PORTAL

HYPERTENSION…
DR KSM BAPELA
LIVER ANATOMY

• Males weighs +/-1600

• Females +/- 1300
• 25% blood supply hepatic artery
• 75% portal vein
• Portal vein NB NB NB
.Portal hypertension is defned as the elevation of the hepatic venous
pressure gradient>5mmhg
.Clinically signifcant portal hypertension is present when pressure
exceeds 10mmhg

.Risk of variceal bleeding increases with pressures beyond 12mmhg

HOW IS PORTAL PRESSURE MEASURED???

• Hepatic venous pressure Gradient is the diference between the

wedged hepatic venous pressure and the free hepatic venous pressure

• Measurements are taken in the WHVP and FHVP positions by infating

and defating the balloon in the tip of the catheter, introduced through
the internal jugular or femoral vein
CLASSIFICATION…

• Pre hepatic
• Portal vein thrombosis
• Splenic vein thrombosis
• Massive splenomegaly
• Hepatic
• Presinusoidal
• Sinusoidal
• Post sinusoidal
• Post hepatic
• Budd-chiari syndrome
• IVC obstruction
PORTO-CAVAL ANASTOMOSIS
DIAGNOSIS
SPECIAL INVESTIGATIONS

For delineating morphological abnormalities in the liver

.CT scan : A coronary vein larger than 5-6mm in diameter
.Abdominal ultrasound : dilated portal vein 22mm in transverse
diameter
MANAGEMENT

• TIPS
• Portocaval shunt
THANK YOU………

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