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"
having abnormally high blood pressure
a person who has abnormally high blood pressure

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』》
高血圧の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/10 21:14:50」(JST)

wiki en

Portal hypertensive gastropathy refers to changes in the mucosa of the stomach in patients with portal hypertension; by far the most common cause of this is cirrhosis of the liver. These changes in the mucosa include friability of the mucosa and the presence of ectatic blood vessels at the surface. Patients with portal hypertensive gastropathy may experience bleeding from the stomach, which may uncommonly manifest itself in vomiting blood or melena; however, portal hypertension may cause several other more common sources of upper gastrointestinal bleeding, such as esophageal varices and gastric varices. On endoscopic evaluation of the stomach, this condition shows a characteristic mosaic or "snake-skin" appearance to the mucosa of the stomach.

Pathogenesis

Several studies have found that patients with portal hypertension develop increased blood flow to the stomach.^[1] The physiological findings that correlate with worsening portal hypertensive gastropathy include an increased portal venous pressure gradient and decreased hepatic blood flow.^[2] Biopsies of the stomach in patients with portal hypertensive gastropathy show ectatic (or dilated) blood vessels, evidence of bleeding by means of red blood cells in the lamina propria, and edema in the stomach wall.^[3]

Clinical findings

Most patients with portal hypertensive gastropathy have either a stable or improving course in the appearance of the gastropathy on endoscopy. However, according to retrospective data, roughly one in seven patients with portal hypertensive gastropathy will develop bleeding (either acute or chronic) attributable to the gastropathy.^[4] Patients with chronic bleeding will usually come to the attention of the medical system because of anemia.

The diagnosis of portal hypertensive gastropathy is usually made on endoscopy. The usual appearance of portal hypertensive gastropathy on endoscopy is a mosaic-like or reticular pattern in the mucosa. Red spots may or may not be present. The pattern is usually seen throughout the stomach.^[3] A similar pattern can be seen with a related condition called gastric antral vascular ectasia (GAVE), or watermelon stomach. However, in GAVE, the ectatic blood vessels are more commonly found in the antrum or lower part of the stomach.^[3]

Treatment

Argon plasma coagulation, seen here to treat gastric antral vascular ectasia, has also been used to treat bleeding from portal hypertensive gastropathy

Medications

Several treatment options have been developed for portal hypertensive gastropathy. The first is the use of beta-blockers, which reduce portal pressures. Non-selective beta blockers (such as propranolol and nadolol) have been used to decrease the pressure of the portal vein in patients with esophageal varices, and have been shown to regress portal hypertensive gastropathy that has been worsened by medical treatment of varices.^[5] Propranolol has also been evaluated in patients with chronic cirrhosis and portal hypertensive gastropathy ^[6] Other medications that primarily treat bleeding, including anti-fibrinolytic medications such as tranexamic acid have also been used in case reports of patients with portal hypertensive gastropathy.^[7] These medications work by stabilizing deposits of fibrin at sites that ordinarily would bleed.

Finally, octreotide, an analogue of somatostatin that leads to vasoconstriction of the portal circulation, can be used for active bleeding due to portal hypertensive gastropathy.^[8] Sucralfate, a coating medication has also been used, but evidence is from animal models.^[9]

Procedural

Portal hypertensive gastropathy can also be treated with endoscopic treatment delivered through a fibre-optic camera into the stomach. Argon plasma coagulation and electrocautery have both been used to stop bleeding from ectatic vessels, and to attempt to obliterate the vessels, but have limited utility if the disease is diffuse.^[8]^[10]

Transjugular intrahepatic portosystemic shunt procedures, or TIPS involve decompressing the portal vein by shunting a portal venule to a lower pressure systemic venule, under guidance with fluoroscopy. Since it treats the root cause of portal hypertension gastropathy, it has been putatively used for the condition. The literature reports suggest both regression of portal hypertensive gastropathy on endoscopic images and improvement in bleeding after TIPS.^[11]

