One major aspect of this work is to evaluate the long-term results and extend the use of selective shunting for bleeding gastroesophageal varices. With these procedures, bleeding is controlled by decompression of the variceal area while portal flow is maintained to the liver. Studies thus far have shown that there is excellent control of bleeding from varices and the risk from encephalopathy has been greately reduced both in terms of incidence and severity. The procedure has been limited thus far to about 60% of the patient population; excluded are patients with marked ascites and/or those requiring an emergent procedure. The current study will test the feasibility of extending the selective concept to these major groups of patients. A small but important group is that of non-cirrhotic portal vein thrombosis. New evidence indicates that such patients are greatly benefited by and are excellent candidates for the selective shunt. Portal-systemic encephalopathy is a major problem in the cirrhotic and is often worsened severely by portacaval type shunts. This syndrome is still poorly understood, but is a major source of morbidity to a vast number of patients with liver disease in this country. It is clear that there is intolerance to protein and in all probability there are specific nitrogenous substances such as ammonia and various amino acids which are especially related to the pathophysiology of encephalopathy. Our work in this area involves the study of various synthetic diets, including solutions with specifically tailored amino acid contents. The hypothesis that there are specific amino acid patterns which ameliorate encephalopathy will be tested. Also, the metabolism of tyrosine will be elucidated in cirrhotics. Another major source of morbidity in these patients is intractable ascites. Our study is concerned with the nature of the ascites (including chylous) and methods of therapy, particularly peritoneovenous shunting and its effect upon hemodynamic changes, alterations in the coagulation system, and renal pathophysiology.