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Portal hypertension

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  • 1. PORTAL HYPERTENSION Subject: Applied Doppler, Vascular Doppler.
  • 2. TOPICS: Definition. Anatomy. Causes Ultrasound Finding. References.
  • 3. DEFINITION OF PORTAL HYPERTENSION. Portal hypertension occurs when the pressure in the portal venous system is raised. This may happen as a result of chronic liver disease, particularly in the cirrhotic stage, when the nodular and fibrosed nature of the parenchyma impedes the flow of blood into the liver.
  • 4. ANATOMY
  • 5. • The portal venous system extends from the intestinal capillaries to the hepatic sinusoids. This venous system carries the blood from the abdominal gastrointestinal tract, the pancreas, gallbladder, and spleen back to the heart (coursing through the liver). • The portal vein supplies 70% of the blood flow to the liver, but only 40% of the liver oxygen supply. The remainder of the blood comes from the hepatic artery, and blood from both of these vessels mixes in the sinusoids. • The liver receives a tremendous volume of blood, on the order of 1.5 liters per minute.
  • 6. CAUSES: Normal portal vein pressures range from 5–10 mm Hg. Portal hypertension is present when the portal vein pressure exceeds 12 mmHg. 1) Prehepatic or Infrahepatic Causes. 2) Intrahepatic or Hepatic Causes . 3) Posthepatic or Suprahepatic Causes.
  • 7. 1. PREHEPATIC OR INFRAHEPATIC CAUSES i. Congenital Atresia Or Stenosis. ii. Thrombosis Of Portal Vein. iii. Thrombosis Of Splenic Vein. iv. Extrinsic compression (e.g , tumor). Portal Vein Thrombosis
  • 8. 2. INTRAHEPATIC OR HEPATIC CAUSES . i. liver cirrhosis ii. hepatic fibrosis (e.g. due to Wilson's disease,hemochromatosis, or congenital fibrosis) iii. less commonly noncirrhotic causes such as schistosomiasis, massive fatty change and diffuse granulomatous diseases.
  • 9. 3. POSTHEPATIC OR SUPRAHEPATIC CAUSES. i. Budd-chiari Syndrome ( Hepatic Vein Thrombosis ) ii. IVC thrombosis. iii. Cardiac Disease: a. Constrictive Pericarditis. b. Valvuar Heart Disease. c. Right Heart Failure.
  • 10. • Ascites (free fluid in the peritoneal cavity) & Cirrhotic liver Transabdominal ultrasound shows loops of small bowel with thickened walls floating within ascitic fluid due to portal hypertension Cirrhotic right hepatic lobe with the surrounding ascites.
  • 11. • Splenomegaly. Splenomegaly in portal hypertension. The inferior splenic margin is blunted, descending below and medial to the left kidney. Varices at the splenic hilum in portal hypertension.
  • 12. • Dilated portal veins The Normal Portal Vein is < 1.3 cm, > 20% change in caliber with respiration
  • 13. • Ligamentum Teres Para-umbilical channel running along the ligamentum teres to the anterior abdominal wall in a patient with end-stage chronic liver disease and portal hypertension.
  • 14. • Porto System Collaterals Splenic Vein Occlusion Longitudinal color Doppler ultrasound shows an umbilical vein collateral extending anteriorly from left portal vein branch
  • 15. • Dilated Hepatic Arteries
  • 16. • Portal vein thrombosis A, Longitudinal view ofthe main portal vein (arrow) shows hypoechoic thrombus throughout the venous lumen. B, Transverse view ofthe left portal vein shows focal isoechoic thrombus (arrow) within thelumen. C, Longitudinal view of the main portal vein shows focal hyperechoic thrombus (arrows) within the lumen. D, Transverse view of the main portal vein shows a large hyperechoic thrombus (arrow) near the splenic vein confluence. Portal vein thrombosis in different patients.
  • 17. • Hepatofugal (reversed) portal flow Reversed PV flow in portal hypertension. Note the increased velocity of hepatic arterial flow indicated.
  • 18. REFERENCES: