Portal Hypertension Flashcards
Describe the drainage of blood from the superior hemorrhoidal vein.
To the IMV, the splenic vein, then the portal vein
Where does blood grain into from the IMV?
Into the splenic vein
Where does the portal vein begin?
At the confluence of the splenic vein and the SMV
What are the 6 potential routes of portal-systemic collateral blood flow?
- Umbilical vein
- Coronary vein to esophageal varices
- Retroperitoneal veins (veins of Retzius)
- Diaphragm veins (veins of Sappey)
- Superior hemorrhoidal vein to middle and inferior hemorrhoidal veins and then iliac vein
- Splenic veins to the short gastric veins
What is the pathophysiology of portal hypertension?
Elevated portal pressure resulting from resistance to portal flow
What level of portal pressure is normal?
< 10 mmHg
What is the etiology of portal hypertension?
- Prehepatic (e.g. thrombosis of portal vein, atresia of portal vein)
- Hepatic (e.g. distortion of normal parenchyma, hepatocellular carcinoma)
- Posthepatic (e.g. Budd-Chiari syndrome, thrombosis of hepatic veins)
What is the most common cause of portal hypertension in the US?
Cirrhosis
How many patients with alcoholism develop cirrhosis?
< 20%
What percentage of patients with cirrhosis develop esophageal varieces?
40%
How many patins with cirrhosis develop portal hypertension?
66%
What is the most common physical finding in patients with portal hypertension?
Splenomegaly
What are the 4 associated clinical findings in portal hypertension?
- Esophageal varices
- Splenomegaly
- Caput medusae
- Hemorrhoids
What is the name of the periumbilical bruit heard with caput medusae?
Cruveilhier-Baumgarten bruit
What is the portal-systemic collateral circulation involved in esophageal varices?
Coronary vein backing up into the azygous system
What is the portal-systemic collateral circulation involved in caput medusae?
Umbilical vein draining into the epigastric veins
What is the portal-systemic collateral circulation involved in retroperitoneal varices?
Small mesenteric veins (veins of Retzius) draining retroperitoneally into lumbar veins
What is the portal-systemic collateral circulation involved in hemorrhoids?
SVC backing up into the middle and inferior hemorrhoidal veins
What are possible causes of portal hypertension?
Cirrhosis, schistosomiasis, hepatitis, Budd-Chiari syndrome, hemochromatosis, Wilson’s disease, portal vein thrombosis, tumors, splenic vein thrombosis
What is the most common cause of portal hypertension outside of the US?
Schistosomiasis