Finally, cryotherapy involves the use of pressurized carbon dioxide administered through the endoscope to freeze and destroy tissue in a focal area. It is being studied for the treatment of portal hypertensive gastropathy.^[12]

Similar conditions

Congestion of the mucosa in other parts of the gastrointestinal tract can also be seen in portal hypertension. When the condition involves the colon, it is termed portal hypertensive colopathy.^[13]

References

^ Iwao T, Toyonaga A, Sumino M et al. (1992). "Portal hypertensive gastropathy in patients with cirrhosis". Gastroenterology 102 (6): 2060–5. PMID 1587424.
^ Gupta R, Sawant P, Parameshwar RV, Lele VR, Kulhalli PM, Mahajani SS (1998). "Gastric mucosal blood flow and hepatic perfusion index in patients with portal hypertensive gastropathy". J. Gastroenterol. Hepatol. 13 (9): 921–6. doi:10.1111/j.1440-1746.1998.tb00762.x. PMID 9794191.
^ ^a ^b ^c Thuluvath PJ, Yoo HY (2002). "Portal Hypertensive gastropathy". Am. J. Gastroenterol. 97 (12): 2973–8. doi:10.1111/j.1572-0241.2002.07094.x. PMID 12492178.
^ Primignani M, Carpinelli L, Preatoni P et al. (2000). "Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC)". Gastroenterology 119 (1): 181–7. PMID 10889167.
^ Lo GH, Lai KH, Cheng JS et al. (2001). "The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy: a prospective, controlled trial". Gastrointest. Endosc. 53 (6): 579–84. doi:10.1067/mge.2001.114062. PMID 11323582.
^ Pérez-Ayuso RM, Piqué JM, Bosch J et al. (1991). "Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis". Lancet 337 (8755): 1431–4. doi:10.1016/0140-6736(91)93125-S. PMID 1675316.
^ McCormick PA, Ooi H, Crosbie O (1998). "Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis". Gut 42 (5): 750–2. doi:10.1136/gut.42.5.750. PMC 1727106. PMID 9659175.
^ ^a ^b Garcia N, Sanyal AJ (2001). "Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia". Current treatment options in gastroenterology 4 (2): 163–171. doi:10.1007/s11938-001-0028-0. PMID 11469974.
^ Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P (1987). "Effects of propranolol and sucralfate on ethanol-induced gastric mucosal damage in chronic portal hypertensive rats". J. Hepatol. 5 (2): 162–6. doi:10.1016/S0168-8278(87)80568-8. PMID 3693860.
^ Sato T, Yamazaki K, Toyota J et al. (2005). "Efficacy of argon plasma coagulation for gastric antral vascular ectasia associated with chronic liver disease". Hepatol. Res. 32 (2): 121–6. doi:10.1016/j.hepres.2005.04.004. PMID 15967712.
^ Urata J, Yamashita Y, Tsuchigame T et al. (1998). "The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy". J. Gastroenterol. Hepatol. 13 (10): 1061–7. doi:10.1111/j.1440-1746.1998.tb00571.x. PMID 9835325.
^ Clarke JO, Thuluvath PJ (2007). "Endoscopic frontiers in the field of hepatology". Minerva gastroenterologica e dietologica 53 (1): 101–9. PMID 17415347.
^ Bini EJ, Lascarides CE, Micale PL, Weinshel EH (2000). "Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study". Gastrointest. Endosc. 52 (4): 511–6. doi:10.1067/mge.2000.108478. PMID 11023569.

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. 成人における上部消化管出血のまれな原因 uncommon causes of upper gastrointestinal bleeding in adults
2. 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
3. 成人における門脈圧亢進症 portal hypertension in adults
4. 経頸静脈的肝内門脈大循環短絡術：適応および禁忌 transjugular intrahepatic portosystemic shunts indications and contraindications
5. 成人における急性上部消化管出血へのアプローチ approach to acute upper gastrointestinal bleeding in adults

English Journal

Portal hypertensive gastropathy in cirrhotics without varices: a case-control study.

