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Quality assurance and recommendations for quality assessment of screening colonoscopy in Belgium |
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Role of vasoactive substances and cellular effectors in the pathophysiology of cirrhotic portal hypertension: the past, the present and the future - Georges Brohée lecture |
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| In the last decade, knowledge regarding mechanisms involved in
the pathogenesis of portal hypertension has taken unprecedented
levels. However, many aspects still remain to be elucidated. Portal
hypertension is primarily caused by an increase in resistance to
portal outflow and secondly by an increase in splanchnic blood
flow. In a later phase, these changes lead to a hyperdynamic
circulation with increased cardiac output and decreased systemic
vascular resistance and perfusion pressure. Regional alterations
in vasoreactivity (vasodilation and vasoconstriction) play a central
role in the pathophysiology of portal hypertension by contributing
to increased intrahepatic resistance, hyperdynamic circulation,
and expansion of the collateral circulation. Among vasoactive
substances activated in portal hypertension, nitric oxide (NO) is
considered as the most important vasodilator. Endothelin-1 and
cyclooxygenase-derived prostaglandins are the foremost vasoconstrictor
factors. The imbalance between the hyperresponsiveness
and overproduction of vasoconstrictors and the hyporesponsiveness
and impaired production of vasodilators are the main responsible
of the increased vascular one in the sinusoidal area of the
liver. In addition to an imbalance in vasoactive substances, a major
role has been attributed to activated hypercontractile hepatic stellate
cells which cause vascular remodelling as an adaptive response
to the changed balance in vasoactive substances. The present paper
aims to elucidate on available knowledge and novel mechanisms
gathered over the last years with regard to cirrhotic portal hypertension
and the increased intrahepatic vascular resistance in
particular. [Product Details...] |
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Acta gastroenterologica is abstracted/indexed in Current Contents, Excerpta Medica, Index medicus, ISI.
Published by © Universa Press, Wetteren, Belgium. All rights reserved.
Published by © Universa Press, Wetteren, Belgium. All rights reserved.