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    Clinical and haemodynamic studies in portal hypertension

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    TripathiD_2004redux.pdf (34.39Mb)
    Date
    2005
    Author
    Tripathi, Dhiraj.
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    Abstract
     
     
    Over the last 20 years, there have been significant advances in the management of portal hypertension, with the introduction of drug therapy and the transjugular intrahepatic portosystemic stent-shunt (TIPSS). This development continues at a strong pace as our understanding of the pathogenesis of portal hypertension deepens. There are 2 aims of this thesis:
     
    1. To study the haemodynamic effects of two novel vasoactive agents on the portal and systemic circulations.
     
    a. Carvedilol, a vasodilating non-cardioselective beta-blocker with op antagonism. The acute and chronic haemodynamic effects of this agent will be studied, with particular attention paid to patient tolerability.
     
    b. Losartan, an angiotensin II receptor antagonist. The chronic effects of this agent will be studied in patients with well compensated cirrhosis.
     
    These laboratory based studies will assist in determining the suitability of these agents for use in controlled clinical trials on patients at risk of variceal bleeding.
     
    2. TIPSS has been used extensively in the management of portal hypertension, particularly variceal bleeding. Two studies will be presented in this thesis aimed at answering the following questions.
     
    a. Is TIPSS effective for the management of gastric variceal bleeding? Gastric variceal bleeding is less common than oesophageal variceal bleeding, hence there are relatively few studies investigating the effect of TIPSS on bleeding gastric varices. This study will also compare gastric variceal bleeding with oesophageal variceal bleeding, and aim to correlate clinical outcomes with haemodynamic data.
     
    b. Is it necessary to continue portographic TIPSS surveillance indefinitely if variceal band ligation is combined with TIPSS for the prevention of oesophageal variceal rebleeding? This is the hypothesis for a randomised controlled trial comparing TIPSS alone with TIPSS plus variceal band ligation. This study will address 2 drawbacks of TIPSS, namely the need for long-term portographic to ensure TIPSS patency and hepatic encephalopathy.
     
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    http://hdl.handle.net/1842/30855
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