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Karaciğer Sirozunda Hepatik ve Renal Hemodinamik Değişikliklerin Doppler US ile Değerlendirilmesi

Color Doppler US Evaluation Of Hepatic And Renal Hemodynamics In The Cirrhosis

Journal Name:

  • Fırat Tıp Dergisi

Publication Year:

  • 2007

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objectives: We aimed to figure out the value of colour Doppler ultrasonography (CDUS) to determine the hepatic and renal hemodynamics in cirrhotic patients. Materials and Methods: 40 cirrhotic patients (11 Child A, 17 Child B and 12 Child C) and a control group of 20 healthy individuals were examined. Renal artery resistive index, renal artery pulsatility index, hepatic artery resistive index, hepatic artery pulsatility index, portal vein velocity, portal vein diameter and hepatic vascular index were assessed in all the individuals. The cirrhotic patients were divided into subgroups according to their Child scores and presence of ascites. The statistical differences between control group, whole and subgroups of cirrhotic patients were evaluated through these parameters. Results: Statistically, there was a significant difference regarding all the parameters between cirrhotic patients and control group and between Child C group and control group (p<0.05). Also, a highly statistical significance was observed concerning the RA-RI, RA-PI, HA-PI, PV-V and HVI parameters among the studied groups (p<0,001). RA-RI, RA-PI, and HA-PI increased in cirrhosis while PV-V and HVI decreased. PV-V and HVI parameters were remarkably different between the Child groups (p<0.0001). RA-RI, RA-PI, HA-PI and PV-V were also the other parameters which were significantly different (p<0.05). Conclusion: Colored Doppler ultrasonography is a reliable modality that can be used to figure out the changes occurred in hepatic and renal hemodynamics in the presence of cirrhosis and its progression. ©2007, Firat University, Medical Faculty
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Abstract (Original Language): 
Amaç: Sirozlu olgularda karaciğer ve renal hemodinamilerdeki değişiklikler açısından renkli Doppler ultrasonografinin (RDUS) değerini ortaya koymayı amaçladık Gereç ve Yöntem: Renkli Doppler ultrasonografi ile 40 sirozlu olgu (11 Child A, 17 Child B, 12 Child C) ve renal ve hepatik fonksiyonları tümüyle normal olan 20 sağlıklı kişiden oluşan kontrol grubu incelendi. Tüm olgularda renal arter rezistif indeksi (RA-RI), renal arter pulsatilite indeksi (RA-PI), hepatik arter rezistif indeksi (HA-RI), hepatik arter pulsatilite indeksi (HA-PI), portal ven hızı (PV-HIZ), portal ven çapı (PV-ÇAP) ve hepatik vasküler indeksi (HVI) değerlendirildi. Sirozlu olgular Child evrelemesi ve assit varlığına göre alt gruplara ayrıldı. Bu parametreler açısından kontrol grubu, genel sirozlu grup ve alt gruplar arasındaki istatistiksel fark değerlendirildi. Bulgular: Siroz grubu ile kontrol grubu arasında ve Child C grubu ile kontrol grubu arasında tüm parametrelerde istatistiksel olarak anlamlı farklılık mevcuttu (p<0,05). RA-RI, RA-PI, HA-PI, PV-HIZ ve HVI parametreleri açısından yüksek istatistiksel anlamlılık izlendi (p<0,001). RA-RI, RA-PI ve HA-PI sirozda yükselme gösterirken PV-HIZ ve HVI azalmaktaydı. Child grupları arasında PV-HIZ ve HVI parametreleri açısından yüksek istatistiksel anlamlı fark tespit edildi (p<0,0001). Ek olarak Child A-B evreleri arasında RA-RI, RA-PI ve PV-ÇAP, Child A-C evreleri arasında RA-RI, RA-PI, HA-PI ve PV-ÇAP, Child B-C evreleri arasında HA-PI açısından anlamlı fark saptandı (p<0,05). Assitli ve assitsiz gruplar karşılaştırıldığında sadece HVI yüksek anlamlılık taşımaktaydı (p<0,0001). RA-RI, RA-PI, HA-PI ve PV-HIZ ise anlamlı fark taşıyan diğer parametrelerdi (p<0,05). Sonuç: RDUS siroz varlığı ve progresyonu ile ortaya çıkabilecek hepatik ve renal hemodinamilerde meydana gelen değişiklikleri ortaya koymada kullanışlı ve güvenilir bir modalitedir. ©2007, Fırat Üniversitesi, Tıp Fakültesi
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REFERENCES

