Portal hypertension occurs when blood pressure increases in the portal vein system, usually due to liver scarring or cirrhosis blocking blood flow through the liver. This puts patients at risk of esophageal varices, internal hemorrhoids, and caput medusae. Symptoms include gastrointestinal bleeding. Treatments focus on preventing complications through medication, banding, surgery like TIPS, or liver transplantation.

1. NUR FARRA
NAJWA BINTI
ABDUL AZIM
082015100035
APPLIED ANATOMY OF
PORTAL CIRCULATION

2. OBJECTIVES
 Portal hypertension and its consequences
 Symptoms
 Managements (treatments)

3. PORTAL HYPERTENSION

4. Increase in the blood pressure within the portal
venous system.
Veins coming from the stomach, intestine, spleen,
and pancreas merge into the portal vein, which then
branches into smaller vessels and travels through
the liver.
Vessels in the liver are blocked due to liver
damage, blood cannot flow properly through the
liver.
High pressure in the portal system develops.
This increased pressure in the portal vein may
lead to
Development of large, swollen veins (varices).
Varices can rupture and bleed, resulting in
potentially life-threatening complications.

6. CAUSE
Liver cirrhosis
Scarring which
accompanies the
healing of liver injury
Scar tissue blocks the
flow of blood through
the liver
Clot
Blood from the liver
to the heart
A parasitic infection called
schistosomiasis, and focal nodular
hyperplasia, a disease seen in people
infected with HIV

7. SYMPTOMS
 No specific symptoms
 Chance of developing portal hypertension is high if
had liver disease that lead to liver cirrhosis
 Gastrointestinal bleeding (black, tarry stools or blood in the
stools)
 Hematemesis
 Ascites
 Encephalopathy / confusion / forgetfulness caused
by poor liver function

8. TREATMENTS
 Treatment focuses on preventing or managing the
complications
 Diet
 Medications
 Lactulose can help treat confusion and other mental changes
associated with encephalopathy.
 Nonselective beta-blockers (nadolol or propranolol)
 Endoscopic therapy
 Banding
 Sclerotherapy
 Surgery
 Transjugular intrahepatic portosystemic shunt (TIPS)
 Distal splenorenal shunt (DSRS)
 and radiology

10. CONSEQUENCES
1. Esophageal varices
2. Internal
haemorrhoids
3. Caput medusa

11. ESOPHAGEAL VARICES
 Abnormal, enlarged veins in the lower part of the
esophagus
 Esophageal varices occur most often in people with
serious liver diseases (liver cirrhosis, portal
hypertension)

12.  Symptoms
 Hematemesis
 Bloody stool
 Shock
 Managements
 Medication
 A medication that tightens
blood vessels
(vasoconstriction) may be
used. Examples include
octreotide or vasopressin.
 Esophageal transection
 TIPS , DSRS
 Banding
 Once the bleeding is stopped,
 prevent future bleeding
including:
 Drugs called beta blockers,
such as propranolol and
nadolol that reduce the risk of
bleeding.
 Transjugular intrahepatic
portosystemic shunt (TIPS).
This is a procedure to create
new connections between
two blood vessels in your
liver. This can decrease
pressure in the veins and
prevent bleeding episodes
from happening again.

14. HEMORRHOID

15. INTERNAL HEMORRHOIDS
 Inside the rectum
 Can't see or feel them
 Don't usually hurt because there are few pain-
sensing nerves in the rectum.
 Bleeding may be the only sign that they are there.
 Sometimes internal haemorrhoids prolapse, or
enlarge and protrude outside the anal sphincter.
 See or feel them as
moist
pink pads of skin that are pinker than the surrounding
area.

16.  Symptoms
 Bright red bleeding from the
anus. Blood may streak the
bowel movement or the toilet
paper.
 Tenderness or pain during
bowel movements.
 Painful swelling or a lump near
the anus.
 Anal itching.
 A mucus anal discharge.
 Managements
 Creams, ointments and
suppositories can help relieve
swelling and inflammation
symptoms in the short-term.
 Warm (but not hot) sit baths
are a traditional therapy for
piles: sit in about 8 cm of
warm water for 15 minutes,
several times a day, especially
after a bowel movement.
 Painkillers, such
as paracetamol
 Products with
local anaesthetic
 If constipated, recommend
using a laxative.

17.  Injection or sclerotherapy
 Injected with a solution that creates a scar and closes off the
haemorrhoid.
 The injection will only hurt a little.
 Banding
 Coagulation or cauterisation.
 Using either an electric probe, a laser beam, or an infrared light,
a tiny burn painlessly seals the end of the haemorrhoid, causing it
to close off and shrink. This is
most useful for prolapsed
haemorrhoids.
 Surgery.
 Traditional surgery,

18. CAPUT MEDUSAE
 Caput medusae, also known as palm tree sign, is
the appearance of distended and engorged
paraumbilical veins, which are seen radiating from
the umbilicus across the abdomen to join systemic
veins.

19.  Symptoms
 Portal hypertension
 Legs and belly to swell
 Enlarged spleen
 Umbilicus, or belly button, may stick out.
 A very large caput medusae it is possible to
sometimes hear the blood humming as it passes
through the inside of your veins with the sound
becoming louder when you breathe in. This is
known as a Cruveilhier-Baumgarten murmur

20.  Treatments
 Treating what is causing you to have caput medusae.
 Liver transplant.
 Sometimes if there is a lot of fluid build-up in your stomach
you may need to have it drained away.

21. SUMMARY
•SPLENOMEGALY
•ASCITES
•EDEMA
•HEMATEMESIS

22. ANY DOUBTS ?