Sonography in Portal Hypertension and TIPS [antikvár]

Ultrasound diagnosis of portai hypertension - current concepts K. Seitz and W. Wermke Introduction The diagnosis, hemodynamic assessment and etiological classification of portai hypertension are topics of ongoing current clinical interest - the investigation of diseases involving portai hypertension is an everyday occurrence in gastroenterology. Since invasive methods of measuring portai pressure are not used - except for special problems or scientific research - the most important diagnostic techniques are esophago-gastroduodenoscopy and sonography. Both diagnostic methods are complementary: endoscopic procedures have precedence in detecting the sources of bleeding, including hemostatic measures. On the other hand sonography is the most important method for diagnosing the etiology of variceal bleeding and has largely superseded diagnostic laparoscopy. With improvements in the imaging quality and introduction of Doppler techniques, sonography has increasingly taken over the functions of angiographic methods. Sonography generally produces equivalent results and it is often easier to use and more suitable for investigating particular problems. Increased knowledge and technical progress have resulted in an increase in the demands placed on ultrasound operators. Diagnostic parameters, such as hepatosplenomegaly, ascites and the diameter of the portai vein, which were used in the early 1980s, are no longer adequate to provide the totál spectrum of possible diagnoses - modern sonographic techniques allow more subtle changes to be detected. Nowadays it is important to have reliable diagnostic criteria for portai hypertension and its hemodynamic effects, and to clarify the etiology or, at least, to reduce it to a small number of differential diagnoses.