Portal Hypertension

portal hypertension is

the elevation of blood pressure within the portal venous system

the common cause of portal hypertension

cirrhosis

portal hypertension can also result from

portal vein thrombosis, hepatic vein thrombosis, IVC thrombosis, or compression of the portal veins by a tumor in an adjacent organ

what results in portal hypertension

the pressure within the portal veins increasing

because the liver becomes so scarred with cirrhosis,

the blood flowing to the liver meets greater vascular resistance, resulting in portal hypertension or high blood pressure within the portal veins

portosystemic collaterals and varicosities can consequently

develop within the abdomen as a result of the body’s attempt to repair itself by channeling blood away from the damaged liver

examples of portosystemic collaterals that may result from portal hypertension

1. coronary vein

2. short gastric vein

3. gastrorenal pathway

4. splenorenal pathway

5. umbilical vein

6. anterior abdominal wall vein

7. superior mesenteric vein

a patent or recanalized paraumbilical vein is noted extended from the left lobe of this patient who is suffering from cirrhosis and portal hypertension

one of the most common sonographically identifiable collaterals in portal hypertension is

the recanalization of the paraumbilical vein, also termed a patent paraumbilical vein

the umbilical vein is associated with

the left portal vein, ligamentum teres, and falciform ligament

cruveilhier-baumgarten syndrome

when the umbilical vein becomes open again and shunts blood away from the liver and into the inferior epigastric veins or superior epigastric vein

recanalized paraumbilical vein is demonstrated extended from left portal vein toward the anterior abdominal wall in a patient with portal hypertension

in a patient with portal hypertension, splenic varices are noted adjacent to the spleen in area of the splenic hilum

abdominal varicosities may be noted

by the splenic hilum, renal hilum, and gastroesophageal junction

enlargement and — may be seen with portal hypertension

reversed flow within the coronary vein, also referred to as the left gastric vein

normal coronary vein can be seen arising

from the splenic vein and extending superiorly toward the left

with portal hypertension, the coronary vein will demonstrate

abnormal flow toward the esophagus and will measure greater than 6 mm

shunting of blood toward the esophagus increases the risk for

esophageal hemorrhage and death

enlarged coronary vein can be seen posterior to the left lobe in a patient with portal hypertension

with portal hypertension, along with hepatofugal flow, the portal vein diameter — and —

will exceed 13mm in the AP dimension and the superior mesenteric vein will exceed 10mm

hematemesis, if present, is an ominous sign of

ruptured esophageal varices because it is markedly increases mortality and morbidity

caput medusa

recognizable dilation of the superficial veins of the abdomen

surgically placed shunts include

portocaval shunt, splenorenal shunt, and mesocaval shunt

a common, minimally invasive interventional treatment for portal hypertension

transjugular intrahepatic portosystemic shunt (TIPS)

TIPS

placement of a stent between the portal veins and hepatic veins to shunt blood and reduce portal systemic pressure

if you suspect cirrhosis, be sure to closely analyze the — for evidence of recanalization of the paraumbilical vein

left portal vein

the recanalized paraumbilical vein will extend from

the left portal vein, continues through the left lobe, and may travel inferiorly toward the umbilicus

clinical findings of portal hypertension

1. abnormal liver function tests

2. ascites

3. diarhhea

4. fatigue

5. hepatomegaly (initially)

6. hepatic encephalopathy

7. caput medusa

8. tremors

9. gastrointestinal bleeding

sonographic findings of portal hypertension

1. hepatomegaly (initially)

2. shrunken right lobe of the liver

3. enlarged caudate lobe of the liver

4. nodular surface irregularity

5. coarse echotexture

6. splenomegaly

7. ascites

8. monophasic flow within the hepatic veins

9. hepatofugal flow within the portal veins

10. enlargement of the portal vein (diameter will exceed 13 mm in the AP)

11. enlargement of the SMV'

12. enlargement and reversed flow within the coronary vein

13. enlarged hepatic arteries

14. abdominal varicosities at the splenic hilum, renal hilum, and gastroesophageal junction