pht

1. Hepatic portal
vein
&
portal
hypertension Submitted by: jyoti
 Group: 21
 Semester: 7th

2. How did…
…Devdas die?

3. Portal system
Portal circulation
The portal vein is a blood
vessel that carries all the
deoxygenated blood and
nutrients from GIT and spleen
to liver.

4. Hepatic Portal Vein
 Origin & end in capillaries / venous
sinusoids
 Size: 8cm X 1 cm
 Diameter 0.8 to 0.9
 Drains
 Abdominal part of alimentary tract
(except lower part of anal canal)
 Spleen & Pancreas
 Conveys absorbed products of
digested food to liver
 Devoid of valves
 Reservoir of blood : 1200 ml / min

5. Formation
 Union of Sup mesenteric & Splenic vein
 Between neck of Pancreas & IVC at level L2

6. Course: Extrahepatic part
 Passes upwards & Rt,
behind neck of pancreas &
1st part of duodenum
 Enters rt free margin of
lesser omentum in front of
epiploic foramen with BD &
HA
 Reaches porta hepatis &
divides into rt & Lt
branches.

7. Course: Intrahepatic part
 Branches of portal vein
 Segmental brs
 Brs in Portal canal
 Hepatic sinusoids
 Central veins
 Sublobular veins
 Hepatic veins
IVC

8. Tributaries

9. Tributaries Formative
 Sup Mesenteric vein
 Splenic vein
 Received by Trunk
 Rt & lt Gastric veins
 Superior PD vein
 Received by branches
 Cystic vein
 Paraumbilical veins
 Occasional
 Inf mesenteric
 Rt gastro-epiploic
 Pre-pyloric vein.

10. Branches
Rt Branch
 Shorter, wider
 Receives cystic vein
Lt branch
 Narrower, longer
 Runs in Porta hepatis
from Rt to Lt
 Brs to Caudate & Quadrate
lobe
 Receives Paraumbilical veins

11. Parts
3
1
2
• Infraduodenal
• Retroduodenal
• Supraduodenal

12.  Infra duodenal
 Ant: Neck of Pancreas
 Post: IVC
 Retro duodenal
 Ant: Duodenum (1st Part), Bile duct, GD artery
 Post: IVC
 Supra duodenal : In rt free margin of lesser omentum
 Ant : hepatic artery & bile duct
 Post: IVC
 Surrounded by Hepatic plexus of nerves, lymphatics & LN

13. Relations

14. Portocaval anastomosis
The portal venous
system have several
anastomosis with
systemic venous system.
In case of portal
hypertension these
anastomosis may
become engorged ,
dilated or rupture.

15. Site Caval Portal Effect in
PHT
Lower end of
esophagus
Esophageal
tributaries of
hemiazygos V
Oesophageal
tributaries of
Lt gastric V
Oesophageal
varices
Umbilicus Veins of AAW Paraumbilical
veins
(tributaries of
Lt br of Portal
V)
Caput
medusae
Lower end of
rectum &
Anal canal
Middle & inf
rectal Vs
Sup rectal V Anorectal
varices,
Internal
hemorrhoids

16. Site Caval Portal
Post abd wall • Lt renal V
• Veins of Post Abd
wall
• Splenic V
• Veins of
retroperitoneal
organs like
duodenum, Asc &
Desc colon
Bare area of liver Diaphragmatic veins Hepatic brs of Portal V
Liver Patent Ductus
venosus (rare)
Lt br of portal v
Post wall of vagina Vaginal venous plx Sup rectal v
Falciform lig Diaphragmatic v Paraumblical v

17.  > 12 mm of Hg
 Causes :
 Pre hepatic : Thrombosis of portal vein, congenital atresia
 Hepatic: Cirrhosis, hepatic fibrosis: wilsons disease, congenital fibrosis and
hemochromatosis.
 Post hepatic: liver to right side of heart. Hepatic vein thrombosis, IVC
thrombosis, congenital malformation of IVC, constrictive pericarditis.
 Effects: Splenomegaly, Ascites, Collateral
circulation through sites of Portasystemic
anastomosis
Portal hypertension

18. Signs and symptoms
 Ascites
 Splenomegaly
 Thrombocytopenia
 Hepatic encephalo[athy
 Anastmosis: esophageal varices (bleedings)
gastric varices
anorectal varices
caput medusa(around umbilicus)

19. Internal piles (Hemorrhoids)

20. Caput Medusae

21. Esophageal varices

22. MANAGEMENT
 HEMORRHAGES : selective beta blockers
 ASCITES: diuretics(spironolactone)
 Antibiotics:vancomycin
 TIPS PROCEDURE:
TRANSJUGULAR INTRAHEPATICPORTAL SYSTEMIC SHUNT
artificial channel within the liver establishing
communication between portal vein and hepatic vein