[Cirrhosis of the liver without portal hypertension (author's transl)]. / Cirrosi epatica senza ipertensione portale.

A group of patients with "cirrhosis of the liver", confirmed by biotic examination, were first subjected to radiographic examination of the coeliac tripod so as to confirm the presence of porto-hepatic or portocaval shunts; the blocked suprahepatic pressure and the porto-hepatic gradient were then determined. The porto-hepatic gradient values showed high variability, ranging from normal values (4 mm Hg) to values of 24 or more mm Hg, characteristic of portal hypertension of high severity. This is confirmation of the possibility that a cirrhosis, even though with presence of collateral circulations, need not necessarily be linked to a hemodynamic situation of portal hypertension. The observation, then, of normal portal pressure in the most advanced stages of cirrhosis (3rd stage according to the ALPERT and MITRA classification) seems to indicate the tendency to normalization of the portal pressure values in evolution of the disease.

[Blocked suprahepatic pressure and the portohepatic gradient in evaluation of the portal circulation (author's transl)]. / La pressione sovraepatica bloccata e il gradiente porto-epatico nella valutazione del circolo portale.

Blocked suprahepatic pressure and the portohepatic gradient were studied in correlation with the circulation parameters and expressed by graphical representation allowing approximate quantitative evaluation of their variation. It is a complete analysis of the possible variations produced in the hepatic and portal circulation by extrahepatic and especially intrahepatic shunts resulting from morphological changes due to the active and passive fibrous septa that are established during cirrhosis. This leads to a hemodynamic classification of the condition of the portal and hepatic circulation, evidencing the importance of determination of the blocked suprahepatic pressure and portohepatic pressure gradient for correct interpretation of the clinical picture and for medical or surgical therapeutic guidance.