understanding portal hypertension
DESCRIPTION
Understanding Portal hypertensionTRANSCRIPT
![Page 1: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/1.jpg)
Portal Hypertension: Learn from the start
Pratap Sagar Tiwari, Lecturer, NGMC
![Page 2: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/2.jpg)
What does Portal HTN mean ?
• In simpler terms. It means Hypertension or increased blood pressure in the Hepatic portal system.
• Note: this isnt an standard definition
What is hepatic portal System ????
![Page 3: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/3.jpg)
Hepatic portal system
• The hepatic portal system is the system of veins that consists of the hepatic portal vein and its tributaries.
• It is also called the portal venous system.
Pic taken from : http://imageradiology.blogspot.com/2010/10/hepatic-portal-vein.html
It is one of the two portal system in the body and the other being is the Hypophyseal portal system is a blood system of vessels in the brain that connects the hypothalamus with the anterior pituitary.
![Page 4: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/4.jpg)
Portal circulation
Hepatic Artery Proper
Hepatic portal vein
25%
75%
Hepatic vein
IVC
IMV
Splenic vein
SMV
Cystic vein
Gastric vein
GI tract
Spleen
![Page 5: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/5.jpg)
Portal circulation
• The liver receives about 75% of its blood through the hepatic portal vein, with the remainder coming from the hepatic artery proper.
• The hepatic portal vein is a blood vessel that conducts blood from the gastrointestinal tract and spleen to the liver.
• The blood leaves the liver to the heart in the hepatic veins.• The hepatic portal vein is usually formed by the confluence
of the superior mesenteric and splenic veins and also receives blood from the inferior mesenteric, gastric, and cystic veins.
![Page 6: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/6.jpg)
Portal triad
Pic taken from : https://cms.webstudy.com/WebstudyFileSystem/testovaci/GetFile/293875/Ch%2022/Ch22b/index.html
![Page 7: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/7.jpg)
Portal triad
A portal triad (a component of the hepatic lobule) It consists of the following five structures:1. proper hepatic artery2. hepatic portal vein3. common bile duct4. lymphatic vessels5. branch of the vagus nerve
![Page 8: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/8.jpg)
Portal vein & tributaries
HEART
IVC
Bile canaliculi & sinusoids Hepatic vein
Systemic cirulation
PreHepatic IntraHepatic
PostHepatic
Occulsion↑ resistance↑ pressure hypertension
![Page 9: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/9.jpg)
Portal HTN :causes
Ref: HEMODYNAMIC PRINCIPLES OF PORTAL HYPERTENSION. Sleisenger-2010. http://www.uptomed.ir
![Page 10: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/10.jpg)
Portal HTN : manifestations
![Page 11: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/11.jpg)
Understanding HVPG
Ref: http://www.ias.ac.in/meetings/annmeet/71am_talks/sksarin/img46.html
![Page 12: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/12.jpg)
Portal hypertension
• PHTN is hypertension (high BP) in the portal vein system, which is composed by the portal vein, and its branches.
• Portal venous pressure is the blood pressure in the hepatic portal vein, and is normally between 5-10 mmHg.
• NOTE: Wedged hepatic venous pressure (WHVP)= hepatic sinusoidal pressure• hepatic venous pressure gradient HVPG= WHVP- FHVP• Normal HVPG = < 5 mmhg
• Portal hypertension is defined as elevation of hepatic venous pressure gradient to >5mmHg.
![Page 13: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/13.jpg)
Summary
• Normal portal venous pressure is generally considered to be between 5 -10 mm Hg.
• Once the portal venous pressure rises to 12 mm Hg or greater, complications can arise, such as varices ,ascites etc.
• Portal hypertension is defined as elevation of hepatic venous pressure gradient to >5mmHg.
![Page 14: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/14.jpg)
Prognostic value of HPVG in CLDMeasurement(mmhg) Significance
1-5 normal
6-10 Preclinical sinusoidal portal htn
≥10 Clinically significant phtn
≥12 Increase risk of rupture of varices
≥16 Increase risk of mortality
≥20 Treatment failure and mortality in acute variceal bleeding
Ref: Iris W. Liou, MD. Screening for Varices and Prevention of Bleeding http://hepatitisc.uw.edu/
Portal hypertension is defined as elevation of hepatic venous pressure gradient to >5mmHg.
An HPVG of ≥10 mmHg defines clinically significant portal hypertension
![Page 15: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/15.jpg)
Differentiating Sinusoidal from preSinusoidal portal HTN
Intrahepatic PVP WHVP FHVP HVPGPresinusoidal ↑ N N NSInusoidal ↑ ↑↑ ↑ ↑
WHVP = sinusoidal pressureHVPG = WHVP – FHVP
Portal venous pressure is increased ,so portal hypertensionBut WHVP increases in Sinusoidal ,so Ascites is common in Sinusoidal causes of portal htn(increased Sinusoidal pressure= transudation of fluid )
![Page 16: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/16.jpg)
Schematic dig showing blood flow
Normal Portal HTNSource: emedicine
![Page 17: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/17.jpg)
Overall Manifestations: PHTN
• Ascites• Varices• Hepatic encephalopathy• Splenomegaly
![Page 18: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/18.jpg)
Next Part :• Investigation & Management of portal
hypertension
![Page 19: Understanding Portal hypertension](https://reader036.vdocuments.site/reader036/viewer/2022081507/554b31d7b4c905da088b5079/html5/thumbnails/19.jpg)
• Thankyou