Portal hypertension

Published on January 11, 2011 Reviewed on June 15, 2018   22 min

A selection of talks on Clinical Practice

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Hello, and welcome to this Henry Stewart Lecture on Portal Hypertension. My name is John Reinus, an I am chief of Clinical Hepatology at the Montefiore Medical Center in New York, and Professor of Clinical medicine at the Albert Einstein College of Medicine.
My thesis in this presentation is, that portal hypertension causes multiple regional circulatory derangements, that result in extra and intravascular volume overload and organ dysfunction. It is this volume overload and consequent organ dysfunction, that are responsible for the clinical signs and symptoms of portal hypertension, in affected individuals.
The circulatory system can be compared to the plumbing system of a large city. At various times, different parts of the city require a greater flow. And similarly at different times throughout the day, different parts of the body require greater circulation of blood. The circulatory system, therefore needs some form of regulatory control. And this is provided by the autonomic input from the central nervous system, in response to signals from a variety of receptors, including mechanoreceptors, osmoreceptors, chemoreceptors and thermoreceptors. In addition, regulation is provided by the endothelial release of a number of short acting chemical mediators, including nitric oxide, carbon monoxide, prostacyclin and endothelin.
The role of the liver is to act as a metabolically active filter within the circulation. Blood enters the liver from the splanchnic veins containing a variety of nutrients, as well as potential toxins. It is filtered, the nutrients are acted on by the liver cells. Toxins are removed, and then the blood is returned to the central circulation.