The Complications of Cirrhosis of the Liver
Authors: MARSHALL J. ORLOFF
Journal: Annals of Internal Medicine (1967)

The UCLA Interdepartmental Conference1 January 1967The Complications of Cirrhosis of the LiverMARSHALL J. ORLOFF, M.D., NICHOLAS A. HALASZ, M.D., CHARLES LIPMAN, M.D., ARTHUR D. SCHWABE, M.D., F.A.C.P., JAMES C. THOMPSON, M.D., WILLIAM A. WEIDNER, M.D.MARSHALL J. ORLOFF, M.D.Search for more papers by this author, NICHOLAS A. HALASZ, M.D.Search for more papers by this author, CHARLES LIPMAN, M.D.Search for more papers by this author, ARTHUR D. SCHWABE, M.D., F.A.C.P.Search for more papers by this author, JAMES C. THOMPSON, M.D.Search for more papers by this author, WILLIAM A. WEIDNER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-66-1-165 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDr. Marshall J. Orloff: This conference will review the natural history of cirrhosis of the liver and the treatment of the disease and its complications. A case to be presented by Dr. Lipman illustrates some of the problems we will consider.DR. CHARLESLIPMAN: Case 1 is that of a 43-year-old Caucasian bartender who was admitted to the Medical Service at Harbor General Hospital for the first time in mid-September 1964 with swelling of the abdomen and lower extremities of 3 months' duration. The patient gave a history of regular ingestion of large amounts of alcohol for 20 years and...References1. RATNOFFPATEK ODAJ: The natural history of Laennec's cirrhosis of the liver. Medicine (Balt.) 21: 207, 1942. CrossrefGoogle Scholar2. GARCEAUCHALMERS AJTC: The natural history of cirrhosis. I. Survival with esophageal varices. New Eng. J. Med. 268: 469, 1963. CrossrefMedlineGoogle Scholar3. HIGGINS WH: The esophageal varix: a report of one hundred and fifteen cases. Amer. J. Med. Sci. 214: 436, 1947. CrossrefMedlineGoogle Scholar4. ATIKSIMEONE MF: Massive gastrointestinal bleeding: a study of two hundred and ninety-six patients at City Hospital of Cleveland. Arch. Surg. (Chicago) 69: 355, 1954. Google Scholar5. NACHLASO'NEILCAMPBELL MMJEAJ: The life history of patients with cirrhosis of the liver and bleeding esophageal varices. Ann. Surg. 141: 10, 1955. CrossrefMedlineGoogle Scholar6. COHNBLAISDELL RFW: The natural history of the patient with cirrhosis of the liver with esophageal varices following the first massive hemorrhage. Surg. Gynec. Obstet. 106: 699, 1958. MedlineGoogle Scholar7. TAYLORJONTZ FWJG: Cirrhosis with hemorrhage. Arch. Surg. (Chicago) 78: 786, 1959. CrossrefGoogle Scholar8. MERIGANHOLLISTERGRYSKASTARKEYDAVIDSON TCRMPFGWCS: Gastrointestinal bleeding with cirrhosis: a study of 172 episodes in 158 patients. New Eng. J. Med. 263: 579, 1960. CrossrefMedlineGoogle Scholar9. ORLOFF MJ: A comparative study of emergency transesophageal ligation and nonsurgical treatment of bleeding esophageal varices in unselected patients with cirrhosis. Surgery 52: 103, 1962. MedlineGoogle Scholar10. FIGLEY MM: Splenoportography: some advantages and disadvantages. Amer. J. Roentgen. 80: 313, 1958. Google Scholar11. SELDINGER SI: A simple method of catheterization of the spleen and liver. Acta Radiol. 48: 93, 1957. CrossrefMedlineGoogle Scholar12. ROUSSELOTPANKEMORENO LMWFAH: Further evaluation of splenic pulp manometry as a differential diagnostic test of acute upper gastrointestinal bleeding. Amer. J. Gastroent. 35: 474, 1961. MedlineGoogle Scholar13. BERGSTRAND I: The localization of portal obstruction by splenoportography. Amer. J. Roentgen. 85: 1111, 1961. Google Scholar14. STEINERSHERLOCKTURNER RESMD: Percutaneous splenic portal venography. J. Fac. Radiol. 