Portal_Hypertension-1

Portal_Hypertension-1 - Portal Hypertension Portal Vic...

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Portal Hypertension Portal Hypertension Vic Vernenkar, D.O. St. Barnabas Hospital Bronx, NY
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Background Portal pressure gradient 12 mmHg or more Often associated with varices and ascites. Many conditions are associated with it, the most common being cirrhosis of the liver.
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Anatomy Portal vein drains blood from the small and large intestines, stomach, spleen, pancreas,and gallbladder. The superior mesenteric vein and splenic vein join behind the pancreas to form the portal vein . The portal trunk divides in to 2 lobar veins, the right drains the cystic vein, the left receives umbilical and paraumbilical veins that enlarge to form the caput medusae. The coronary vein drains the distal esophagus, which also enlarge in PT.
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Pathophysiology P=FR, where P is pressure gradient thru the portal system, F is the volumeof blood flowing thru the system, R is the resistance to flow. Changes in either F or R affect the pressure. In most types of portal hypertension, both flow and resistance are altered.
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Increase in Resistance Liver disease is responsible for a decrease in portal vascular radius, producing an increase in portal vascular resistance. In cirrhosis, the increase occurs at the microcirculation (sinusoidal). The resistance is also due to active myofibroblasts, vascular smooth muscle cells in the intrahepatic veins.
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Increase in Flow The increase in blood flow is caused by splanchnic arteriolar vasodilitation caused by release of endogenous vasodilators. The increased flow aggravates the increase in portal pressure and contributes to why PT exists despite the formation of portosystemic collaterals that divert as much as 80% of portal flow.
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Manifestations of Splanchnic Vasodilitation Increased cardiac output Arterial hypotension Hypovolemia The above explains rationale for treating patients with low sodium diet and diuretics to attenuate the hyperkinetic state
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Mortality/Morbidity Variceal hemorrhage most common complication 90% with cirrhosis develop varices. 30% of these bleed. The first episode is estimated to carry a mortality of 30-50%.
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History Directed towards determining the cause, the presence of complications of portal hypertension. Jaundice, transfusions, IVDA, pruritis,
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Portal_Hypertension-1 - Portal Hypertension Portal Vic...

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