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Capital Region Health Park
711 Troy-Schenectady Road
Latham, New York 12110

47 New Scotland Ave
Albany, NY 12208

(518) 262-5149
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Interventional Care - Interventional Radiology

Community Vein Care at Community Care Physicians, P.C.   

Cirrhosis (Chronic Liver Disease)

Cirrhosis is a chronic disease of the liver that results from a number of different causes, all of which cause the liver to function abnormally.  The most common causes of cirrhosis include alcohol abuse, hepatitis, biliary cirrhosis, genetic diseases (such as Wilson’s Disease, Cystic Fibrosis, Alpha-1 Antitrypsin Deficiency, Hemochromotosis, etc.), and drug overdoses. 

Symptoms associated with Cirrhosis include fatigue, weakness, nausea, and decreased appetite.  Cirrhosis of the liver can lead to a condition known as Portal Hypertension, which is an elevation of pressure within the veins bringing blood into the liver from the esophagus, stomach, spleen, and intestines. 

When patients have portal hypertension, they are at risk for bleeding into these organs from varices, which are veins that have become enlarged and prone to rupture to the increase in pressure.  In addition, these patients are at risk for fluid accumulation in the abdomen, which is known as ascites.  Finally, patients with cirrhosis are at risk for developing tumors (hepatocellular carcinoma) within the liver.

Diagnosis of Cirrhosis

  1. Ultrasound: This is a non-invasive test that uses sound waves to directly visualize the liver and abdomen.  It can detect abnormalities in the appearance of the liver and whether or not fluid (ascites) is present in the abdomen.  Importantly, ultrasound can potentially detect liver tumors, which can occur in patients with cirrhosis.  It can also detect an enlarged spleen, which is commonly present in patients with cirrhosis.  Finally, ultrasound can help determine if the portal vein, which brings blood to the liver from the esophagus, stomach, spleen, and intestines, is open and if flow is heading towards or away from the liver, which could have implications for treatment.

  2. CT/MRI: These imaging tests are helpful in patients with cirrhosis because they provide additional information about the liver.  In particular, they are able to determine if the portal vein is open and if flow is heading towards or away from the liver.  The exams are good at detecting the presence or absence of tumors within the liver.

  3. Liver Biopsy: This is an invasive test that is performed to obtain a small sample of tissue from the liver in order to make the diagnosis of cirrhosis.  This type of evaluation can also help determine the actual cause for cirrhosis in a particular patient.  The test is performed by numbing the skin and then advancing a small needle into the liver.  Ultrasound is typically used during the procedure to monitor the position of the needle at all times.  Approximately 3-4 samples are obtained and sent to a pathologist for further evaluation.  The procedure itself carries with it a small risk of bleeding, which is why patients are observed and monitored after the procedure.

    Patients with fluid in the abdomen (ascites), or patients with clotting abnormalities, it becomes more complicated to perform a biopsy directly through the skin and into the liver because there is an increased risk of bleeding. 

    In these patients, a transjugular liver biopsy is performed.  During this procedure, a small catheter (tube) is placed into the Internal Jugular Vein in the neck.  Using x-rays for guidance, this catheter is advanced into the Hepatic Vein, which is the vein draining blood from the liver. 

    Once the catheter is within the Hepatic Vein, a small needle is advanced into the catheter and directed into the liver through the wall of the vein.  The tissue samples are obtained in this manner, which is safer for the patient since the risk of bleeding is reduced.

Interventional Treatment Options for Cirrhosis

  1. Paracentesis: This procedure is performed to drain fluid (ascites) from the abdomen.  It is often performed when the fluid build-up becomes uncomfortable for a patient, leading to shortness of breath, reduced appetite, or leg swelling.  The procedure involves placing a small catheter (tube) into the abdomen and connecting that tube to a system that drains the fluid into bottles.

  2. Transjugular Intrahepatic Portosystemic Shunt (TIPS):  This procedure is designed to address the symptoms of portal hypertension that cannot be addressed using less invasive techniques.  These include internal bleeding from varices (enlarged veins) into the esophagus, stomach, and intestines, and fluid build-up within the abdomen (ascites).  The goal of this procedure is to reduce the pressure in the portal vein, which is the main vein bringing blood into the liver.  The pressure in this vein is high in Cirrhosis due to the changes in the liver caused by this disease.  Reducing the pressure in the portal vein can lead to a reduction in these symptoms.

    The procedure is performed by placing a small catheter (tube) into the Internal Jugular Vein.  Using x-rays for guidance, this catheter is directed into the Hepatic Vein, which is the main vein draining blood from the liver.  At this point in the procedure, a small needle is placed into the catheter and directed from the Hepatic Vein into the Portal Vein, through the liver itself.  Once the needle reaches the Portal Vein, the two veins can be connected by placing a stent through the liver with one end in the Hepatic Vein and one end in the Portal Vein.  With the stent in place, the pressure within the Portal Vein decreases since blood can now easily flow through the stent into the Hepatic Vein and then to the rest of the body.

    This procedure is very effective at reducing the bleeding associated with esophageal and gastric varices.  In addition, it is effective at reducing the build up of fluid within the abdomen (ascites), which can allow these patients to not require frequent Paracentesis.  Risks of the procedure include bleeding and the development of confusion (encephalopathy).  The confusion occurs because the shunt that we created through the liver limits the ability of the liver to clear toxins such as ammonia from the blood.  Fortunately, this can often be treated with diet and a drug known as lactulose although in extreme cases, a decision may need to be made to shut down the TIPS if the encephalopathy cannot be treated with this medication. 

    One other problem with a TIPS is that it is always at risk for shutting down due to tissue build-up and clot formation within the stent.  Fortunately, new advances in stent technology have made this a much rarer event than it used to be.  However, we still recommend that patients undergoing a TIPS procedure be monitored with ultrasound examinations performed on a regular basis to monitor patency of the stent.

  3. Splenic Pulp Embolization: Some patients with portal hypertension due to cirrhosis may develop clot in the Splenic Vein, which is the main vein draining blood from the spleen.  These patients may present with bleeding varices limited to the stomach.  These patients can be treated by a Partial Splenic Embolization that reduces the blood flow into the spleen with the subsequent effect of reducing pressure within the Splenic Vein.  This procedure is performed by placing a small catheter (tube) into the Femoral Artery and directing that tube using x-rays for guidance into the Splenic Artery, which is the artery bringing blood into the spleen.  Once the catheter is in place within the Splenic Artery, small particles are injected into the spleen until flow to approximately 1/3 of the spleen has been blocked.  This will be enough to reduce pressure within the Splenic Vein and reduce the bleeding into the stomach from gastric varices.  This procedure also has the added effect of helping to increase the platelet count in these patients, which can also help to reduce bleeding.

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