Portal hypertension
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Portal hypertension
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Gastrointestinal system pathology review
Appendicitis: Pathology review
Cirrhosis: Pathology review
Colorectal polyps and cancer: Pathology review
Congenital gastrointestinal disorders: Pathology review
Diverticular disease: Pathology review
Esophageal disorders: Pathology review
Gallbladder disorders: Pathology review
Gastrointestinal bleeding: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
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Assessments
Portal hypertension
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Portal hypertension
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The patient is started on emergent therapy for her symptoms. Which of the following best explains the pathophysiology of this patient’s current condition?
External References
First Aid
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2016
Budd-Chiari syndrome p. 401
portal hypertension p. 398
Cirrhosis p. 398
portal hypertension p. 398
Portal hypertension p. 398
ARPKD p. 630
cirrhosis and p. 398
pulmonary arterial hypertension p. 703
Schistosoma spp. p. 158
serum markers for p. 399
varices and p. 374
Schistosomiasis
portal hypertension p. 398
Transcript
Content Reviewers
Portal hypertension means increased blood pressure in the hepatic portal system - or portal venous system.
Most commonly, this happens because of hepatic cirrhosis, which is when the liver tissue is replaced by fibrotic, functionless tissue.
Now, the portal venous system comprises the portal vein and its tributaries - namely, the splenic, and mesenteric veins.
This blood contains all the nutrients absorbed in the GI tract, but it also carries toxins that the liver metabolizes so that they can be safely excreted by the kidneys.
Once the liver processes all these substances, it sends the blood to the heart, through the inferior vena cava, to enter the systemic venous system.
Now, there’s a few points in the boundaries of the hepatic portal system, where it could be connected with the systemic venous system that collects blood from the rest of the body: the inferior portion of the esophagus, the superior portion of the anal canal, and the round ligament of the liver - which used to be the umbilical vein during fetal life.
At birth, the umbilical cord is cut, and the umbilical vein collapses to form the round ligament.
Normally, the round ligament stays shut because pressures in the portal venous system and the systemic venous system are the same, between 5 and 10 Millimeters of Mercury
But in some situations, an obstruction may prevent blood flow from the portal vein towards the inferior vena cava.
Summary
Portal hypertension is hypertension in the hepatic portal system, which is composed of the portal vein and its branches and tributaries. This can lead to serious complications, such as the development of enlarged veins in the esophagus and stomach, called varices, which can rupture and cause bleeding. It can also lead to ascites, an accumulation of fluid in the abdomen, and liver failure. Treatment involves medications to reduce pressure in the portal vein, such as beta-blockers like propranolol.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Portal hypertension: pathophysiology, diagnosis and management" Internal Medicine Journal (2015)
- "Pathophysiology of Portal Hypertension and Esophageal Varices" International Journal of Hepatology (2012)
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