References: 

1. Popper H. Pathologic aspects of cirrhosis. Am J Pathol 1977; 87: 228-264.
2. Schrier RV, Caramelo C. Hemodynamic and hormonal alterations in hepatic cirrhosis. Epstein M. The Kidney in Liver Disease, Baltimore; Williams and Wilkins, 1988; 265.
3. Groszmann RJ. Hyperdynamic circulation of liver disease 40 years later pathophysiology and clinical consequences. Hepatology 1994; 26: 1359-1363.
4. Benoit JN, Granger N. Splanchnic hemodynamics in chronic portal venous hypertension. Semin Liver Dis, 1986; 6: 287-291.
5. Kroeger RG, Groszman RJ. Increased portal venous resistance hinders portal pressure reduction during the administration of beta - adrenergic blocking agent in portal hypertensive model.
Hepatology 1985; 5:97-102.
6. Benoit JN, Barrowman JA, Harper SL. Role of humoral factors in the intestinal hyperemia associated with chronic portal
hypertension. Am J Physiol 1984; 247: 486-491.
7. Ebstein M, Schneider N, Befeler B. Relationship of systemic and intrarenal hemodynamics in cirrhosis. J Clin Lab Med 1977; 89:
1175-1187.
8. Fernandez-Seara J, Prieto J, Quiroga J, et al. Systemic and regional hemodynamics in patients with liver cirrhosis and ascites with and without functional renal failure. Gastroenterology 1989;
97: 1304-1312.
32
Fırat Tıp Dergisi 2007;12(1):28-33
9. Fine LG, Sakhrani LM. Towards a physiological definition of the hepatorenal syndrome. Epstein M (editor). The kidney in liver disease. New York: Elsevier, 1983; 107-119.
10. Arroyo V, Gines P, Jimenez W, Rodes J. Ascites, renal failure and electrolyte disorders in cirrhosis: pathogenesis, diagnosis and treatment. Oxford Textbook of Clinical Hepatology. Oxford: Oxford University Press, 1991; 427- 470.
11. Epstein M, Berk DP, Hollenberg NK, et al Renal failure in patients with cirrhosis: the role of active vasoconstriction. Am J Med 1970; 49: 175-185.
12. Schrier RW, Arroyo V, Bernardi M. Peripheral arteriyel vasodilatation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988; 8:
1151-1155.
13. Lach J, Gines P, Arroyo V. Prognostic value of arterial pressure endogenous vasoactive system and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites.
Gastroenterology 1988; 94: 482-487.
14. Pinto HC, Abrantes A, Esteves AV, Almieda H, Correia PJ. Long term prognosis of patients with cirrhosis liver and upper gastrointestinal bleeding. Am J Gastroenterol 1989; 84: 1239¬1293.
15. Caeser J, Shaldon S, Chiandussi L. The use of indocyanine gren in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci 1965; 21: 43-57.
16. Huet PM, Lavoie P, Viallet A. Simultaneous estimation of hepatic and portal blood flows by an indicator dilution technique.
J Lab Clin Med 1973; 83: 836-846.
17. Price JM, Voorhes AB Jr, Britton RC. Operative hemodynamic study in portal hypertension. Significance and Limitation. Arch Surg 1967; 95: 843-851.
18. Omnishi K, Saito M, Nakayama T, Jida S, Nomura F, Koen H. Portal venous hemodynamic in chronic liver disease effect of posture change and exercise. Radiology 1985; 155:757-761.
19. Moriyasu F, Ban N, Nishida O, Nakamura T, Miyake T, Uchino H. Clinical application of an ultrasonic duplex system in the quantitative measurement of portal blood flow. J Clin Ultrasound 1986; 14: 579-588.
20. Gill RW. Pulsed Doppler with B mode imaging for quantitative
blood flow measurement. Ultrasound Med Biol 1979; 5: 223-225.
21. Ljubicic N, Duvnjak M, Rotkvic I, Kopjar B. Influence of the degree of liver failure on portal flow in patients with cirrhosis. Scand Gastroenterol 1990; 25: 395-400.
