Vascular Abnormalities

Question 1

Portal hypertension: define and causes

Answer 1

Define:
Normal portal vein pressure: 5-10mmHg(14 cmH2o)
Portal hypertension: wedge hep c pressure more than 5mmhg than ivc, splenic v pressure more than 15 mmhg and portal vein p more than 30cm h2o
Pre and post sinusoidal
Pre : intra or extra hepatic
Extra in child: umbilical vein catherization/ thrombosis/ omphalitis
Adult: pancreatitis, tumor, HCC, trauma, sepsis, splenectomy and hypercoagulable state
Intra: cirrhosis, Mets, schistosomiasis, primary biliary cirrhosis, pvc and methotrexate
Post sinu: ivc, hep v thrombosis, constrictive pericarditis

Question 2

Portal hypertension
USG

Answer 2

Dilated port v >13mm
With portosys shunt decrease in size
Several areas: ge junction: coronary vein, retroperitoneal, haemorrhoidal(sup with middle/inf rectal), splenorenal, paraumbilical
Paraumbilical vein: protection against esophageal varices

Doppler: phasic normal undulated, p for pedal
Disease: loss of undulation, flat, biphasic and then reversal
Increase of less than 20% in size after post pradial : port hypertension

Question 3

Portal vein thrombosis : b vs m

Answer 3

Benign: less dilatation
Malignant: gross dilatation: pulsatile flow

Question 4

Budd chiari vs hepatic veno occlusive disease

Answer 4

Hep v with or without ivc involved in BC
Small hepatic venules in HVOD
HVOD seen in Jamaica after alkaloid toxicity from bush tea and also after chemo/ radio
HVOD: normal hep v flow
Portal flow: reverse or to and fro or reduced port v flow

Question 5

Peliosis hepatis

Answer 5

Rare disorder with vascular spaces like hemagioma but with portal tracts in bwt the fibrous stroma
Very diff to diagnose radiologically
Echogenic masses with calcification
Can be seen in hiv, chronic wasting disorders and following renal and liver transplantation