Portal hypertension
Introduction
Introduction The normal portal pressure is 110-180 mm water column. Because of various reasons, the portal blood flow is blocked. When the blood stagnates, the portal pressure rises, and a series of symptoms and signs of portal pressure increase appear, called portal hypertension. Portal hypertension (PHT) is a common clinical syndrome. The pathophysiological effects of visceral and systemic hyperkinetic circulation affect almost all organs. Portal hypertension related diseases have also been recognized, such as portal hypertension. Gastrointestinal disease, functional hepatopulmonary syndrome, functional renal failure, etc.
Cause
Cause
The main causes of portal hypertension can be divided into intrahepatic and extrahepatic types.
Intrahepatic type: According to the pathological form, it can be divided into two types: anterior sinus occlusion and posterior sinus occlusion The common cause of anterior sinus obstruction is schistosomiasis cirrhosis. A common cause of post-sinus occlusion is cirrhosis after hepatitis.
Extrahepatic type: mainly the main thrombus formation of the extrahepatic portal vein, and the portal vein is mainly caused by obstruction of the branch. Portal hypertension is more common in middle-aged men and the disease progresses slowly. Symptoms and signs vary according to the etiology. The clinical manifestations are splenomegaly, hypersplenism, and then esophageal and gastric varices, hematemesis and melena and ascites and other symptoms and signs, but mainly splenomegaly, spleen function Hyperthyroidism, hematemesis and ascites.
(A) splenomegaly: most of the spleen combined with symptoms of hypersplenism, such as anemia, blood cells and thrombocytopenia. In general, the larger the spleen, the more pronounced the spleen function.
(B) Upper gastrointestinal bleeding: When the portal pressure is increased, the varicose veins of the fundus vein and the lower esophagus are made. Therefore, lower esophageal varices are an important manifestation of portal hypertension. Often bleeding due to ulcers, trauma. Because of liver function damage caused by coagulation dysfunction, bleeding is not easy to stop. The clinical manifestations include hematemesis and tar-like stools and other symptoms of upper gastrointestinal bleeding.
(3) Ascites: In the late stage of intrahepatic portal hypertension, the appearance of ascites is a manifestation of impaired liver function. In patients with ascites, the superficial veins of the abdominal wall tend to be more pronounced, sometimes accompanied by jaundice.
Examine
an examination
Related inspection
Liver dynamic blood pool imaging duodenal barium meal angiography liver disease ultrasound diagnosis of hepatobiliary dynamic imaging liver, gallbladder, pancreas, spleen MRI examination
Diagnostic points:
1. Medical history: Ask about whether there is hepatitis, schistosomiasis, long-term drinking, malnutrition, lower extremity edema and other medical history. Have no nose. Bleeding gums and upper gastrointestinal bleeding.
2. Physical examination: pay attention to whether there is liver palm, spider mites, jaundice, whether there is abdominal wall venous engorgement, whether the liver and spleen are swollen, the degree and hardness of swelling, whether the surface is smooth, and whether there is ascites.
3. Laboratory examination: check the three routine, platelet count, thrombin time, jaundice index, liver function, transaminase, serum white, globulin. When suspected of being a tumor, check for alkaline phosphatase (AKP). Alpha-fetoprotein (AFP). r-GT and so on.
4. X-ray examination: X-ray examination of the esophagus and gastric fundus with or without varicose veins. Renal venography should be performed for patients with spleno-renal venous anastomosis.
5. ECG examination, liver B-ultrasound or CT examination.
6. X-ray barium meal examination to exclude gastric varices, feasible fiberoptic examination.
Diagnosis
Differential diagnosis
Portal venous gas (PVG) refers to the imaging signs of abnormal accumulation of gas in the portal vein and its intrahepatic portal vein due to various reasons, usually diagnosed by abdominal X-ray film. Common in neonatal necrotizing enterocolitis. Neonatal necrotic enterocolitis is the main clinical manifestation of abdominal distension, vomiting and blood in the stool. The cystic gas in the intestinal wall is a serious disease characterized by X-ray.
Portal vein thrombosis (PVT) is the leading cause of extrahepatic portal hypertension. Thrombotic obstruction of portal vein is often secondary to chronic liver disease and tumor disease. Simple extrahepatic portal vein obstruction is more common in adolescents and children. The most prominent and most common symptom is hemorrhage of the esophagogastric varices. Acute onset patients have symptoms such as abdominal pain, vomiting, and bloating, but rarely cause liver infarction.
When hardened, the portal pressure increases. When the water exceeds 200 mm, the blood flow to the normal digestive organs and spleen is blocked by the liver, resulting in a portal-body collateral circulation between many parts of the portal system and the vena cava.