Zardi EM1, Ghittoni G, Margiotta D, Viera FT, Di Matteo F, Rossi S.
European journal of gastroenterology & hepatology.Eur J Gastroenterol Hepatol.2015 Jan;27(1):91-6. doi: 10.1097/MEG.0000000000000234.
OBJECTIVE: Information is lacking on portal hypertensive gastropathy (PHG) in cirrhotics without varices; our aim it is to evaluate whether clinical and sonographic parameters are associated with PHG and may provide information suitable for the management of these patients.PATIENTS AND METHODS: Afte
PMID 25386762

Characterization of uncommon portosystemic collateral circulations in patients with hepatic cirrhosis.

Wu Q1, Shen L1, Chu J1, Ma X1, Jin B1, Meng F1, Chen J1, Wang Y1, Wu L1, Han J1, Zhang W1, Ma W1, Wang H1, Li H1.
Oncology letters.Oncol Lett.2015 Jan;9(1):347-350. Epub 2014 Oct 22.
The purpose of the present study was to characterize uncommon portosystemic collateral circulation in hepatic cirrhosis. Portosystemic uncommon collateral circulation (UCC) was detected, characterized and evaluated by a combination of spiral computed tomography angiography, three-dimensional imaging
PMID 25435990

[Gastric vascular lesions in cirrhosis: gastropathy and antral vascular ectasia.]

Casas M1, Calvet X2, Vergara M2, Bella MR3, Junquera F2, Martinez-Bauer E4, Campo R2.
Gastroenterologia y hepatologia.Gastroenterol Hepatol.2014 Dec 10. pii: S0210-5705(14)00295-7. doi: 10.1016/j.gastrohep.2014.10.005. [Epub ahead of print]
Portal hypertensive gastropathy (GHP) is a complication of portal hypertension usually associated with liver cirrhosis. The pathogenesis is unclear but the presence of portal hypertension is an essential factor for its development. GHP may be asymptomatic or present as gastrointestinal bleeding or i
PMID 25499848

Japanese Journal

内視鏡的食道静脈瘤結紮術後に門脈圧亢進症性胃症から吐血した1例

日本腹部救急医学会雑誌 35(5), 671-674, 2015
NAID 130005106514

巨大肝囊胞が原因と思われた正常肝における胃静脈瘤の1例

福岡医学雑誌 = Fukuoka acta medica 104(11), 449-455, 2013-11-25
NAID 120005385233

出血をきたした門脈圧亢進症性胃症に対する部分的脾動脈塞栓術の有用性について

日本門脈圧亢進症学会雑誌 18(4), 173-176, 2012
NAID 130004852860

Related Pictures

★リンクテーブル★

リンク元	「門脈圧亢進症性胃症」「門脈圧亢進性胃障害」
関連記事	「hypertensive」「port」「portal」

「門脈圧亢進症性胃症」

Portal hypertensive gastropathy
	Image of portal hypertensive gastropathy seen on endoscopy of the stomach. The normally smooth mucosa of the stomach has developed a mosaic like appearance, that resembles snake-skin.
Classification and external resources
ICD-9	537.89

　　[★]

英: portal hypertensive gastropathy, PHG
関: 門脈圧亢進性胃障害

上昇した門脈圧を基礎として発生する胃粘膜のうっ血性病変で、内視鏡検査によって診断される。
組織学的に炎症を伴わず、粘膜内の浮腫と粘膜内および粘膜下層の血管拡張で特徴づけられる。
1985年McCormackらによって発表された内視鏡分類が広く用いられている。

「門脈圧亢進性胃障害」

　　[★]

英: portal hypertensive gastropathy
関: 門脈圧亢進症性胃症

「hypertensive」

　　[★]

adj.

高血圧性の、高血圧の

関: HBP、high blood pressure、HT、hypertension

「port」

　　[★]

n.

