Journal
LIVER INTERNATIONAL
Volume 38, Issue 4, Pages 570-580Publisher
WILEY
DOI: 10.1111/liv.13589
Keywords
cardiac dysfunction; liver failure; multi-organ syndrome; portal hypertension
Categories
Funding
- Novo Nordisk Foundation
- Capital Region of Copenhagen
- University of Copenhagen
- Novo Nordisk Fonden [NNF11OC1014467, NNF13OC0006329] Funding Source: researchfish
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Patients with cirrhosis and portal hypertension often develop complications from a variety of organ systems leading to a multiple organ failure. The combination of liver failure and portal hypertension results in a hyperdynamic circulatory state partly owing to simultaneous splanchnic and peripheral arterial vasodilatation. Increases in circulatory vasodilators are believed to be due to portosystemic shunting and bacterial translocation leading to redistribution of the blood volume with central hypovolemia. Portal hypertension per se and increased splanchnic blood flow are mainly responsible for the development and perpetuation of the hyperdynamic circulation and the associated changes in cardiovascular function with development of cirrhotic cardiomyopathy, autonomic dysfunction and renal dysfunction as part of a cardiorenal syndrome. Several of the cardiovascular changes are reversible after liver transplantation and point to the pathophysiological significance of portal hypertension. In this paper, we aimed to review current knowledge on the pathophysiology of arterial vasodilatation and the hyperdynamic circulation in cirrhosis.
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