Portal HTN PDF
Document Details
Uploaded by SuperiorAntigorite4686
LMU College of Dental Medicine
Tags
Summary
This document discusses portal hypertension, a condition where the portal vein becomes compressed, leading to pressure buildup. The text details the various complications, including ascites, esophageal varices, and hepatic encephalopathy, and the underlying mechanisms. It also mentions the role of estrogen metabolism in liver disease.
Full Transcript
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
