Pathophysiology is a branch of medicine which explains the function of the body as it relates to diseases and conditions. Later on, an increase in portal venous inflow will help to maintain and aggravate portal. Several pathophysiologic changes occur in the patient with liver cirrhosis that should be considered when surgery is planned. Feb 27, 2017 portal hypertension pathophysiology want to learn more. Genetics and pathophysiology of essential hypertension 4 mechanisms can not be isolated, and are probably more complex. Portal hypertension is defined by a pathologic increase in the pressure of the portal venous system. Portal hypertension pathophysiology of portal hypertension mechanisms pathophysiology of clinical signs clinical manifestations management options 3292018 2 3. Increase in portal pressure is because of an increase in vascular resistance and an elevated portal blood flow. Pdf pathophysiology of portal hypertension, whats new. Portal hypertension pathophysiology want to learn more. Angiogenesis, or the process of new blood vessel formation from pre. Pathophysiology of portal hypertension jaime bosch, m.
Hypertension sufia husain pathology department ksu, riyadh march 2014 a free powerpoint ppt presentation displayed as a flash slide show on id. Portal hypertension pathophysiology on the web most recent articles. Pathophysiology of portal hypertension the liver wiley. Pathology of portal hypertension, symptoms, complications and treatment options. Circulatory irregularities, such as splanchnic vasodilation, vasoconstriction and hypoperfusion of the kidneys, water and salt retention, and increased cardiac output, also occur. Free download hypertension powerpoint presentation slides. The pathophysiology of hypertension is an area which attempts to explain mechanistically the causes of hypertension, which is a chronic disease characterized by elevation of blood pressure. Pressure in the portal system, as with pressure in any system, develops through an interaction of flow and resistance. To understand the pathophysiology of hypertension, the basic physiology of blood pressure must be discussed. Portal hypertension is the main prognostic factor in cirrhosis. This chapter discusses the intrahepatic environment in cirrhosis and the series of events leading to progressive fibrosis and eventually distortion of hepatic lobular architecture. It is detected in about 50% of cirrhosis patients, and approximately 515% of cirrhosis patients show newly formed varices or. In order to ensure faster downloads and user safety, we have uploaded this. Hypertension is a cause of morbidity and mortality.
Selected topics and controversies related to esophageal varices are covered, including noninvasive diagnostic methods, bleeding prophylaxis in adults and children, rescue treatments, and the clinical dilemma of portal vein thrombosis. Pathophysiology of portal hypertension sciencedirect. Portal hypertension is a common clinical syndrome associated with chronic liver diseases and is characterized by a pathological increase in portal pressure. The introduction of new pharmacological agents, endoscopic variceal band ligation, and transjugular intrahepatic portosystemic stentshunt tipss has increased the therapeutic options available for this disorder. Pathophysiology and epidemiology of portal hypertension.
Portal hypertension commonly complicates cirrhosis, and variceal haemorrhage is its worst and most lifethreatening complication. Portal hypertension an overview sciencedirect topics. In this part of the article, you will be able to access the pathophysiology of disease 7th edition pdf almost instantly using our direct links mentioned at the end of this article. The effects are due to increase hydrostatic pressure and back up of blood flow which are unable to flow through the. Two theories on the pathophysiology of portal hypertension have been proposed.
Definition portal hypertension is defined as the elevation of the hepatic venous pressure gradient to 5 mmhg. Renal 5% parenchymal renovascular 0,3% corrected to normal by balloon treatment or surgery. Regional alterations in vasoreactivity vasodilation and vasoconstriction play a central role in the pathophysiology of portal hypertension by contributing to increased intrahepatic resistance. Clinically significant portal hypertension is present when gradient exceeds 10 mmhg. Portal hypertension is associated with changes in the. Apr 10, 20 pathophysiology of hypertension secondary hypertension h. Gi disease may be limited to the gi tract eg, reflux esophagitis, peptic ulcer, diverticular disease, be a manifestation of a systemic disorder eg, inflammatory bowel disease, or present as a systemic disease resulting from a primary gi pathologic process eg, vitamin deficiencies resulting from malabsorption. Pathophysiology of hypertension htn, high blood pressure. The study of intrahepatic portal hypertension is evolving to include platelet activation and thrombosis as crucial factors for its pathophysiology. Oct 05, 2010 effects of alcoholic liver disease, liver cirrhosis causes portal hypertension. Oct 23, 2012 changes in portal pressure are regulated by changes in hepatic vascular resistance, which is normally under neurohumoral control, and portal tributary blood flow.
