a different machine or platform
put or turn on the left side, of a ship; "port the helm"
a grand and imposing entrance (often extended metaphorically); "the portals of the cathedral"; "the portals of heaven"; "the portals of success"

PrepTutorEJDIC

〈C〉〈U〉『港』 / 〈C〉『港町』,『港市』
(船の)左舷(さげん);(飛行機の)(機首に向かって)左側 / 左舷の,左側の / 〈かじなど〉‘を'左舷に向ける
=porthole / (船の)荷役口 / (装甲車・城壁などの)銃眼,砲門
ポートワイン(ポルトガル原産の甘口のぶどう酒で深紅色)
控え銃(つつ)の姿勢(銃をからだの正面に斜めに保持し先端が左肩の近くにくる) / 〈銃など〉‘を'控え銃にする
〈C〉(堂々とした)門,入り口 / 《複数形》《文》(大きな建物の)正門,表玄関 / 《複数形》《文》(…の)発端《+『of』+『名』》
高血圧[症] / 過度の緊張

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/28 13:02:32」(JST)

wiki en

Portal hypertension is hypertension (high blood pressure) in the portal vein system, which is composed of the portal vein, and its branches and tributaries.

Portal hypertension is defined as elevation of hepatic venous pressure gradient to >5mmHg. Generally, in clinical practice the pressure is not measured directly until the decision to place a transjugular intrahepatic portosystemic shunt (TIPS) has already been made. As part of that procedure, a hepatic vein wedge pressure is measured with the assumption of no pressure drop across the liver yielding portal vein pressure.

Signs and symptoms

Consequences of portal hypertension are caused by blood being forced down alternate channels by the increased resistance to flow through the systemic venous system rather than the portal system. They include:

Ascites (free fluid in the peritoneal cavity).^[1]
Hepatic encephalopathy.
Increased risk of spontaneous bacterial peritonitis.
Increased risk of hepatorenal syndrome.
Splenomegaly (enlargement of the spleen) with a consequent accumulation of red blood cells, white blood cells, and platelets,^{[citation needed]} together leading to mild pancytopenia.^{[citation needed]}
Development of varices at portacaval anastomoses: Esophageal varices, gastric varices, anorectal varices (not to be confused with hemorrhoids), and caput medusae. Esophageal and gastric varices pose an ongoing risk of life-threatening bleeding, with bloody vomiting or melena.

Causes

Causes can be divided into pre-hepatic, intra-hepatic, and post-hepatic.

Prehepatic causes include portal vein thrombosis or congenital atresia.
Intrahepatic causes include liver cirrhosis, hepatic fibrosis (e.g. due to Wilson's disease, hemochromatosis, or congenital fibrosis), and less commonly noncirrhotic causes such as schistosomiasis, massive fatty change and diffuse granulomatous diseases (e.g. sarcoidosis, miliary tuberculosis).^[2]
Posthepatic obstruction occurs at any level between liver and right heart, including hepatic vein thrombosis, inferior vena cava thrombosis, inferior vena cava congenital malformation, and constrictive pericarditis.

Diagnosis

HVPG (hepatic venous pressure gradient) measurement has been accepted as the gold standard for assessing the severity of portal hypertension, and replaced the old one - contrast angiography.^[3] Portal hypertension is defined as HVPG greater than or equal to 5mm Hg and is considered to be clinically significant when HVPG exceeds 10 to 12 mm Hg.^[4]

Treatment

Portosystemic shunts

These can be categorized by several different concepts: selective vs non-selective, mesocaval vs portocaval, and the specific arrangement of vessels, e.g. end-to-side or side-to-side. Selective shunts select non-intestinal flow to be shunted to the systemic venous drainage while leaving the intestinal venous drainage to continue pass through the liver. The most well known of this type is the splenorenal, or Warren, shunt. This connects the splenic vein to the left renal vein thus reducing portal system pressure while minimizing any encephalopathy. In an H-shunt, which could be mesocaval (from the superior mesenteric vein to the inferior vena cava) or could be, unlikely, portocaval (from the portal vein to the inferior vena cava) a graft, either synthetic or the preferred vein harvested from somewhere else on the patient's body, is connected between the superior mesenteric vein and the inferior vena cava. The size of this shunt will determine how selective it is.

