Clinical and histological recovery from “life-threatening-severe acute alcoholic hepatic failure with complete hepatofugal portal blood flow

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• 作者：Keiichi Fujiwara (1)
  Takeshi Toriyabe (1)
  Yoshihiro Fukuda (1)
  Osamu Yokosuka (1)
  
• 关键词：Acute hepatic failure ; Doppler ultrasound ; Portal blood flow ; Portal hypertension
• 刊名：Clinical Journal of Gastroenterology
• 出版年：2011
• 出版时间：February 2011
• 年：2011
• 卷：4
• 期：1
• 页码：39-42
• 全文大小：365KB
• 参考文献：1. Beckett AG, Livingstone AV, Hill KR. Acute alcoholic hepatitis. Br Med J. 1961;5260:1113-. CrossRef
  2. Maddrey W. Alcoholic hepatitis: clinicopathologic features and therapy. Semin Liver Dis. 1988;3:91-02. CrossRef
  3. Chedid A, Mendenhall CL, Gartside P, French SW, Chen T, Rabin L. Prognostic factors in alcoholic liver disease. VA Cooperative Study Group. Am J Gastroenterol. 1991;86:210-.
  4. Tai D, Changchien CS, Chen CJ, Chiou SS, Lee CM, Kuo CH, et al. Sequential evaluation of portal venous hemodynamics by Doppler ultrasound in patients with severe acute hepatitis. Am J Gastroenterol. 1996;91:545-0.
  5. Shiraki S, Tsukada K, Ozeki N, Takeuchi T, Gotoh K, Noguchi Y, et al. Measurement of portal blood flow by an ultrasonic “duplex-system composed of a pulsed Doppler flowmeter and a linear-type real time B mode electroscanner. Gastroenterol Jpn. 1988;23:37-3. CrossRef
  6. Yang SS, Wu CH, Chen TK, Lee CL, Lai YC, Chen DS. Portal blood flow in acute hepatitis with and without ascites: a non-invasive measurement using an ultrasonic Doppler. J Gastroenterol Hepatol. 1995;10:36-1. CrossRef
  7. Valla D, Flejou JF, Lebrec D, Bernuau J, Rueff B, Salzmann JL, et al. Portal hypertension and ascites in acute hepatitis: clinical, hemodynamic and histological correlations. Hepatology. 1989;10:482-. CrossRef
  8. Navasa M, Garcia-Pagán JC, Bosch J, Riera JR, Ba?ares R, Mas A, et al. Portal hypertension in acute liver failure. Gut. 1992;33:965-. CrossRef
  9. Kaneko T, Sugimoto H, Inoue S, Tezel E, Ando H, Nakao A. Doppler ultrasonography for postoperative hepatofugal portal blood flow of the intrahepatic portal vein. Hepatogastroenterology. 2003;50:1825-.
  10. Duvoux C, Radier C, Roudot-Thoraval F, Maille F, Anglade MC, Van Nhieu JT, et al. Low-grade steatosis and major changes in portal flow as new prognostic factors in steroid-treated alcoholic hepatitis. Hepatology. 2004;40:1370-. CrossRef
  
• 作者单位：Keiichi Fujiwara (1)
  Takeshi Toriyabe (1)
  Yoshihiro Fukuda (1)
  Osamu Yokosuka (1)
  
  1. Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
  

文摘

A 25-year-old man who was a heavy alcohol drinker was admitted to our hospital after presenting with general malaise, dyspnea, abdominal distension, systemic edema and jaundice. His liver function tests showed hyperbilirubinemia and prolonged prothrombin time, and a computed tomography scan and ultrasound showed liver atrophy and massive ascites. Furthermore, Doppler ultrasound revealed complete hepatofugal portal blood flow in the portal trunk and intrahepatic portal branches. Causes other than alcohol were excluded, and he was diagnosed as having severe acute alcoholic hepatic failure (Maddrey’s discriminant function score 43.3, MELD score 21), although not clinically typical. He was treated with anti-coagulation therapy according to the precise evaluation of portal blood flow by Doppler ultrasound, and marked clinical, biochemical and hemodynamic improvements were observed. Liver biopsy performed 2?months after onset showed submassive necrosis with pericellular fibrosis. Liver biopsy performed three years after onset showed mild portal fibrosis with a marked improvement. Doppler ultrasound is an indispensable tool for evaluating patients with severe acute hepatitis.