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Mellss yr5 surgery portal hypertension intro
- 1. Nur Amalina Aminuddin 082012100067 Portal Hypertension
- 3. Types of circulation Systemic Aka greater circulation. RV LV Provide blood circulation to organs Pulmonary Aka lesser circulation LVRV Oxygenation of blood Portal
- 4. Portal circulation part of systemic circulation passes through two sets of capillaries before draining into a systemic vein. Portal vein Vein draining the first capillary network Efferent artery Artery draining the first capillary network Examples: Arterial portal system Hepatic portal circulation Hypothalamo hypophyseal portal circulation Venous portal system Renal portal circulation
- 8. Drains the deoxygenated blood from lower esophagus upper anal canal, pancreas, spleen, gall bladder Carries nutrient rich blood from intestines to liver Importance: First bypass effect Certain drugs become inactive after being metabolised by liver, hence route other than oral should be given eg. Nitroglycerin, midazolam Activation of prodrug Requires metabolism by liver to activate Eg.Dextometrophan, fospropanol
- 10. Drainage of portal circulation Inferior mesentric v splenic v Splenic v +superior mesentric v portal vein Direct into portal vein Left and right gastric v Posterior superior pancreatoduodenal v Portal vein banches into left and right portal vein cystic v drains directly into right portal vein Passed throught liver sinusoids into hepatic vein inferior vena cava
- 12. Portocaval anastomosis Anastomosis between hepatic portal circulation and systemic circulation Become dilated as reversal of flow occur in portal hypertension
- 13. Region Portal circulation Systemic circulation Esophageal Esophageal branch of left gastric vein Esophageal branches of Azygos vein Rectal Superior rectal vein Middle rectal veins and inferior rectal veins Paraumbilical Paraumbilical veins Superficial epigastric vein Retroperitoneal Splenic vein Renal vein, suprarenal vein, paravertebral vein, and gonadal vein Right colic vein, middle colic vein, left colic vein Retroperitoneal veins of Retzius Intrahepatic Perihepatic veins of Sappey Superior epigastric vein Left branch of portal vein Inferior vena cava
- 14. Tableegion Name of clinical condition Portal circulation Systemic circulation Esophageal Esophageal varices Esophageal branch of left gastric vein Esophageal branches of Azygos vein Rectal Rectal Varices Superior rectal vein Middle rectal veins and inferior rectal veins Paraumbilical Caput medusae Paraumbilical veins Superficial epigastric ve Retroperitoneal Splenorenal Shunt [2] Splenic vein Renal vein, suprarenal vein, paravertebral vein , and gonadal vein (no clinical name) [3] Right colic vein, middle colic vein, left colic vein Retroperitoneal veins of Intrahepatic Hepatic pseudolesions[4] Perihepatic veins of Sappey Superior epigastric vein Patent ductus venosus Left branch of portal vein Inferior vena cava
- 15. High Blood Flow ¼ Cardiac¼ Cardiac OutputOutput 1.5 L/min1.5 L/min ¼ Cardiac¼ Cardiac OutputOutput 1.5 L/min1.5 L/min HepaticHepatic ArteryArtery 1/3 Flow1/3 Flow 2/3 Oxy2/3 Oxy Portal VeinPortal Vein 2/3 Flow2/3 Flow 1/3 Oxy1/3 Oxy
- 18. Portal hypertension Elevation of the hepatic venous pressure gradient to >5 mmHg
- 19. Pathophysiology Increased resistance P= F X R Contraction of smooth muscle cells Scarring of parenchyma Decreased NO production
- 20. Increased portal blood flow from hyperdynamic circulation Caused by arterial vasodilation mediated by NO Lead to increased efflux of blood to portal system HEPATIC ARTERY BUFFER RESPONSE P= F X R
- 21. Portosystemic Shunt Rise in portal pressure Reversal of flow Dilated collateral vessel
- 23. Causes Classification Causes Prehepatic •Portal vein thrombosis •Splenic vein thrombosis •Massive splenomegaly Hepatic •Cirrhosis •Alcoholic hepatitis •Venoocclusive disorder •Congenital hepatic fibrosis Posthepatic •Budd Chiari syndrome •Inferior vena caval webs •Congestive cardiac failure
- 28. Reference Robbins and Cottran’s Pathological Basis of Disease, 8th edition,2010 Guyton and Hall’s Textbook of Medical Physiology, 12th edition, 2011 Harrison’s Principle of Internal Medicine, 19th edition, volume 2 , 2015. https://www.ncbi.nlm.nih.gov/books/NBK53067/h epatic Physiology and Pathophysiology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC30 12579/Regulation of hepatic blood flow,2010
Notes de l'éditeur
- current (I) equals the voltage difference (ΔV) divided by resistance (R). , the voltage difference is the pressure difference (ΔP; sometimes called driving pressure, perfusion pressure, or pressure gradient), the resistance is the resistance to flow (R) offered by the blood vessel and its interactions with the flowing blood, and the current is the blood flow (F).
- current (I) equals the voltage difference (ΔV) divided by resistance (R). , the voltage difference is the pressure difference (ΔP; sometimes called driving pressure, perfusion pressure, or pressure gradient), the resistance is the resistance to flow (R) offered by the blood vessel and its interactions with the flowing blood, and the current is the blood flow (F) . he velocity of the steady flow of a fluid through a narrow tube (as a blood vessel or a catheter) varies directly as the pressure and the fourth power of the radius of the tube and inversely as the length of the tube and the coefficient of viscosity.