22. Chawla Y, Santa N, Dhiman K, Dilawari B. Portal
hemodynamics by dupplex Doppler sonography in different grades of cirrhosis. Digestive Diseases and Sciences 1998; 43:
354-357.
23. Haag K, Rössle M, Ochs A, et al. Correlation of dupplex sonography findings and portal pressure in 375 patients with portal hypertension. AJR 1999; 172: 631-635.
24. Sabba C, Ferraioli G, Genecin P. Evaluation of postprandial hiperemia in süperior mesenteric artery and portal vein in healthy and cirhotic humans: an operator blind echo Doppler study. Hepatology 1991; 13: 714-718.
Serhatlıoğlu ve Ark
25. Omnishi K, Saito M, Nakayama T. Portal venous hemodynamic in chronic liver disease effect of posture change and exercise.
Radiology 1985; 155:757-761.
26. Zironi G, Gaiani S, Fenyves D, et al. Value of measurement of mean portal flow velocity by Doppler flowmetry in the diagnosis of portal hypertension. J Hepatol 1992; 16:298-303.
27. Iwao T, Toyonaga A, Oho K, et al. Value of Doppler ultrasound parameters of portal vein and hepatic artery in the diagnosis of cirrhosis and portal hypertension. The American Journal of Gastroenterology 1997; 92: 1012-1017.
28. Schneider AW, Kalk JF, Klein CP. Hepatic arterial pulsatility
index in cirrhosis: correlation with portal pressure. J Hepatology
1999; 30: 876-881.
29. Alpern MB, Rubin JM, Williams DM, Capele P. Porta hepatis
duplex Doppler US with angiographic correlation. Radiology
1987; 162: 53-56.
30. Vassiliades VG, Ostrow TD, Chezmar JL, Hertzler GL, Nelson RC. Hepatic arterial resistive indices correlation with the severity of cirrhosis. Abdom Imaging 1993; 18: 61-65.
31. Piscaglia F, Gaiani S, Zironi G, et al. Intra and extrahepatic arterial resistances in chronic hepatitis and liver cirrhosis.
Ultrasound in Medicine and Biology 1997; 23 : 675-682.
32. Taourel P, Blanc P, Dauzat M, et al. Doppler study of mezenteric, hepatic and portal circulation in alcoholic cirrhosis relationship between quantitative Doppler measurements and the severity of portal hypertension and hepatic failure. Hepatology 1998; 28:
932-936.
33. Maroto A, Gines A, Salo J, et al. Diagnosis of functional kidney failure in cirrhosis with Doppler sonography prognostic value of
resistive index. Hepatology 1994; 20: 839-844.
34. Platt JF, Ellis JH, Rubin JM, Merion RM, Lucey MR. Renal
duplex Doppler ultrasonography: a non invsive predictor of kidney dysfunction and hepatorenal failure in liver disease.
Hepatology 1994; 20: 362-369.
35. Saccerdoti D, Bolognesi M, Merckel C, Angeli P, Gatta A. Renal vasoconstruction in cirrhosis evaluated by duplex Doppler
ultrasonography. Hepatology 1993; 17:219-224.
36. Rivolta R, Maggi A, Cazzaniga M, et al. Reduction of renal cortical blood flow assessed by Doppler in cirrhotic patients with refractory ascites. Hepatology 1998; 28: 1235-1240.
37. Platt JF, Marn CS, Baliga PK, et al. Renal disfunction in hepatic disease: early identification with renal duplex Doppler US in patients who undergo liver transplantation. Radiology 1992; 183:
801-806.
38. Colli A, Cocciolo M, Riva C, Martinez E. Abnormal renovascular impedance in patients with hepatic cirrhosis: detection with duplex US. Radiology 1993; 187: 561-563.
39. Abdallah AF, Bakr AM, El-Haggar M, Amer T. Renal
hemodynamic changes in children with liver cirrhosis. Pediatr
Nephrol 1999; 13: 854-858.

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