8: 158, 1957. CrossrefGoogle Scholar15. REYNOLDSFREEDMANWINSOR TBTW: Results of the treatment of bleeding esophageal varices with balloon tamponage. Amer. J. Med. Sci. 224: 500, 1952. CrossrefMedlineGoogle Scholar16. HAMILTON JE: The management of bleeding esophageal varices associated with cirrhosis of the liver. Ann. Surg. 141: 637, 1955. CrossrefMedlineGoogle Scholar17. LUDINGTON LG: A study of 158 cases of esophageal varices. Surg. Gynec. Obstet. 106: 519, 1958. MedlineGoogle Scholar18. CONN HO: Hazards attending the use of esophageal tamponade. New Eng. J. Med. 259: 701, 1958. CrossrefMedlineGoogle Scholar19. READDAWSONKERRTURNERSHERLOCK AEAMDNMDS: Bleeding oesophageal varices treated by oesophageal compression tube. Brit. Med. J. 1: 227, 1960. CrossrefMedlineGoogle Scholar20. ORLOFF MJ: Emergency treatment of bleeding esophageal varices in cirrhosis. Curr. Probl. Surg. p. 13, July 1966. CrossrefMedlineGoogle Scholar21. BAINBRIDGETREVAN FAJW: Some actions of adrenalin upon the liver. J. Physiol. (London) 51: 460, 1917. CrossrefGoogle Scholar22. SCHWARTZBALESEMERSONMAHONEY SIHWGLEB: The use of intravenous Pituitrin in treatment of bleeding esophageal varices. Surgery 45: 72, 1959. MedlineGoogle Scholar23. MERIGANPLOTKINDAVIDSON TCGRCS: Effect of intravenously administered posterior pituitary extract on hemorrhage from bleeding esophageal varices. A controlled evaluation. New Eng. J. Med. 266: 134, 1962. CrossrefMedlineGoogle Scholar24. SHALDONSHERLOCK SS: The use of vasopressin ('Pitressin') in the control of bleeding from oesophageal varices. Lancet 2: 222, 1960. CrossrefMedlineGoogle Scholar25. WANGENSTEENBARANOFSKY OH: The ulcer problem. (I) Etiology, with special reference to an interrelationship between the vascular and the acid-peptic digestive factors; (II) characterization of a satisfactory operation which will protect against recurrent ulcer. Canad. Med. Ass. J. 53: 309, 1945. MedlineGoogle Scholar26. ORLOFFTHOMAS MJHS: Pathogenesis of esophageal varix rupture: a study based on gross and microscopic examination of the esophagus at the time of bleeding. Arch. Surg. (Chicago) 87: 301, 1963. CrossrefMedlineGoogle Scholar27. WANGENSTEENSMITH SLRB: Intragastric cooling for upper gastrointestinal bleeding. Ann. N. Y. Acad. Sci. 115: 328, 1964. CrossrefMedlineGoogle Scholar28. LOSOWSKYJONESLIEBERDAVIDSON MSDPCSCS: Local factors in ascites formation during sodium retention in cirrhosis. New Eng. J. Med. 268: 651, 1963. CrossrefGoogle Scholar29. RAPAPORTAMESMIKKELSENGOODMAN SISBSJR: Plasma clotting factors in chronic hepatocellular disease. New Eng. J. Med. 263: 278, 1960. CrossrefMedlineGoogle Scholar30. GIROLAMI M: Treatment of ascitic atrophic cirrhosis of the liver with high dosages of testosterone propionate. J. Amer. Geriat. Soc. 6: 306, 1958. CrossrefMedlineGoogle Scholar31. GIDEKELSHERLOCKPETERSONVANAMEE LIPASP: Management of refractory fluid retention with a combination of L-arginine monohydrochloride and mercurials. New Eng. J. Med. 263: 221, 1960. CrossrefMedlineGoogle Scholar32. HOWARDLEEVY MMCM: Management of ascites. Arch. Intern. Med. (Chicago) 112: 702, 1963. CrossrefMedlineGoogle Scholar33. ORLOFFWRIGHTDE BENEDETTIHALASZANNETTSMUSICANTGOODHEAD MJPWMJNADLMEB: Experimental ascites. VII. The effects of external drainage of the thoracic duct on ascites and hepatic hemodynamics. Arch. Surg. (Chicago) 93: 119, 1966. CrossrefGoogle Scholar34. ORLOFFSNYDER MJGB: Experimental ascites. II. The effects of portacaval shunts on ascites produced with an internal vena cava cannula. Surgery 50: 220, 1961. MedlineGoogle Scholar35. ORLOFFSPITZWALLTHOMASHALASZ MJBRMHHSNA: Experimental ascites. IV. Comparison of the effects of end-to-side