Portal hypertension Integrated lecture ppt

Portal hypertension Integrated lecture ppt

1. PORTAL HYPERTENSION DR. SUNDIP CHARMODE ASSOCIATE PROFESSOR DEPARTMENT OF ANATOMY AIIMS RAJKOT

2. DEFINITION Portal hypertension is defined as the elevation of the hepatic venous pressure gradient to > 5 mmHg . Clinically significant portal hypertension is present when gradient exceeds 10 mmHg. Risk of variceal bleeding increases beyond a gradient of 12 mmHg .

3. CAUSES OF PORTAL HYPERTENSION Pre-hepatic: Congenital portal atresia Portal vein thrombosis Phlebitis of portal vein Splenic vein thrombosis Hepatic: Cirrhosis Chronic hepatitis Parasitic infections (schistosomiasis Post-hepatic: Budd- chiari syndrome Hepatic venous thrombosis) Constrictive pericarditis Tricuspid valve incompetence 

4. PORTAL HYPERTENSION SIGNS Enlarged Hemorrhoids Caput Medusa Platypnea/Orthodeoxia Hepatosplenomegaly SYMPTOMS Hematemesis Malena/hematochezia Bloated stomach with rapid weight gain (from fluid). Edema Mental confusion or disorientation.

5. ESOPHAGEAL VARICES Dilated veins usually found in the submucosa of the lower esophagus.

6. RISK FACTORS CONTRIBUTING TO HEMORRHAGE Muscular exertion from lifting heavy objects. Straining at stool. Sneezing, coughing, or vomiting. Esophagitis; irritation of vessels by poorly chewed foods or irritating fluids; or reflux of stomach contents. 

7. FORMATION OF PORTAL VEIN Union of Superior Mesenteric vein and Splenic vein behind the neck of pancreas at L2. Carries blood from GI tract to liver.

8. SITES OF PORTO-CAVAL ANASTOMOSES Sl. No. Name of the site Portal system Systemic circulation 1. At the lower end of esophagus Esophageal tributaries of Left gastric vein Esophageal tributaries of Hemi-azygous vein. 2. At the lower end of rectum and anal canal Superior rectal vein, a tributary of Inferior Mesenteric vein Middle and inferior rectal veins. 3. At the umbilicus Para-umbilical veins of portal vein From above : Superior Epigastric Vein and Lateral thoracic vein. From below : Inferior and Superior Epigastric veins From sides : Posterior Intercostal and Lumbar veins. 4. Behind the Peritoneum of Posterior Abdominal wall Splenic and Colic veins Left Renal veins through several small veins known as ‘Veins of Retzius.’ 5. At the Bare area of liver Portal radicles of Liver Diaphragmatic veins through several small veins passing through loose areolar tissue.

9. Portal hypertension Development of pressure gradient of 12 mm Hg or greater Venous collaterals develop from high portal system pressure to systemic veins Formation of abnormal varicoid vessels Vessels may rupture causing life-threatening hemorrhage. 

10. CAPUT MEDUSAE It is one of the cardinal clinical sign of portal hypertension. Latin for "head of Medusa"

11. DEFINITION The appearance is due to cutaneous portosystemic collateral formation between distended and engorged paraumbilical veins that radiate from the umbilicus across the abdomen to join systemic veins. Blood from the portal venous system is shunted through the umbilical veins into the abdominal wall veins.

12. PATHO-PHYSIOLOGY

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