浙江大学医学院：门脉高压症（PPT讲稿）Portal hypertension

Portal Hypertension 门脉高压症 the First Affiliated Hospital, College of Medicine Zhejiang University 浙江大学医学院附属第一医院 Prof Zhang min MD 张珉

Portal Hypertension 门脉高压症 the First Affiliated Hospital, College of Medicine, Zhejiang University 浙江大学医学院附属第一医院 Prof. Zhang Min, MD 张 珉

What do we know about Portal Hypertension? Portal Hypertension arteriovenous shunting and/ esophageal or mechanical obstruction varices moderate anemia … neutropenia … thrombocytopenia caput marked medusae ascite Of course er failure and hemorrhoids its signs are often present as well

What do we know about Portal Hypertension?

Introduction of portal Hypertension As early as the 17th century, it was realized that structural changes in the portal circulation could cause gastrointestinal bleeding In 1902 gilbert and carnot introduced the term portal hypertension"to describe this condition Then, What's Portal Hypertension?

• As early as the 17th century, it was realized that structural changes in the portal circulation could cause gastrointestinal bleeding. • In 1902, Gilbert and Carnot introduced the term "portal hypertension" to describe this condition. Introduction of Portal Hypertension Then, What's Portal Hypertension?

Definition Portal hypertension is defined as a pressure >12 mmHg This increased pressure results from a functional obstruction to blood flow from any point in the portal system s origin(in the splanchnic bed )through the hepatic veins(exit into the systemic circulation)or from an increase in blood flow in the system

Definition • Portal hypertension is defined as a pressure > 12 mmHg. • This increased pressure results from a functional obstruction to blood flow from any point in the portal system's origin (in the splanchnic bed) through the hepatic veins (exit into the systemic circulation) or from an increase in blood flow in the system

Pathophysiology The normal pressure of portal vein 5-10mmHg(13-24cmH2O)

Pathophysiology • The normal pressure of portal vein: 5-10mmHg (13~24 cmH2O)

Anatomy of portal system Esophageal veins The portal vein LIver Short supplies 70% of the gastric veins blood flow to the liver portal veins Left, night gastric veins but only 40% of the Splenic vein Portal vein liver oxygen supply Gastro- The remainder of the Veins from epiploic vein pancreas blood comes from the duodenum Inferior mesenteric hepatic artery, and vein Veins from ascending Superior blood from both of colon mesenteric vein these vessels mixes in the sinusoids Veins from Veins from descending jejunum ileum sigmoid colon

Anatomy of Portal System The portal vein supplies 70% of the blood flow to the liver, but only 40% of the liver oxygen supply. The remainder of the blood comes from the hepatic artery, and blood from both of these vessels mixes in the sinusoids

Ducts and vessles of the liver Tow concept Glisson's sheath Lobule of the liver

Ducts and vessles of the liver Tow concepts: Glisson’s sheath Lobule of the liver

Sinus Central Portal triad Liver lobule

Liver lobule Portal triad Central v. Sinus

小叶间动脉 I nterlobular artery 小叶间静脉 Interlobular vein --小叶间胆管 Interlobular bile duct 中央静脉 Central vein 肝小叶 Hepatic lobule 肝小叶模式图 igr

Four ramus communicans between portal and systemic circulations esophageal and gastric veins anterior abdominal wall veins retroperitoneal venous plexus inferior rectal-anal veins

Four ramus communicans between portal and systemic circulations esophageal and gastric veins inferior rectal-anal veins anterior abdominal wall veins retroperitoneal venous plexus