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Understanding Portal hypertension

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Understanding Portal hypertension

Understanding Portal hypertension

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  • 1. Portal Hypertension: Learn from the start Pratap Sagar Tiwari, Lecturer, NGMC
  • 2. 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 ????
  • 3. 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.
  • 4. Portal circulation Hepatic vein IVC 25 % Hepatic Artery Proper 75 % Hepatic portal vein SMV GI tract Splenic vein Spleen IMV Gastric vein Cystic vein
  • 5. 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.
  • 6. Portal triad Pic taken from : https://cms.webstudy.com/WebstudyFileSystem/testovaci/GetFile/293875/Ch%2022/Ch22b/index.html
  • 7. Portal triad A portal triad (a component of the hepatic lobule) It consists of the following five structures: 1. proper hepatic artery 2. hepatic portal vein 3. common bile duct 4. lymphatic vessels 5. branch of the vagus nerve
  • 8. PostHepatic Portal vein & tributaries PreHepatic Bile canaliculi & sinusoids Hepatic vein IntraHepatic IVC Occulsion↑ resistance↑ pressure hypertension Systemic cirulation HEART
  • 9. Portal HTN :causes Ref: HEMODYNAMIC PRINCIPLES OF PORTAL HYPERTENSION. Sleisenger-2010. http://www.uptomed.ir
  • 10. Portal HTN : manifestations
  • 11. Understanding HVPG Ref: http://www.ias.ac.in/meetings/annmeet/71am_talks/sksarin/img46.html
  • 12. 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.
  • 13. 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.
  • 14. Prognostic value of HPVG in CLD Measurement(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 An HPVG of ≥10 mmHg defines clinically significant portal hypertension 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.
  • 15. Differentiating Sinusoidal from preSinusoidal portal HTN Intrahepatic PVP WHVP FHVP HVPG Presinusoidal ↑ N N N SInusoidal ↑ ↑↑ ↑ ↑ WHVP = sinusoidal pressure HVPG = WHVP – FHVP Portal venous pressure is increased ,so portal hypertension But WHVP increases in Sinusoidal ,so Ascites is common in Sinusoidal causes of portal htn (increased Sinusoidal pressure= transudation of fluid )
  • 16. Schematic dig showing blood flow Normal Source: emedicine Portal HTN
  • 17. Overall Manifestations: PHTN • • • • Ascites Varices Hepatic encephalopathy Splenomegaly
  • 18. Next Part : • Investigation & Management of portal hypertension
  • 19. • Thankyou

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