THEME XIV: PORTAL HYPERTENSION
1. What is the definition of portal hypertension?
- Portal hypertension is defined the portal pressure higher than 5 mmHg
2. When does usually portal hypertension occur?
Portal hypertension usually occurs because increased portal venous resistance that is in location →
- Prehepatic
- Intrahepatic
- Post hepatic
3. Which is the most common cause of prehepatic portal hypertension?
- The most common cause of prehepatic portal hypertension is portal vein thrombosis (PVT)
4. When the portal vein is thrombosed in the absence of liver disease, hepatopetal (to the liver) portal collateral vessels develop to restore portal perfusion. How this state is termed?
- The state is termed “cavernomatous transformation of the portal vein”
5. What does “Budd-Chiari syndrome” mean?
- “Budd Chiari syndrome” means hepatic venous thrombosis, which is one of the post hepatic causes of portal hypertension.
6. Which is the most common cause of portal hypertension?
- The most common cause of portal hypertension is liver cirrhosis (interhepatic obstruction
- which increases intrahepatic vascular resistance by fibrosis, thrombosis and nodular regeneration.
7. Portal hypertension stimulates portosystemic collateralisation. Which is the most important collateral network and why?
- The collateral network though the coronary artery and short gastric veins to the azygous vein is clinically the most important.
- because in results in the formation of the esophagogastric varices.
8. What does “Caput medusae” mean?
- “Caput medusae” means recanalized umbilical veins from the left portal vein to the epigastric venous system due to portal hypertension.
9. Which instrumental method is used to establish esophageal varices in cases of portal hypertension?
- Esophago-gastro endoscopy allows to established varices in cases of portal hypertension.
- The size, distribution and colour of varices are determined by endoscopy.
10. Which is the imagine method of first choice in diagnosis of portal hypertension?
- Abdominal ultrasound – it is cheap, easy to perform and well tolerated by the patient.
In portal hypertension (↑ pressure in the portal system, e.g. due to cirrhosis), blood is forced through these anastomoses into the systemic circulation as a “bypass” route. Because these collateral vessels are thin-walled and not meant to handle high flow, they become dilated and can rupture, leading to serious complications.
Sites of Portocaval Anastomosis
- Lower end of esophagus: (esophageal varices) left gastric vein (Portal) & esophageal branch of azygos vein.
- Lower part of rectum: (Hemorrhoids) superior rectal vein (Portal) & middle rectal and inferior rectal veins.