Portal hypertension

Question 1

What makes up the portal vein ?

Answer 1

Superior mesenteric + Splenic vein+ gastric + part from inferior mesentric = Portal vein

Question 2

What does the portal vein carry outflow from ?

Answer 2

1. Spleen
2. Oesophagus
3. Stomach
4. Pancreas
5. Small and large intestine

Question 3

Describe the hepatic blood flow

Answer 3

Oxygenated blood from hepatic arteries + deoxygenated blood from portal vein travels to ==> Liver sinusoids ==> central vein ==> hepatic vein ==> IVC ==> R atrium of the heart

Question 4

The portal venous system has several anastomosis with the systemic venous system. What are the 4 collateral pathways ?

Answer 4

1. Esophageal and gastric venous plexus
2. Umbilical vein from the left portal vein to the epigastric venous system
3. Retroperitoneal collateral vessels
4. The hemorrhoidal venous plexus

Question 5

Define what portal hypertension is

Answer 5

This is a Portal vein - Hepatic vein pressure gradient > 5 mm Hg

Question 6

What are the causes of portal hypertension ?

Answer 6

• Prehepatic - due to thrombosis (portal or splenic vein)
• Intrahepatic - cirrhosis, schistosomiasis, alcoholic hepatitis, congenital hepatic fibrosis
• Post-hepatic - budd-chiari syndrome, veno-occlusive disease, RHF

Question 7

What are the potential complications of portal hypertension ?

Answer 7

• Haematemesis or melaena - suggest bleeding varices.
• Lethargy, irritability and changes in sleep pattern - suggest encephalopathy.
• Increased abdominal girth, weight gain - suggest ascites.
• Abdominal pain and fever - suggest spontaneous bacterial peritonitis.

Question 8

What are the signs of portal hypertension ?

Answer 8

• Dilated veins in the anterior abdominal wall and caput medusae (tortuous collaterals around the umbilicus). A venous hum, loudest during inspiration, is sometimes heard over large upper abdominal collaterals.
• Splenomegaly.
• Ascites.

Question 9

What is the treatment of portal hypertension ?

Answer 9

Treat the underlying cause