The portal vein carries deoxygenated blood from the gastrointestinal tract and spleen to the liver. In portal hypertension, blood pressure in the portal vein is elevated above normal levels due to conditions that obstruct blood flow through the liver. This causes the formation of collateral blood vessels at sites where the portal and systemic circulations connect. Rupture of these varicose veins can lead to life-threatening bleeding. Management focuses on controlling bleeding episodes and reducing fluid buildup through medications and procedures like TIPS that help bypass blocked liver vessels.

1. Hepatic portal
vein
&
portal
hypertension Submitted by: jyoti
 Group: 21
 Semester: 7th

2. How did…
…Devdas die?

3. Portal system
Portal circulation
The portal vein is a blood
vessel that carries all the
deoxygenated blood and
nutrients from GIT and spleen
to liver.

4. Hepatic Portal Vein
 Origin & end in capillaries / venous
sinusoids
 Size: 8cm X 1 cm
 Diameter 0.8 to 0.9
 Drains
 Abdominal part of alimentary tract
(except lower part of anal canal)
 Spleen & Pancreas
 Conveys absorbed products of
digested food to liver
 Devoid of valves
 Reservoir of blood : 1200 ml / min

5. Formation
 Union of Sup mesenteric & Splenic vein
 Between neck of Pancreas & IVC at level L2

6. Course: Extrahepatic part
 Passes upwards & Rt,
behind neck of pancreas &
1st part of duodenum
 Enters rt free margin of
lesser omentum in front of
epiploic foramen with BD &
HA
 Reaches porta hepatis &
divides into rt & Lt
branches.

7. Course: Intrahepatic part
 Branches of portal vein
 Segmental brs
 Brs in Portal canal
 Hepatic sinusoids
 Central veins
 Sublobular veins
 Hepatic veins
IVC

8. Tributaries

9. Tributaries Formative
 Sup Mesenteric vein
 Splenic vein
 Received by Trunk
 Rt & lt Gastric veins
 Superior PD vein
 Received by branches
 Cystic vein
 Paraumbilical veins
 Occasional
 Inf mesenteric
 Rt gastro-epiploic
 Pre-pyloric vein.

10. Branches
Rt Branch
 Shorter, wider
 Receives cystic vein
Lt branch
 Narrower, longer
 Runs in Porta hepatis
from Rt to Lt
 Brs to Caudate & Quadrate
lobe
 Receives Paraumbilical veins

11. Parts
3
1
2
• Infraduodenal
• Retroduodenal
• Supraduodenal

12.  Infra duodenal
 Ant: Neck of Pancreas
 Post: IVC
 Retro duodenal
 Ant: Duodenum (1st Part), Bile duct, GD artery
 Post: IVC
 Supra duodenal : In rt free margin of lesser omentum
 Ant : hepatic artery & bile duct
 Post: IVC
 Surrounded by Hepatic plexus of nerves, lymphatics & LN

13. Relations

14. Portocaval anastomosis
The portal venous
system have several
anastomosis with
systemic venous system.
In case of portal
hypertension these
anastomosis may
become engorged ,
dilated or rupture.

15. Site Caval Portal Effect in
PHT
Lower end of
esophagus
Esophageal
tributaries of
hemiazygos V
Oesophageal
tributaries of
Lt gastric V
Oesophageal
varices
Umbilicus Veins of AAW Paraumbilical
veins
(tributaries of
Lt br of Portal
V)
Caput
medusae
Lower end of
rectum &
Anal canal
Middle & inf
rectal Vs
Sup rectal V Anorectal
varices,
Internal
hemorrhoids

16. Site Caval Portal
Post abd wall • Lt renal V
• Veins of Post Abd
wall
• Splenic V
• Veins of
retroperitoneal
organs like
duodenum, Asc &
Desc colon
Bare area of liver Diaphragmatic veins Hepatic brs of Portal V
Liver Patent Ductus
venosus (rare)
Lt br of portal v
Post wall of vagina Vaginal venous plx Sup rectal v
Falciform lig Diaphragmatic v Paraumblical v

17.  > 12 mm of Hg
 Causes :
 Pre hepatic : Thrombosis of portal vein, congenital atresia
 Hepatic: Cirrhosis, hepatic fibrosis: wilsons disease, congenital fibrosis and
hemochromatosis.
 Post hepatic: liver to right side of heart. Hepatic vein thrombosis, IVC
thrombosis, congenital malformation of IVC, constrictive pericarditis.
 Effects: Splenomegaly, Ascites, Collateral
circulation through sites of Portasystemic
anastomosis
Portal hypertension

18. Signs and symptoms
 Ascites
 Splenomegaly
 Thrombocytopenia
 Hepatic encephalo[athy
 Anastmosis: esophageal varices (bleedings)
gastric varices
anorectal varices
caput medusa(around umbilicus)

19. Internal piles (Hemorrhoids)

20. Caput Medusae

21. Esophageal varices

22. MANAGEMENT
 HEMORRHAGES : selective beta blockers
 ASCITES: diuretics(spironolactone)
 Antibiotics:vancomycin
 TIPS PROCEDURE:
TRANSJUGULAR INTRAHEPATICPORTAL SYSTEMIC SHUNT
artificial channel within the liver establishing
communication between portal vein and hepatic vein