This document summarizes portal hypertension, including its causes, pathophysiology, clinical presentation, diagnosis, and treatment. Portal hypertension is defined as increased pressure in the portal vein greater than 10 mmHg. It can be caused by conditions that obstruct portal blood flow within or outside the liver. Increased pressure leads to formation of collateral veins and complications like variceal bleeding, splenomegaly, and ascites. Diagnosis involves identifying the underlying liver disease and assessing its severity. Treatment aims to prevent variceal bleeding through medication, band ligation, shunt procedures, or TIPS.

1. Portal hypertension Wang Wei General Hospital of Tianjin Medical University

2. Introduction

5. Anatomy

10. Anatomy

15. Fig. 27-1 Etiologies of portal hypertension. These are divided into those associated with normal liver function (presinusoidal) and those associated with liver damage (sinusoidal).

22. pathophysiology of portal hypertension Fig.27.4 Stages in the development of portal hypertension.

30. CLINICAL PRESENTATION Fig. 27-5 Presenting features of portal hypertension.

39. Assessing of hepatic functional reserve It is the best method to predict operative outcome or assessing long-term prognosis in the unoperated patients , and remains the standard for the initial evaluation of patients. Advanced Minimal None Encephalopathy Moderate Slight None Ascites >6 4–6 1–3 PT time (increased seconds) <2.8 2.8–3.5 >3.5 Albumin (g/dL) >3 2–3 <2 Bilirubin (mg/dL) 3 2 1 No. of Points Factor

52. Nonselective shunts

53. TOTAL&PARTIAL PORTOSYSTEMIC SURGICAL SHUNTS Fig.27-15 Partial portosystemic shunt with an 8mm graft between the portal vein and inferior vena cava. Exposure is the same as for the total portacaval shunt. Fig. 27-14 Side-to-side portacaval shunt with direct vein-to-vein anastomosis. The portal vein is dissected from the right side, posterior to the bile duct. The intrahepatic vena cava is fully mobilised. If there is a larger caudate lobe, an interposition graft may be used.

54. SELECTIVE VARICEAL DECOMPRESSION Fig. 27-16 Distal splenorenal shunt, with anastomosis of the splenic to the left renal vein. The gastric fundus, esophagus and spleen are decompressed. Portal hypertension and prograde portal flow are maintained.

59. Fig. 27-13 TIPS. The metallic shunt maintains the transparenchymal track, which has been made through the liver between the portal and hepatic veins.

64. Management of massive hemorhage Fig.27-10 Treatment strategies for esophagastric varices.

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