Portosystemic encephalopathy in a patient treated with peritoneal dialysis
| Autor: | Marcelo Francos, Carmen Felipe, Fernando Rodríguez-Berzosa, Eva López-Valdés, Carlos Chacón, Vicente Paraíso, Amelia Fidalgo, Javier Blázquez, Rocío Martín, Jesús Martín |
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| Rok vydání: | 2006 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty medicine.medical_treatment Portal venous pressure Left gastric vein Encephalopathy Gastroenterology Peritoneal dialysis Peritoneal Dialysis Continuous Ambulatory Internal medicine medicine Humans Portasystemic Shunt Surgical Splanchnic Circulation Ultrasonography Doppler Color Hepatic encephalopathy Ligation Aged business.industry Portal Vein Continuous ambulatory peritoneal dialysis Stomach Hyperammonemia medicine.disease Surgery Nephrology Hepatic Encephalopathy Kidney Failure Chronic Vascular Resistance Portosystemic shunt business Magnetic Resonance Angiography Liver Circulation |
| Zdroj: | American journal of kidney diseases : the official journal of the National Kidney Foundation. 49(6) |
| ISSN: | 1523-6838 |
| Popis: | We present a case of a 75-year-old man with end-stage renal disease caused by immunoglobulin A nephropathy who developed hepatic encephalopathy 15 months after starting continuous ambulatory peritoneal dialysis therapy. Liver test results were normal except for hyperammonemia (ammonia, 317 microg/dL [186 micromol/L]) and mildly increased alkaline phosphatase and gamma-glutamyl transpeptidase levels. Abdominal ultrasonography showed normal liver architecture, and color Doppler ultrasonography showed a normal splenic-portal axis with hepatopetal blood flow. Histological examination of a laparoscopic liver biopsy specimen showed moderate fibrosis limited to portal tracts without necrosis or inflammation. Magnetic resonance angiography and percutaneous transhepatic portal angiography showed a large shunt between the left gastric and azygous veins, with blood flowing from the portal vein to the superior vena cava. The patient was transferred to hemodialysis treatment, and although his condition improved slightly, episodes of encephalopathy did not disappear. Surgical ligation of the left gastric vein was performed. In the 8 months after surgery, he has experienced no further episodes of hepatic encephalopathy or hyperammonemia. We speculate that increased intra-abdominal pressure and vasodilation caused by peritoneal dialysis solutions in a patient with a spontaneous portosystemic shunt resulted in ammonia-rich blood flow from the portal vein to the superior vena cava and encephalopathy. In addition, it is possible that chronic hepatic hypoxia caused by hypoperfusion from portosystemic shunting contributed to the development of liver fibrosis. To our knowledge, this is the first report of spontaneous portosystemic shunt encephalopathy in a patient with a noncirrhotic liver undergoing peritoneal dialysis. |
| Databáze: | OpenAIRE |
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