It should be noted that with the advent of transjugular intrahepatic portosystemic shunting (TIPS), portosystemic shunts are now very rarely performed. TIPS has the advantage of being much easier to perform and it doesn't disrupt any of the liver's vascularity, which will be needed if a given patient's hopes for liver transplant. In general, non-selective shunts are emergency surgeries that are done as quickly as possible to minimize intraoperative blood loss. On the contrary, a splenorenal shunt would be an elective procedure due to its great technical demands. Further contributing to their rare use today is the fact that few, if any, current general surgery residents are trained in how to carry out these surgeries

Prevention of bleeding

Both pharmacological (non-specific ß-blockers like Propranolol and the nitrate isosorbide mononitrate) and endoscopic (banding ligation) treatment have similar results. TIPS (transjugular intrahepatic portosystemic shunting) is superior to either of them at reducing rate of rebleeding. Disadvantages of TIPS include high cost and increased risk of hepatic encephalopathy, and it does not improve the mortality rate.

Active variceal bleeding

After resuscitation, which may require blood transfusion, the management of active variceal bleeding includes administering vasoactive drugs (somatostatin, octreotide or terlipressin), endoscopic banding ligation, balloon tamponade and TIPS(Transjugular intrahepatic portocaval shunt)

Ascites

This should be gradual to avoid sudden changes in systemic volume status which can precipitate hepatic encephalopathy, renal failure and death. The management includes salt restriction, diuretics (spironolactone), paracentesis, transjugular intrahepatic portosystemic shunt (TIPS) and peritoneovenous shunt.

Hepatic encephalopathy

A standard treatment plan may involve lactulose, bowel enemas, and use of oral antibiotics such as rifaximin, neomycin, metronidazole, vancomycin, and the quinolones. Previously, restriction of dietary protein was recommended but this is now refuted by a clinical trial which showed no benefit.^[5] Instead, the maintenance of adequate nutrition is now advocated.^[6]

References

^ "Portal Hypertension". Retrieved 2007-12-07.
^ Perkins, [edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster ; artist, James A. Robbins basic pathology (9th ed.). Philadelphia, PA: Elsevier/Saunders. p. 608. ISBN 978-1-4377-1781-5.
^ Appleton & Lange's review for the ultrasonography examination, By Carol Krebs, Charles S. Odwin, Arthur C. Fleischer, page 309
^ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3457672/
^ Córdoba, J.; López-Hellín, J.; Planas, M.; Sabín, P.; Sanpedro, F.; Castro, F.; Esteban, R.; Guardia, J. (2004). "Normal protein diet for episodic hepatic encephalopathy: Results of a randomized study". Journal of Hepatology 41 (1): 38–43. doi:10.1016/j.jhep.2004.03.023. PMID 15246205.
^ http://www.patient.info/doctor/Hepatic-Encephalopathy.htm

External links

VIDEO - Portal Hypertension: Shunt Surgery in the Era of Transplant and TIPS, Alysandra Lal, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)
Ascites at Merck Manual of Diagnosis and Therapy Home Edition
00863 at CHORUS

Overview at Cleveland Clinic
Children's Liver Disease Foundation

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における門脈圧亢進症 portal hypertension in adults
2. Causes of noncirrhotic portal hypertension
3. 成人における門脈血栓症の疫学および病因 epidemiology and pathogenesis of portal vein thrombosis in adults
4. 成人における肝硬変：合併症、全般的マネージメント、および予後の概要 cirrhosis in adults overview of complications general management and prognosis
5. 成人における慢性門脈血栓症：臨床症状、診断、および管理 chronic portal vein thrombosis in adults clinical manifestations diagnosis and management

English Journal

Abernethy malformation with multiple aneurysms: incidentally found in an adult woman with Caroli's disease.

Kong Y, Zhang H, Liu C, Wu D, He X, Xiao M, Zhao G, Zhang H.SourceDepartment of Hepatobiliary Surgery, Chinese PLA Air Force General Hospital, Beijing, China.
Annals of hepatology.Ann Hepatol.2013 Mar;12(2):327-31.
Abernethy malformation is a rare anomaly with partial or complete congenital absence of the portal vein and subsequent development of extrahepatic portocaval shunts. We present the case of a 28-year-old woman who was incidentally diagnosed with type II Abernethy malformation and multiple aneurysms d
PMID 23396746

Chronological changes in renal vascular reactivity in portal hypertensive rats.

Chuang CL, Huang HC, Chang CC, Lee FY, Wu JC, Lee SD.SourceDivision of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
European journal of clinical investigation.Eur J Clin Invest.2013 Mar;43(3):267-76. doi: 10.1111/eci.12040. Epub 2013 Jan 7.
BACKGROUND: Circulatory dysfunction in portal hypertension is characterized by increased cardiac output, decreased systemic vascular resistance, a fall in mean arterial pressure secondary to splanchnic and systemic vasodilation and hence renal hypoperfusion. Previous studies have disclosed that rena
PMID 23293840

Estrogen derivatives: novel therapeutic agents for liver cirrhosis and portal hypertension.