Since the arteries and veins of the liver together with the portal veins plays a vital role in the. It follows that portal pressure may be increased by an increase in portal blood flow, an increase in vascular resistance, or a combination of both. Introduction as early as the 17th century, it was realized that structural changes in the portal circulation could cause gastrointestinal bleeding. Portal hypertension and variceal haemorrhage the lancet. May 14, 2019 portal hypertension often develops in the setting of cirrhosis, schistosomiasis, or extrahepatic portal vein thrombosis. An early view of vascular resistance in cirrhotic livers postulated that portal hypertension is the consequence of a vascular obliterative process, with scar tissue and regenerative nodules, occluding and compressing vascular structure. Portal hypertension often develops in the setting of cirrhosis, schistosomiasis, or extrahepatic portal vein thrombosis. In general practice, the level of blood pressure above which treatment of hypertension is indicated is now set at 14090 mm hg. Depending on the specific type, there are some variations in its pathophysiology. Portal hypertension is a major complication of liver disease, which results from a variety of pathological conditions that increase the resistance to the portal blood flow into the liver. This chapter discusses an overview of current knowledge of the circulatory derangements observed in portal hypertension. Gastrointestinal disease pathophysiology of disease. Portal hypertension is assumed to be present when a patient with chronic liver disease has collateral circulation, splenomegaly, ascites, or portosystemic encephalopathy.
Clinical consequences of cirrhosis include impaired hepatocyte function, the increased intrahepatic resistance of portal hypertension, and hepatocellular carcinoma. Pathophysiology of portal hypertension springerlink. Hypertension is a chronic condition in which there is high blood pressure. Pathophysiology of portal hypertension and esophageal varices. Portal hypertension is defined as a portal pressure of greater than 12mm hg or a hepatic venous wedge pressure that exceeds the pressure of the inferior vena cava by 5mm hg. The remaining 20% is supplied by the hepatic artery 3292018 3 4. Many of the most lethal complications of liver disease are directly related to the presence of portal hypertension, including ascites, portal systemic encephalopathy, and hemorrhage from gastroesophageal varices. Understanding the pathophysiology of portal hypertension could be of great utility in preventing and curing the complications of portal hypertension, such as esophageal varices, hepatic. Ppt pathophysiology of portal hypertension powerpoint. In 1902, gilbert and carnot introduced the term portal hypertension to describe this condition. Some recapitulation of general principles is essential to the understand ing of the pathophysiology of portal hypertension. Imaging, diagnosis, and endovascular management is the first volume in collaboration between thieme and the sir. A role for asymmetric dimethylarginine in the pathophysiology of portal hypertension in rats with biliary cirrhosis. Huether, msn, phd professor emeritus college of nursing university of utah salt lake city, utah kathryn l.