ポート、出入口

関: gateway

「portal」

　　[★]

adj.

門脈の

関: portal vein

[1] Iwao T, Toyonaga A, Sumino M et al. (1992). "Portal hypertensive gastropathy in patients with cirrhosis". Gastroenterology 102 (6): 2060–5. PMID 1587424.

[2] Gupta R, Sawant P, Parameshwar RV, Lele VR, Kulhalli PM, Mahajani SS (1998). "Gastric mucosal blood flow and hepatic perfusion index in patients with portal hypertensive gastropathy". J. Gastroenterol. Hepatol. 13 (9): 921–6. doi:10.1111/j.1440-1746.1998.tb00762.x. PMID 9794191.

[PHGrev-3] Thuluvath PJ, Yoo HY (2002). "Portal Hypertensive gastropathy". Am. J. Gastroenterol. 97 (12): 2973–8. doi:10.1111/j.1572-0241.2002.07094.x. PMID 12492178.

[4] Primignani M, Carpinelli L, Preatoni P et al. (2000). "Natural history of portal hypertensive gastropathy in patients with liver cirrhosis. The New Italian Endoscopic Club for the study and treatment of esophageal varices (NIEC)". Gastroenterology 119 (1): 181–7. PMID 10889167.

[5] Lo GH, Lai KH, Cheng JS et al. (2001). "The effects of endoscopic variceal ligation and propranolol on portal hypertensive gastropathy: a prospective, controlled trial". Gastrointest. Endosc. 53 (6): 579–84. doi:10.1067/mge.2001.114062. PMID 11323582.

[6] Pérez-Ayuso RM, Piqué JM, Bosch J et al. (1991). "Propranolol in prevention of recurrent bleeding from severe portal hypertensive gastropathy in cirrhosis". Lancet 337 (8755): 1431–4. doi:10.1016/0140-6736(91)93125-S. PMID 1675316.

[7] McCormick PA, Ooi H, Crosbie O (1998). "Tranexamic acid for severe bleeding gastric antral vascular ectasia in cirrhosis". Gut 42 (5): 750–2. doi:10.1136/gut.42.5.750. PMC 1727106. PMID 9659175.

[Rev2-8] Garcia N, Sanyal AJ (2001). "Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia". Current treatment options in gastroenterology 4 (2): 163–171. doi:10.1007/s11938-001-0028-0. PMID 11469974.

[9] Geoffroy P, Duchateau A, Thiéfin G, Zeitoun P (1987). "Effects of propranolol and sucralfate on ethanol-induced gastric mucosal damage in chronic portal hypertensive rats". J. Hepatol. 5 (2): 162–6. doi:10.1016/S0168-8278(87)80568-8. PMID 3693860.

[10] Sato T, Yamazaki K, Toyota J et al. (2005). "Efficacy of argon plasma coagulation for gastric antral vascular ectasia associated with chronic liver disease". Hepatol. Res. 32 (2): 121–6. doi:10.1016/j.hepres.2005.04.004. PMID 15967712.

[11] Urata J, Yamashita Y, Tsuchigame T et al. (1998). "The effects of transjugular intrahepatic portosystemic shunt on portal hypertensive gastropathy". J. Gastroenterol. Hepatol. 13 (10): 1061–7. doi:10.1111/j.1440-1746.1998.tb00571.x. PMID 9835325.

[12] Clarke JO, Thuluvath PJ (2007). "Endoscopic frontiers in the field of hepatology". Minerva gastroenterologica e dietologica 53 (1): 101–9. PMID 17415347.

[13] Bini EJ, Lascarides CE, Micale PL, Weinshel EH (2000). "Mucosal abnormalities of the colon in patients with portal hypertension: an endoscopic study". Gastrointest. Endosc. 52 (4): 511–6. doi:10.1067/mge.2000.108478. PMID 11023569.

匿名

検索

案内

案内

portal hypertensive gastropathy