Portal HTN

Question 1

Where does the inflow of blood for the liver come from?

Answer 1

70% from the hepatic portal vein

30% from the hepatic artery (to supply the liver with oxygen & nutrients)

Question 2

Where is everything that is absorbed in the GI tract filtered?

Answer 2

In the liver

Question 3

Which vessel does the outflow of blood from the liver go from?

Answer 3

The hepatic vein (100% outflow)

Question 4

Portal Hypertension?

Answer 4

Persistently elevated blood pressure in the hepatic portal system (>12 mmHg)

Question 5

What value does portal HTN persistently have to be over?

Answer 5

> 12 mmHg over baseline

Question 6

Pre-hepatic HTN?

Answer 6

Portal HTN in the vessels before the liver

Question 7

Intra-hepatic HTN?

Answer 7

Portal HTN in the vessels within the liver

Question 8

Post-Hepatic HTN?

Answer 8

Portal HTN in the vessels after the liver

Question 9

What is Portal HTN primarily due to?

Answer 9

Cirrhosis (intra-hepatic)

Question 10

What is the major complication of portal HTN?

Answer 10

Hemorrhage from ruptured varix

Question 11

What are other complications that can arise from portal HTN? (do not need to explain)

Answer 11

• Portosystemic shunts
• Ascites
• Splenomegaly

Question 12

Portosystemic shunts?

Answer 12

• pressure increases in the hepatic portal system and is displaced into accessory vessels by creating new channels. (collateral vessels -> collateralization). Channels form between hepatic portal system and the rest of the systemic vessels.
• Ruptured varix (massive bleed which makes it a major problem)
• Decreased blood flow to the liver

Question 13

How does splenomegaly occur?

Answer 13

We have the splenic vein that is apart of the hepatic portal system, if you have portal HTN , the splenic vein is engorged as well and fluid will move into the interstitial space of the spleen and enlarge the spleen.

Question 14

What results in hypersplenism?

Answer 14

Massive splenomegaly

Question 15

Hypersplenism?

Answer 15

An overreactive spleen

Question 16

What is the function of the spleen? What occurs in hypersplenism?

Answer 16

To filter old and damaged blood cells in the body but in hypersplenism this function is exaggerated and there is an increase in the scavenging of blood vessels, including platelets and WBCs. [This leads to anemia, thrombocytopenia, and leukopenia]