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Case40-years-oldfemalehepatitisBfortenyearsTarrystoolsspittingblood(hematemesis

)CasePE:ascitesabdominalwallvaricosisSplenomegalyBRT:WBC2×109/LPLT60×109/LWhatisthemostpossiblediagnosis?Whatreasoncancausehissymptomsandsigns?Howtotreatthispatient？QuestionsWhatislivercirrhosis?Whatisportalhypertension?Isthereanyconnectionbetweenthem?QuestionsNormalliverLivercirrhosisHepatitis↓LiverCirrhosis↓LiverCancerTrilogyLiverCirrhosis↓upperGastrointestinalhemorrhage↓DeathSurgery-PortalHypertensionPortalHypertensionDefinitionAnatomyPathophysiology&CausesClassificationsClinicalmanifestationDiagnosisTreamentPortalHypertensionaconditioninwhichthebloodpressureoftheportalvenoussystemistoohigh

Portalvenouspressurenormallyrangesfrom13to24cmH2O.portalpressureabove25cmH2ODefinitionDefinitionAnatomyPathophysiology&CausesClassificationsClinicalmanifestationDiagnosisTreamentPortalHypertensionAnatomy:extrahepticAnatomy:intrahapticAnatomy:DefinitionAnatomyPathophysiology&CausesClassificationsClinicalmanifestationDiagnosisTreamentPortalHypertensionP=F×RP:portalvenouspressureF:portalbloodflowR:resistancetoflowPathophysiologyⅠ.IncreasedResistancetoflowA.Prehepatic(portalveinobstruction)B.HepaticC.Posthepatic1.Congenitalatresiaorstenosis1.Cirrhosis1.Budd-Chiarisyndrome2.Thrombosisofportalvein2.Acutealcoholicliverdisease2.Constrictivepericarditis3.Thrombosisofsplenicvein3.Congenitalhepaticfibrosis4.Extrinsiccompression4.Idiopathicportalhypertension5.SchistosomiasisⅡ.IncreasedportalbloodFlowA.Arterial-portalvenousfistulaB.Increasedsplenicflow1.Banti’ssyndrome2.SplenomegalyCausesDefinitionAnatomyPathophysiology&CausesClassificationsClinicalmanifestationDiagnosisTreamentPortalHypertensionPrehepaticHepaticPosthepatic1.Congenitalatresiaorstenosis1.Cirrhosis1.Budd-Chiarisyndrome2.Thrombosisofportalvein2.Acutealcoholicliverdisease2.Constrictivepericarditis3.Thrombosisofsplenicvein3.Congenitalhepaticfibrosis4.Extrinsiccompression4.Idiopathicportalhypertension5.SchistosomiasisClassificationPresinusoidal:schistosomiasisSinusoidal:hepatitisBorCPostsinusoidal:alcoholicliverdisease

HepaticportalhypertensionPresinusoidal:schistosomiasisPresinusoidal:schistosomiasisSinusoidal:hepatitisBorCPostsinusoidal:alcoholicliverdiseasefattyliveralcoholichepatitisfibrosiscirrhosis

DefinitionAnatomyPathophysiology&CausesClassificationsClinicalmanifestationDiagnosisTreamentPortalHypertensionSplenomegalywithorwithouthypersplenismAscitesHematemesisandmelenaAbdominalwallvaricosisHepaticencephalopathyorhepaticcomaOthers:fatigue,somnolence,anorexia…Clinicalmanifestation1SplenomegalySplenomegalywithhypersplenism2Ascites3Abdominalwallvaricosis4Hematemesis5Hepaticencephalopathy

DefinitionAnatomyPathophysiology&CausesClassificationsClinicalmanifestationDiagnosisTreamentPortalHypertensionHepatitisBorCAlcoholismSchistosomiasisOthers1HistoryPalmarErythema(liverpalm)SpiderAngioma2PhysicalexaminationAbdominalwallvaricosis

Ascites2PhysicalexaminationWhitebloodcellcountPlateletcountRedbloodcellcountPositiveforhepatitisDisfunctionofliver3LaboratoryfindingsUltrasound

LivercirrhosisDiameterofportalvein≥1.0cm（normal0.6-1.0cm）Splenomegaly4Imagingexamination:BUSLiveratrophySplenomegalyAscites4Imagingexamination:CTComputedTomographyX-raybariummealexaminationNormalEsophagealvarices4Imagingexamination:XBMEsophagealvaricesNormalEsophagealandgastricvarices5GastroscopyDefinitionAnatomyPathophysiology&CausesClassificationsClinicalmanifestationDiagnosisTreamentPortalHypertensionPurpose:

Treatcomplications:esophagogastricvaricealhemorrhage,splenomegalywithhypersplenismorascites.Non-surgicaltreatmentSurgicaltreatmentTreatmentBloodtransfusionVasopressinSomatostatinBalloontamponadeEndoscopictreatmentNon-surgicaltreatmentBloodtransfusionVasopressinorterlipressinSomatostatinBalloontamponadeEndoscopicsclerotherapyEndoscopictreatmentShuntoperationTIPS(transjugularinterhepaticportosystemicshunt)DevascularizationoperationSurgicaltreatmentEstablishachannelbetweenportalveinsystemandvenacavasystem.Advantage:reducethepressureofportalveinsystem,stopbleeding,eliminateascitesDisadvantage:hepaticencephalopathyShuntoperationPortal-VenaShuntoperationPortal-VenaShuntoperationSplenic-RenalShuntoperationTransjugularInterhepaticPortosystemicShunt)TIPSTIPSBlockupthebloodchannelsbetweenportalveinandazygousveintostopbleeding.Advantage:stopbleeding,improveliverfunctionDisadvantage:increasethepressureofportalveinDevascularization

operationDevascularization

operationLivertransplantationThebesttreament:removethecauseofportalhypertension-----livercirrhosisAdvantage:achievelong-termsurvivalratesgenerallyabove70%.Disadvantage:expensive,thedonorshortageLivertransplantationPrehepaticportalhypertensionPancreatic,splenic,retroperitonealdiseaseeg:inflammation,tumour,deformity,trauma,etalOnlyspleenveinisobstructe

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