PORTAL HYPERTENSION: Pathophysiology and Common Treatments
Aug 24, 2023
PORTAL HYPERTENSION: Pathophysiology and Common Treatments
An animated primer on the physiological causes and effects of portal hypertension, which is defined by increased hydrostatic pressure in the hepatic portal vein. The hepatic portal system routes blood from the digestive tract through the liver to protect our bodies from any potentially dangerous substances we consume. When this system is blocked, pressure builds in the hepatic portal vein, which can lead to varices, hepatic encephalopathy, splenomegaly, and ascites. Treatments focus on managing these effects via medication and non-surgical procedures. If portal hypertension is caused by end-stage liver disease, e.g. cirrhosis, a liver transplant may be required.https://www.cedars-sinai.org/health-l …https://www.mayoclinic.org/tests-proc …https://www.umcvc.org/health-library/ …https://www.cirse.org/patients/ir-pro …https://www.betheamedicalmedia.com https://www.instagram.com/betheamedic …
Content
0.24 -> the liver is the primary filter between
2.76 -> blood returning from the digestive tract
4.92 -> which can carry nutrients minerals amino
7.5 -> acids drugs and anything else we consume
9.9 -> and the systemic circulation
12.12 -> so what happens when this filter is
13.86 -> obstructed
16.12 -> [Music]
24.3 -> blood is supplied to the digestive
26.4 -> system from three branches of the
28.26 -> abdominal aorta the Celiac trunk and the
31.14 -> superior and inferior mesenteric
32.94 -> arteries various substances enter the
35.88 -> bloodstream through the GI epithelium
37.8 -> then from the lower esophagus to the
40.32 -> upper colon blood drains from the
42.18 -> digestive tract into the splenic gastric
44.46 -> and mesenteric veins all of which
46.68 -> combine to form a single hepatic portal
48.48 -> vein that goes to the liver
51.66 -> the functional unit of the liver is the
53.7 -> hepatic lobule
55.559 -> here blood flows from small branches of
58.079 -> the hepatic portal vein through
59.399 -> sinusoids lined with hepatocytes these
62.82 -> specialized cells detoxify blood as it
65.46 -> passes to the central vein in each
66.96 -> lobule before returning to systemic
69.06 -> circulation via the hepatic vein
72.9 -> portal hypertension refers to increased
75.299 -> hydrostatic pressure in the hepatic
77.1 -> portal vein and is typically caused by
79.439 -> changes within the liver itself
81.72 -> these changes may include blood clots
83.759 -> tumors and parasitic infections
86.46 -> but in Western countries cirrhosis is
88.86 -> the condition most commonly associated
90.9 -> with portal hypertension
92.88 -> cirrhosis refers to widespread scarring
95.1 -> of the liver and can be caused by
96.9 -> long-term alcohol abuse viruses such as
99.36 -> hepatitis C and B certain drugs Advanced
102.78 -> fatty liver disease or excess iron
104.46 -> intake
106.38 -> around a liter of blood flows into the
108.72 -> liver from the portal vein every minute
111 -> as pressure increases blood flow is
113.46 -> rerouted to areas of anastomosis between
115.799 -> the systemic and portal circulatory
117.6 -> systems which can lead to varices or
120.72 -> distended vessels that can easily
122.46 -> rupture and cause excessive bleeding
125.219 -> varices occur most often at the lower
127.38 -> esophagus rectum and umbilicus
131.58 -> without the detoxifying effects of the
133.92 -> liver blood that circulates back to the
136.08 -> body contains nitrogenous waste products
138.42 -> primarily ammonia
140.459 -> these substances pass into the brain
142.62 -> resulting in hepatic encephalopathy
145.2 -> alter Consciousness changes in mood and
147.72 -> personality mobility issues and in some
150.42 -> cases coma
152.52 -> portal hypertension also causes
154.319 -> increased pressure in the splenic vein
156.06 -> while not as likely to rupture this
158.34 -> backup causes splenomegaly leading to a
160.44 -> reduction in blood components including
162.18 -> red blood cells which causes anemia
164.7 -> white blood cells leading to increased
166.68 -> risk of infection and platelets which
169.2 -> can exacerbate any bleeding
172.2 -> The increased pressure in hepatic
174.42 -> sinusoids and the splanchonic bed also
176.76 -> leads to ascites or excess fluid in the
179.4 -> peritoneal cavity
181.92 -> treatments for portal hypertension vary
183.959 -> depending on the underlying cause some
186.36 -> conditions such as schistosomiasis can
188.94 -> be cured with drugs while others like
190.92 -> cirrhosis are indicative of end-stage
192.959 -> liver disease and require a liver
194.58 -> transplant
196.44 -> more often the goal of therapy is to
198.9 -> manage the sequelae the effects of
201 -> portal hypertension
203.459 -> varices can be treated endoscopically
205.5 -> either by banding or injection of a
207.659 -> sclerosing agent
209.7 -> hepatic encephalopathy is treated
211.5 -> pharmaceutically by lactulose which
213.659 -> draws ammonia into the large intestine
215.7 -> so that it can be excreted and stool
218.819 -> ascites is managed by dietary
220.799 -> restrictions and medications and severe
223.08 -> cases can be treated with paracentesis
224.819 -> the drainage of excess fluid using a
227.22 -> sterile needle inserted into the
229.019 -> peritoneal cavity
231.42 -> beta blockers are used to increase
233.099 -> vasoconstriction in the gut thus
235.26 -> reducing expansionic bed outflow and
237.54 -> decreasing pressure in the portal vein
240.84 -> for severe portal hypertension a
243 -> transjugular intrahepatic portal
245.22 -> systemic shunt or TIPS procedure can
247.86 -> relieve pressure
249.42 -> this procedure involves forming a mesh
251.7 -> and forced Channel within the liver to
253.5 -> allow blood to return to the systemic
255.36 -> circulation via the hepatic vein as with
258.299 -> the other collateral Pathways blood that
260.22 -> hasn't been filtered by the liver can
261.9 -> carry ammonia and other toxins and
264 -> hepatic encephalopathy is a significant
266.22 -> post-treatment risk
268.919 -> in short the hepatic portal system
271.139 -> routes blood from the digestive tract
273.419 -> through the liver to protect our bodies
275.04 -> from any dangerous substances that may
276.96 -> be absorbed by the intestines
279.419 -> increase pressure in the portal vein can
281.639 -> lead to life-threatening varices hepatic
283.979 -> encephalopathy splenomegaly and ascites
286.919 -> various medical interventions can help
289.139 -> manage these symptoms and a shunt can
291 -> relieve pressure in the portal vein but
292.8 -> for certain underlying conditions like
294.3 -> cirrhosis a liver transplant is the only
296.759 -> long-term treatment for portal
298.32 -> hypertension underscoring the importance
300.66 -> of addressing lifestyle choices that may
302.759 -> lead to severe and irreversible liver
304.86 -> damage
313.51 -> [Music]
Source: https://www.youtube.com/watch?v=9SKDalgzwlo