Pulmonary venous hypertensionmost common cause usually due to leftsided heart disease valvular, coronary or myocardial, obstruction to blood flow downstream from the pulmonary veins. Lectures by dr prathap bingi on the most important and useful topics in general medicine useful for the medical fraternity portal hypertension pathophysiology. They discuss the pathophysiology of portal hypertension as well as its clinical manifestations and management. Free download pathophysiology of hypertension powerpoint. Portal hypertension is defined as an increase in portal pressure above the normal range of 610 mmhg or, considering the gradient between portal and hepatic veins, as assessed by hepatic vein catheterization, above 5 mmhg. However, despite these advances, mortality remains high. Pathophysiology of hypertension secondary hypertension h. Cirrhosis is the most common cause of portal hypertension, but it can also be present in the absence of cirrhosis, a condition referred to as noncirrhotic portal hypertension. The portal hypertension of cirrhosis is caused by the disruption of hepatic sinusoids, leading to increased resistance in the portal venous system. Esophageal varices are the major complication of portal hypertension. It is now clear that an increased vascular resistance to portal blood flow is the initial factor responsible for the increase in portal pressure. Increased systemic vascular resistance, increased vascular stiffness, and increased vascular responsiveness to stimuli are central to the pathophysiology of hypertension. Mccance, msn, phd professor college of nursing university of utah salt lake city, utah section editors valentina l. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Current concepts on the pathophysiology of portal hypertension. Pathophysiology and treatment article pdf available in continuing education in anaesthesia critical care & pain 43 june 2004 with 15,577 reads how we measure reads. Pathophysiology molecular mechanism and classification dr. Gnanendra dm postgraduate trainee, dept of gastroenterology. P is the pressure gradient through a system, q is the flow in the system, and r is the resistance to that flow. The major therapeutic strategy of esophageal varices consists of primary prevention, treatment for bleeding varices, and secondary prevention, which are provided by. Clinical science of portal hypertensions is an indispensible resource for both beginning and experienced gastroenterological physicians, endoscopists, liver physicians, radiologists, gastroenterological surgeons, liver surgeons, etc. Portal hypertension is associated with both increased portal inflow and increased outflow resistance. Normal anatomy portal vein supplies 80% of the blood to the liver. Pathophysiology of cirrhosis and portal hypertension.
It is detected in about 50% of cirrhosis patients, and approximately 515% of cirrhosis patients show newly formed varices or worsening of varices each year. Experimental models have improved understanding of the pathophysiology of portal hypertension. The primary cause of portal hypertension in cirrhosis is an increase in intrahepatic vascular resistance due to. The primary cause of portal hypertension in cirrhosis is an increase. Pathophysiology of disease 7th edition pdf free download. The pathophysiology of hypertension is an area which attempts to explain mechanistically the causes of hypertension, which is a chronic disease characterized by. Increased vascular resistance is due to an increase in both intrahepatic and portocollateral resistance in comparison to the low resistance of the normal liver. Proof requires measurement of the hepatic venous pressure gradient, which approximates portal pressure, by a transjugular catheter. A mathematical representation of this relationship is found in a modification of ohms law. Portal hypertension 1st edition pdf free download ebook description previously published by the society for interventional radiology sir, this fully revised and updated third edition of portal hypertension. Hepatic blood flow dual blood supply hepatic artery 40% portal vein 60%. This website provides free medical books this website provides over 0 free medical books and more for all students and doctors this website the best choice for medical students during and after learning medicine.
Physiology and the availability of many drugs that can ef. Portal hypertension hepatic and biliary disorders merck. Elevated vascular resistance, inefficient decompression through the venous collaterals and continuous high inflow of splanchnic are all contributing factors to the pathogenesis of portal hypertension. Although direct measurement of portal pressure may provide accurate condition, an invasiveness of portal venous catheterization limits the clinical application.
Portal hypertension mechanisms pathophysiology by aryan. Portal hypertension i best hd video explanation ever. The uploader spent hisher valuable time to create this pathophysiology of hypertension powerpoint presentation slides, to share hisher useful content with the world. Portal hypertension is a term used to describe elevated pressures in the portal venous system a major vein that leads to the liver. The major therapeutic strategy of esophageal varices consists of primary prevention, treatment for bleeding varices, and secondary prevention, which are provided. Subsequently the complexity raises the possibility that undesired anomalies will develop. Portal hypertension is associated with increased resistance to portal blood flow.
Essential hypertension, a rise in blood pressure of undetermined cause, includes 90% of all hypertensive cases and is a highly important public health challenge that remains, however, a major modifiable cause of morbidity and mortality. Clinical investigation of portal hypertension katsutoshi. It is the result of resistance to portal blood flow and may lead to complications such as variceal bleeding and ascites. As early as the 17th century, it was realized that structural changes in the portal circulation could cause gastrointestinal bleeding. This video and other related imagesvideos in hd are available for instant download. If so, share your ppt presentation slides online with. The recent emergence of potent antiviral drugs and new algorithm of treatment for the management of complications due to portal hypertension have sensibly changed our perception of cirrhosis that can be now considered as a multistage liver disease whose mortality risk can be reduced by a tailored approach for any stage of risk. This is the reason why many disorders can occur and they can not be easily included in a single scheme.