Portal Hypertension

by Carlo Raj, MD

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    00:01 Our topic of Portal Hypertension warrants its own discussion.

    00:06 With Portal Hypertension understand that your circulation is moving from the GI or intestine towards the liver.

    00:13 This Portal vein will then enter your Portal triad or Portal Hepatis.

    00:18 And in zone 1, you have one vein, the Portal vein, you have one artery, the hepatic artery. And one duct called the bile duct.

    00:24 Are we clear? In moving from, intestine towards the liver, you're moving from the liver then towards the right atrium.

    00:33 So, therefore, when you talk about portal hypertension, this is how clinically, we categorize portal hypertension.

    00:43 Pre-hepatic, Post-hepatic, or in other words, post sinusoidal.

    00:51 Be very careful.

    00:52 Do not confuse this with pre-hepatic, post-hepatic jaundice.

    00:59 That you're terribly familiar with.

    01:01 when you say pre-hepatic jaundice, prototype, sickle cell disease.

    01:06 massive destructions of RBCs by the spleen resulting in Pre-hepatic jaundice.

    01:13 Hepatic Jaundice.

    01:14 Mixed picture.

    01:16 Post-hepatic jaundice, obstruction.

    01:18 Example, called, choledocholelithiasis.

    01:20 or something like your Primary sclerosing cholangitis.

    01:24 Leave that separate.

    01:26 This is Portal Hypertension.

    01:27 What's the right direction of your Portal vein? From left to right and then from bottom to top. Clear? So where is Post-hepatic, or post sinusoidal? Portal Hypertension? Is it between the liver and the intestine or between the liver and the right atrium? The latter.

    01:46 Because you're moving in that direction, towards the right atrium.

    01:50 Take a look at your differentials now.

    01:53 Post-hepatic includes IVC obstruction.

    01:57 In other words, Inferior Vena Caval Thrombosis, caused by what? Any number of cases such as, maybe *, maybe post * or essential thrombocytosis I don't care what the cause of that excess platelet is, you may then cause obstruction in the Inferior Vena Cava.

    02:17 Who gets damaged? Liver.

    02:20 What zone? Zone 3.

    02:23 What do you call that? Central ovular conjestion.

    02:25 Continue.

    02:26 Eventually, it might impersish the liver might.

    02:31 resulting in post-hepatic portal hypertension.

    02:34 Take a look at some of the other important differentials.

    02:38 What is hepatic veiin thrombosis called? Budd-Chiari Budd-Chiari is specifically hepatic vein thrombosis, where are you? post hepatic.

    02:48 Talk about hepatic.

    02:50 Well, anything, that causes damage. So, for example, vena-occlusion disease.

    02:57 post sinusoidal is my topic for portal hypertension here.

    03:03 Pre-sinuoidal.

    03:05 So, what does pre-sinusoidal mean to you? Now, you are in between the intestine and the liver.

    03:11 Take a look.

    03:11 pre-hepatic portal hypertension.

    03:14 spleenic or portal vein thrombosis Once again, anything that causes thrombosis.

    03:20 Such as, such as polisitemia vera such as PNH.

    03:25 such as essential thrombocytemia.

    03:28 then we have hepatic.

    03:30 Hepatic is a long list.

    03:33 or pre sinusoidal.

    03:34 It could be Schistosomiasis sarcoidosis and myeloproliferative disorders.

    03:42 Sinusoidal.

    03:44 This is your prototype.

    03:45 Now, usually you won't think about portal hypertension.

    03:47 most of you, will be thinking about, oh well, Something caused damaged to the liver resulting in cirrhosis.

    03:53 sure.

    03:54 And this is then referred to being your hepatic portal hypertension.

    03:58 or sinusoidal.

    04:00 At this point, you have learned three different types of portal hypertension.

    04:05 post sinusoidal.

    04:07 Aka, well, what I mean is post hepatic but then you can have hepatic causes.

    04:12 pre-sinusoidal prehepatic and you can have hepatic causes of presinusoidal portal hypertension.

    04:19 Sinusoidal New Entry 155 sinuses.

    04:23 and yes cirrhosis any cause.

    04:26 Let it be viruses let it be alcholol, let it be NASH, autoimmune.

    04:30 So and so forth, all the different causes.

    04:32 of cirrhosis.

    04:34 portal hypertension.

    04:36 greater detail.

    04:37 There is absolutely no way that you will be missing any question because in your head, you have now divided portal hypertension into three different sectors.

    About the Lecture

    The lecture Portal Hypertension by Carlo Raj, MD is from the course Cirrhosis – Liver Diseases.

    Included Quiz Questions

    1. Portal vein thrombosis
    2. Hepatic vein obstruction
    3. Thrombus close to the right atrium in the inferior vena cava
    4. Tumor compressing the hepatic vein
    5. Hepatic vein thrombosis
    1. Cirrhosis
    2. Portal vein thrombosis
    3. Hepatic artery obstruction by tumor
    4. Inferior vena cava obstruction
    5. Splenic vein thrombosis
    1. Zone 3
    2. Zone 1
    3. Zone 2
    4. Portal triad
    5. Central vein

    Author of lecture Portal Hypertension

     Carlo Raj, MD

    Carlo Raj, MD

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    How do we treat this?
    By Hamed S. on 15. March 2017 for Portal Hypertension

    Good way of classifying the causes but missed out on defining the pressure (>5 mmHg) and potential treatment options such as propranolol, TIPS etc.... Also what about the potential complications, which would have been perfect to discuss here ie variceal bleeds