 आप रवजाब्राअ देष्ख॥ब्प, मैम ब्योगियल कोलेज आम्ळाउति आप रवजाब्राउ एश्फूक आद पन्जब्राव देश्कुक मेमूरिल मेटेकल कुलेज आम्रावती आप पेश्यन्त वोज़ा तर्टी तरी योर ओल फीमेन वो प्रज़न्तेद विद हेडेख और मिल पें इन राईट हीपोकोंट्रियम सेंच पास शिक्स मुन्स शी हैद नो कंप्लेंश अव राईद वीच नो कुलेज चानल राईट लोब अप लिवर विज वोज़ा पास मुन्सेिक्स बोग़ वेअग़ और वेईद शी पोटल वेईग़ ठी कर वेईग़ ुवेईच जाप्द मिल पेश्यन्तीट वेईटा ु automobile । � scientific । । । । । । । । of electro-systemic shens represent abnormal vascular connections between the portal and the systemic venus system bypassing the liver. They are rare vascular anomalies that can lead to significant morbidity. They are divided into two types- the extra-hypatic and the intrahepatic ones. The exact ideology of photo-systemics shens is unknown. But it is believed to be the due to failure of phytral ductus venosus to close after birth. In animals, genetic predisposition has also been suggested in certain breed of dogs indicating a possible hereditary component. Now classification of intrahepatic portosystemic shunts, it is classified based on the parx classification. In the type one there is a single vessel in the single segment of the liver which is a communication between the portal and the hepatic vein. In type two there are multiple channels or communicating vessels in a single segment of the liver. In the type three which is R-case the connection between the portal vein and the hepatic vein is a aneurysmal vessel. In type four there are multiple vessels communicating between portal vein and hepatic vein in multiple segments of the liver as we can see here. In type five there is persistent ductus venosus clinical presentation. The clinical presentation of the patient depends on the degree of shunt. 24 to 30 degree shunt volume generally do not produce any symptoms. More than 30 percent shunt volume increases the blood ammonia levels and increases the chance of having symptoms. If the shunt volume is more than 60 percent the patient lands into hepatic encephalopathy. Other associated conditions can be liver cirrhosis or atrophy. Now indications of treatment depending on the degree of shunting portal systemic shunts can significantly affect neurocognitive function especially if associated with elevated ammonia levels galactose levels and encephalopathy. This is an important consideration in childhood since neurological effects can decrease the productivity in adulthood. It is generally recommended that early shunt closure be performed to restore hepatic blood flow to prevent possible long-term neurological and pulmonary effects especially if the patient is already encephalopathy. The treatment may involve medical management endovascular techniques like embolization or surgical ligation of the shunt. These are some of my references. Thank you.