The aim of this study was to investigate the role of portal hypertension determining the severity of bleeding in portal hypertensive rats. The effects of section of branches of the ileocolic vein were studied in sham-operated (SO), partial portal vein-ligated (PPVL), and common bile duct-ligated (CBDL) rats. The ensuing hemorrhage was compared with that caused by section of femoral vein, where the portal hypertensive factor is excluded. In PPVL rats, section of branches of increasing size (divided into fourth, third, second, and first order) resulted in increasingly severe bleeding (arterial pressure: < ؎ 4%, <6 ؎ 12%, <15 ؎ 8%, and <28 ؎ 13%; P F .005; hematocrit <4 ؎ 2%, <6 ؎ 1%, <7 ؎ 2%, and <10 ؎ 4%; P F .005). Bleeding from first-order branches was mild in SO, moderate in PPVL, and severe in CBDL rats, as shown by increasing changes in arterial pressure (<3 ؎ 3%, <12 ؎ 16% and, <43 ؎ 23%; P F .01), hematocrit (<4 ؎ 1%, <12 ؎ 2%, and <32 ؎ 19%; P F .01), and mortality (0%, 0%, and 56%; P F .001). Greater blood loss in CBDL rats was associated with higher portal pressure (16.6 ؎ 2.7 vs. 13.1 ؎ 1.1 mm Hg in PPVL; P F .01) and more prolonged bleeding time (70 ؎ 4 vs. 35 ؎ 3 seconds in PPVL; P F .001). Vessels were similarly dilated in CBDL and PPVL (0.7 ؎ 0.2 and 0.7 ؎ 0.1 vs. 0.4 ؎ 0.1 mm in SO; P F .05). Section of femoral vein caused equal blood loss in SO, PPVL, and CBDL rats, assessed by falls in hematocrit (<8 ؎ 2%, <7 ؎ 1%, <8 ؎ 1%, respectively; NS) and by the blood loss (3.6 ؎ 0.7, 3.5 ؎ 0.9, and 3.8 ؎ 0.7 g; NS). The study shows that the degree of portal pressure elevation is a major determinant of the severity of portal hypertension-related bleeding in PPVL and CBDL rats. (HEPATOLOGY 2000;31:581-586.)
Variceal bleeding is the more frequent and severe complication of portal hypertension in patients with cirrhosis. Al-