Zhang B, Wu ZY.SourceDepartment of General Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
European journal of gastroenterology & hepatology.Eur J Gastroenterol Hepatol.2013 Mar;25(3):263-70. doi: 10.1097/MEG.0b013e32835ab5dc.
Sex differences in the incidence of liver cirrhosis and portal hypertension have been reported by epidemiological studies. Previous studies have indicated that estrogen therapy improved hepatic fibrosis, inhibited the activation of hepatic stellate cells, and reduced portal pressure, whereas the adm
PMID 23104204

Japanese Journal

EUSガイド下ドレナージが有用であった小児膵仮性嚢胞の1例

日本消化機病學會雜誌. 乙 113(1), 71-77, 2016
NAID 130005118420

Epoprostenol Therapy for Pulmonary Arterial Hypertension

Acta Medica Okayama 69(3), 129-136, 2015-06
NAID 120005621906

C型肝硬変による門脈圧亢進症により回腸導管からの出血を来たした1例

泌尿器科紀要 = Acta urologica Japonica 61(1), 19-21, 2015-01
NAID 40020340582

Related Pictures

★リンクテーブル★

リンク元	「門脈圧亢進症」
拡張検索	「idiopathic portal hypertension」「postsinusoidal portal hypertension」「extrahepatic portal hypertension」
関連記事	「port」「portal」「hypertension」

「門脈圧亢進症」

Portal hypertension
	The portal vein and its tributaries.
Classification and external resources
Specialty	Gastroenterology DiseasesDB = 10388
ICD-10	K76.6
ICD-9-CM	572.3
eMedicine	radio/570 med/1889
MeSH	D006975

　　[★]

英: portal hypertension
同: 門脈高圧症
関: 門脈圧、門脈、閉塞肝静脈圧

正常範囲：100-150mmH2O。200mmH2O以上は異常 (YN.B-58)　→　7.4-11mmHg 　(cf. 静脈圧 2-8 mmHg (PHD.61))

分類

部位による

参考1.

肝前性：肝前性門脈圧亢進症：門脈圧(PVP)＞閉塞肝静脈圧(WHVP)

門脈血流↑：動脈・門脈シャント、腹部臓器血流増加、腹腔臓器肉腫
門脈閉塞：肝外門脈閉塞症、門脈血栓、脾静脈血栓、門脈圧排

肝内性：肝内性門脈圧亢進症：類洞前性は肝前性、類洞後性は肝後性と同じ：

前類洞性(肝内門脈閉塞)　：特発性門脈圧亢進症、日本住血吸虫症、先天性肝線維症、門脈域細胞浸潤、肝腫瘍
後類洞性(肝内肝静脈閉塞)：肝硬変のほとんど

肝後性：肝外性門脈圧亢進症：門脈圧(PVP)＜閉塞肝静脈圧(WHVP)　　　　：Budd-Chiari症候群、下大静脈閉塞症、うっ血性心不全

門脈圧亢進症をきたす疾患

参考1 SSUR.644改変

	肝前性	肝内性		肝後性
	肝外門脈閉塞症	特発性門脈圧亢進症	肝硬変	Budd-Chiari症候群
	extrahepatic portal obstruction	idiopathic portal hypertension	liver cirrhosis
門脈圧亢進症に占める割合		2-5%	90%以上
閉塞肝静脈圧 vs 門脈圧	小	小	大	大
閉塞部位	肝外門脈	肝内門脈類洞前	肝内肝静脈類洞後	肝外肝静脈
疫学	(一次性)小児期に発症	中年女性に多い
病因	(一次性)原因不明(新生児臍帯炎) (二次性)腫瘍病変	原因不明		(一次性)原因不明 (二次性)血栓説
症状	肝機能はほぼ正常食道胃静脈瘤、脾腫、汎血球減少	肝機能は良好な事が多い巨脾、食道胃静脈瘤、汎血球減少、脾機能亢進		進行例で肝機能低下腹水、下腿浮腫、下肢静脈瘤、難治性下腿胸腹壁の上行性皮下静脈怒張食道胃静脈瘤、脾腫、汎血球減少
肝臓の外観		表面平滑or波打ち状	再生結節により表面に凹凸を認める
血管検査		(肝静脈造影)肝静脈枝相互吻合、しだれ柳状		(下大静脈造影)膜様閉塞 or 完全閉塞
病理	海綿状血管増生	肝内門脈末梢枝のつぶれ像	肝小葉構造の改築	肝静脈周囲のうっ血と壊死。進行すれば肝硬変
予後	(一次性)10年生存率90%	10年生存率70-80% 肝硬変より良好		(一次性)10年生存率40%