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门静脉高压症 Portal Hypertension

门静脉高压症 Portal Hypertension. 门静脉高压症. What is portal hypertension?.

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门静脉高压症 Portal Hypertension

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  1. 门静脉高压症Portal Hypertension

  2. 门静脉高压症 What is portal hypertension? Portal hypertension is a pathologic state that the liver or associated structures obstruct portal blood flow and result in the portal vein system hypertension, which clinically presents as splenomegaly and hypersplenism, hematemesis and melena from esophageal and gastric varices rupture, and ascites.

  3. 门静脉高压症 ★Anatomy of portal vein system★Etiology★Pathophysiology★Clinical presentation★Diagnosis and differential diagnosis★Treatment

  4. 门静脉高压症-解剖（1） 门静脉系统解剖概要Anatomy of Portal Vein System 了解内容

  5. 门静脉高压症-解剖（2） ◆ The blood flow of splenic vein is 20-30% of that of portal vein ◆The portal vein system is between two capillary networks ◆No valves in portal vein system and the blood flow can be reversed

  6. 门静脉高压症-解剖（3） ◆Four ramus communicans between portal and systemic circulations

  7. 门静脉高压症-解剖（4） 1.胃冠状静脉、胃短静脉→胃底、食道下段交通支→奇静脉、半奇静脉→上腔静脉 胃底、食道下段交通支

  8. 门静脉高压症-解剖（5） 2.肠系膜下静脉、直肠上静脉→直肠下端肛管交通支→直肠下静脉 肛管静脉→下腔静脉 直肠下端肛管交通支

  9. 门静脉高压症-解剖（6） 3.脐旁静脉→前腹壁交通支→腹上深静脉→ 上腔静脉、 腹下深静脉→下腔静脉 前腹壁交通支

  10. 门静脉高压症-解剖（7） 4.肠系膜上、下静脉分支→腹膜后交通支→ 下腔静脉 腹膜后交通支

  11. 门静脉高压症-病因（1） 病 因Etiology 了解内容

  12. 门静脉高压症-病因（2） Portal hypertension should be divided into three types as its blood flow obstructed positions: •pre-hepatic type:•intra-hepatic type:•post-hepatic type:

  13. 门静脉高压症-病因（3） •pre-hepatic type:the portal vein trunk itself obstruction:■congenital deformityobliteration, stenosis■thrombosisinfection, trauma

  14. 门静脉高压症-病因（4） •post-hepatic type:hepatic veins or inferior vena cava in hepatic level obstruction included congenital deformity or thrombosis, calledBudd-Chiari syndrome 巴德-吉亚利综合症

  15. 门静脉高压症-病因（5） •intra-hepatic type:95%, a classification is pre-sinusoidal and post-sinusoidal obstructions by pathology

  16. 门静脉高压症-病因（6） • pre-sinusoidal obstruction:The main cause is schistosomial cirrhosisSchistosomial eggs deposit in small branches withperipheral granulation, resulting in obstructionof blood flow and increaseof portal vein pressure 血吸虫性

  17. 门静脉高压症-病因（7） •post-sinusoidal obstruction:The main cause is post-hepatitis cirrhosis(1)Fibroplasia and regeneration of hepatic cells compress the hepatic sinus, reducing in obstructed blood flow and increased portal vein pressure

  18. 门静脉高压症-病因（8） (2)The shunts between terminal hepatic arteries and portal veins open, and the hepatic arteries blood flow with high-pressure perfuse directly into low-pressured portal veins, which contributes to portal hypertension 肝动脉小分支 门静脉小分支

  19. 门静脉高压症-病因（9） (3)The high hepatic resistance can affect the hepatic lymphatic back-flow, which will further increase the portal pressure

  20. 门静脉高压症-病因（10）

  21. 门静脉高压症-病因（11）

  22. 门静脉高压症-病理生理（1） 病理生理Pathophysiology 熟悉内容

  23. 门静脉高压症-病理生理（2） The normal pressure of portal vein:13-24cmH2OPortal hypertension: 30-50cmH2O

  24. 门静脉高压症-病理生理（3） ★congestive splenomegaly★ramus communicans dilatation★ascites

  25. 门静脉高压症-病理生理（4） 1. congestive splenomegaly and hypersplenism:

  26. 门静脉高压症-病理生理（5）

  27. 门静脉高压症-病理生理（6）

  28. 门静脉高压症-病理生理（7） 2. ramus communicans dilatation:esophageal and gastric veins: varices rupture and gastrointestinal hemorrhageinferior rectal-anal veins: hemorrhoid and bleedinganterior abdominal wall veins: paraumbilical varices (caput medusae)numerous retroperitoneal veins: dilatation and congestion 最重要 但出血与门脉 压力不成比例！

  29. 门静脉高压症-病理生理（8）

  30. 门静脉高压症-病理生理（9）

  31. 门静脉高压症-病理生理（10）

  32. 门静脉高压症-病理生理（11）

  33. 门静脉高压症-病理生理（12）

  34. 门静脉高压症-病理生理（13）

  35. 门静脉高压症-病理生理（14）

  36. 门静脉高压症-病理生理（15） 3. ascites :disordered albumin synthesis anddecreased plasma colloid osmotic pressure caused by hepatocellular function damageincreased capillary filter pressuredue to increased portal hypertension The most important cause for ascites

  37. 门静脉高压症-病理生理（16） lymph liquid leakage into abdominal cavity from surface of the liver because of lymph back-flow obstructionsalt and water retention by aldosterone and antidiuretic hormones deactivation disturbance 醛固酮 问题：临床上如何治疗腹水？

  38. 门静脉高压症-病理生理（17） ★portal hypertensive gastropathy★hepatic or portosystemic encephylopathy

  39. 门静脉高压症-临床表现（1） 临床表现Clinical presentation 熟悉内容

  40. 门静脉高压症-临床表现（2） ☛splenomegaly and hypersplenism:☛hematemesis and melena☛ascites

  41. 门静脉高压症-临床表现（3）

  42. 门静脉高压症-临床表现（4）

  43. 门静脉高压症-临床表现（5）

  44. 门静脉高压症-临床表现（6）

  45. 门静脉高压症-临床表现（7）

  46. 门静脉高压症-诊断（1） 诊断和鉴别诊断Diagnosis and Differential Diagnosis 熟悉内容

  47. 门静脉高压症-诊断（2） Diagnosis▣medical history:hepatitis or schistosomiasis▣clinical presentation:splenomegaly and hypersplenism hematemesis and melena ascites▣investigations:

  48. 门静脉高压症-诊断（3） ◧blood routine examinations:WBC ↓ and Ptc ↓ ◨liver function tests:albumin↓, A/G ratio reversing, prothrombin time↑◩markers of hepatitis B or C:

  49. 门静脉高压症-诊断（4） Child’s classification of patient with liver diseaseChild’ grade A B Cserum bilirubin <34 35-51 >68(μmol/l)albumin (g/l) > 35 28-35 <28prothrombin 1-4 4-6 >6(s’ prolonged)SGPT <100 100-200 >200 <40 40-80 >80ascites absent slight moderateencephalopathy none none or minimal coma

  50. 门静脉高压症-诊断（5） ◪esophageal barium swallow:multiple irregular filling defects as “string of beads” or “earthworm”◧esophagealendoscopy:white, pink, red, cherry red varices

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