Portal Hypertension Notes

1. PORTAL HYPERTENSION

2. DEFINITION:
• It refers to increased pressure gradient in the portal venous system.
• The normal portal venous pressure is 7 to 10 mmHg.
• If this pressure becomes greater than 12 mmHg, then it is called as
portal hypertension.

3. ANATOMY OF PORTAL SYSTEM:
• Generally, the superior mesenteric vein joins with splenic vein to form
portal vein behind the neck of pancreas.

4. CLASSIFICATION:
• The portal hypertension is divided into three types namely;
Prehepatic portal hypertension (obstruction occurs before veins
reach the liver).
Intrahepatic portal hypertension (obstruction in the liver).
Posthepatic portal hypertension (obstruction occurs after veins leave
the liver).

6. CLINICAL FEATURES AND MAIN DIFFERENCES
BETWEEN PREHEPATIC AND INTRAHEPATIC:

7. CLINICAL FEATURES:
• Hematemesis (vomiting of blood) due to bleeding from oesophageal
varices.
• Hematochezia – Bleeding of Frank blood from rectum due to rectal
varices.
• Ascites.
• Altered sensorium / encephalopathy can also occur.

8. INVESTIGATIONS:
• CBC (complete blood count).
• Endoscopy of upper GIT – to explore the esophageal varices and
gastric varices.
• Barium swallow – bag of worms appearance.
• USG – to reveal ascites and cirrhosis of liver.
• CT scan.
• MRI.

9. TREATMENT:
• SUPPORTIVE MANAGEMENT :
IV fluids to correct hypovolemia.
Oxygen saturation.
Nasogastric aspiration.
MEDICAL TREATMENT:
Beta blockers – propranolol.

10. • SURGICAL MANAGEMENT:
Distal splenorenal shunt.
Transjugular intrahepatic portosystemic shunt (TIPS).

11. COMPLICATIONS:
• Hypersplenism – sequestration of RBCs, WBCs and platelets.
• Ascites.
• Hepatorenal syndrome.
• Hepatic encephalopathy.
• Variceal bleeding.

12. THANK YOU!