and side-to-side portacaval shunts on intractable ascites. Surgery 56: 784, 1964. MedlineGoogle Scholar36. ORLOFF MJ: The effect of side-to-side portacaval shunt on intractable ascites, sodium excretion and aldosterone metabolism in man. Amer. J. Surg. 112: 287, 1966. CrossrefMedlineGoogle Scholar37. CONN HO: Spontaneous peritonitis and bacteremia in Laennec's cirrhosis caused by enteric organisms: a relatively common but rarely recognized syndrome. Ann. Intern. Med. 60: 568, 1964. LinkGoogle Scholar38. NORCROSS JW: The management of hepatic coma. Med. Clin. N. Amer. 46: 1313, 1962. CrossrefMedlineGoogle Scholar39. MACKIESTORMONTHOLLISTERDAVIDSON JEJMRMCS: Production of impending hepatic coma by chlorothiazide and its prevention by antibiotics. New Eng. J. Med. 259: 1151, 1958. CrossrefMedlineGoogle Scholar40. OSTROWTIMMERMANGRAY JDRJSJ: Gastric secretion in human hepatic cirrhosis. Gastroenterology 38: 303, 1960. CrossrefMedlineGoogle Scholar41. ORLOFFBADDELEYNUTTINGROSSHALASZSLOOP MJRMROTHNARD: The effects of experimental liver disease and portal hypertension on gastric acid secretion. Surg. Gynec. Obstet. 122: 19, 1966. MedlineGoogle Scholar42. ORLOFFWALLHICKMANSPITZ MJMHEBBR: Experimental ascites. III. Production of ascites by direct ligation of hepatic veins. Surgery 54: 627, 1963. MedlineGoogle Scholar43. MCDERMOTTPALAZZINARDIMONDET WVHGLA: Elective portal systemic shunt. An analysis of 237 cases. New Eng. J. Med. 264: 419, 1961. CrossrefMedlineGoogle Scholar44. MIKKELSENTURRILLPATTISON WPFLAC: Portacaval shunt in cirrhosis of the liver. Clinical and hemodynamic aspects. Amer. J. Surg. 104: 204, 1962. CrossrefMedlineGoogle Scholar45. LINTONELLISGEARY RRDSJE: Critical comparative analysis of early and late results of splenorenal and direct portacaval shunts performed in 169 patients with portal cirrhosis. Ann. Surg. 154: 446, 1961. CrossrefMedlineGoogle Scholar46. WANTZPAYNE GEMA: Experience with portacaval shunt for portal hypertension. New Eng. J. Med. 265: 721, 1961. CrossrefMedlineGoogle Scholar47. HALLENBECKWOLLAEGERADSONGAGE GAEEMARP: Results after portal-systemic shunts in 120 patients with cirrhosis of the liver. Surg. Gynec. Obstet. 116: 435, 1963. MedlineGoogle Scholar48. CLARKEOZERANHARTCRUZECREVLING JSRSJCKV: Peptic ulcer following portacaval shunt. Ann. Surg. 148: 551, 1958. CrossrefMedlineGoogle Scholar49. DUBUQUEMULLIGANNEVILLE TJLVEC: Gastric secretion and peptic ulceration in the dog with portal obstruction and portacaval anastomosis. Surg. Forum 8: 208, 1957. MedlineGoogle Scholar50. LEBEDINSKAYA SI: Über die Magensekretion bei Eckschen Fistelhunden. Z. Ges. Exp. Med. 88: 264, 1933. CrossrefGoogle Scholar51. WINDSORTHOMPSONORLOFF CWJCMJ: Effects of experimental liver disease and portacaval shunts on gastric acid secretion and blood histamine. Surg. Forum 16: 322, 1965. MedlineGoogle Scholar52. ORLOFFWINDSORTHOMPSONGOODHEAD MJCWJCB: Studies of blood histamine in relation to the gastric hypersecretion associated with portacaval shunts. In preparation. Google Scholar53. ORLOFFWINDSOR MJCW: Effect of portacaval shunt on gastric acid secretion in dogs with liver disease, portal hypertension, and massive ascites. Ann. Surg. 164: 69, 1966. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Los Angeles, CaliforniaThis is an edited transcription of an Interdepartmental Clinical Case Conference arranged by the Harbor General Hospital Campus, UCLA School of Medicine, Los Angeles, Calif.Requests for reprints should be addressed to Marshall J. Orloff, M.D., Department of Surgery, Harbor General Hospital, Torrance, Calif. 90509. 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