Portal HTN PDF

Portal HTN o Sinusoids and portal vein become compressed, push on the fluid inside o Pressure start to build up à Intrasinusoidal or portal HTN Ascites o High portal vein pressure à fluid in blood vessels pushed into tissues and across tissues into large open spaces (peritoneal cavity) à excess peri...

Portal HTN o Sinusoids and portal vein become compressed, push on the fluid inside o Pressure start to build up à Intrasinusoidal or portal HTN Ascites o High portal vein pressure à fluid in blood vessels pushed into tissues and across tissues into large open spaces (peritoneal cavity) à excess peritoneal fluid leads to ascites o Congestive splenomegaly: Enlarged spleen due to all fluid and blood backing up from liver to spleen Esophageal Varices o To alleviate the increased pressure within the portal vein o Blood seeks alternative pathways to return to the systemic circulation o Collateral vessels form, attempting to bypass the obstructed flow within the liver. Portosystemic Shunt o Circulatory system divert blood away from the liver due to high liver pressure o Blood follows the path of least resistance shunting away from portal to systemic circulation (towards the heart) Hepatorenal Failure o Changes in portal flow trigger renal vasoconstriction o Low kidney blood flow à reduced filtration à kidney failure followed by liver failure Hepatic Encephalopathy o Low/loss of liver function à less detoxification à Toxins accumulate and gets into the brain à mental deficit Asterixis (ammonia leak) o Ammonia leaks from liver into circulation, reaches brain leading to tremoring or jerky hands when outstretched o More toxins build up à Coma Decrease Estrogen Metabolism o Liver metabolizes estrogen into inactive metabolites, by removing from blood and excreted o Liver damage à increased estrogen in blood can cause: § Gynecomastia (hormonal imbalance from high estrogen) § Spider angiomata (cluster of blood vessels) § Palmar erythema Jaundice: Increase CB and UB (from dead hepatocytes) Hypoalbuminemia Increase Liver Enzymes: ALT, AST, GGT, ALP Bleeding: Less clotting factor production