Spontaneous porto-systemic shunts in liver cirrhosis: Clinical and therapeutical aspects

Abstract

Spontaneous porto-systemic shunts (SPSS) are frequent in liver cirrhosis and their prevalence increases as liver function deteriorates, probably as a consequence of worsening portal hypertension, but without achieving an effective protection against cirrhosis' complications. Several types of SPSS have been described in the literature, each one associated with different clinical manifestations. In particular, recurrent or persistent hepatic encephalopathy is more frequent in patients with splenorenal shunt, while the presence of gastric varices and consequently the incidence of variceal bleeding is more common in gastrorenal shunt. In the advanced stage, the presence of large SPSS can lead to the so called “portosystemic shunt syndrome”, characterized by a progressive deterioration of hepatic function, hepatic encephalopathy and, sometimes, portal vein thrombosis. The detection of SPSS in patients with liver cirrhosis is recommended in order to prevent or treat recurrent hepatic encephalopathy or variceal bleeding.

Keywords: Porto-systemic shunts; Liver cirrhosis; Variceal bleeding; Hepatic encephalopathy; Portal vein thrombosis; Porto-systemic shunt syndrome

Core tip: Liver cirrhosis is characterized by a progressive increase in portal hypertension and the consequent formation of porto-systemic shunts, that act as “release valves” to reduce the portal pressure, but also act as bypasses to normal liver flow. As the shunt becomes large enough, the complications appear including hepatic encephalopathy, variceal bleeding, portal vein thrombosis and the deterioration of liver function.