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Printable Handouts
Navigable Slide Index
- Introduction
- Presentation thesis
- Regional circulatory regulation
- Normal liver function
- When the liver is sick
- Normal liver
- Cirrhotic liver
- Portal pressure (1)
- Portal pressure (2)
- Cirrhosis and portal pressure
- Initial circulatory effects of hypertension
- Effect of portal hypertension on regional circulation
- Effective plasma volume
- Effects on renal circulation
- The arteriolar vasodilation hypothesis in cirrhosis
- Cirrhosis and portal pressure
- The cardiac output at rest in Laennec's cirrhosis
- The hyperdynamic circulation
- Shunting of portal blood flow (1)
- Esophageal varices
- Ascites (liver sweat)
- Renal function and effective plasma volume
- Mortality after decompensation
- TIPS procedure
- Shunting of portal blood flow (2)
- MELD score as a predictor of death after TIPS
- Causes of death following TIPS
- Cardiac hemodynamics in alcoholic patients
- Cirrhotic cardiomyopathy
- Pulmonary hypertension
- Portopulmonary hypertension
- Causes of portopulmonary hypertension
- Portopulmonary hypertension - statistics
- Hepatopulmonary syndrome (1)
- Hepatopulmonary syndrome (2)
- Hepatopulmonary syndrome (3)
- Consequences of portal hypertension
- Orthotopic liver transplantation - the only remedy
- Thanks
Topics Covered
- Portal hypertension causes regional circulatory derangements that result in extra- and intra-vascular volume overload and organ dysfunction
- Vascular tone is mediated by autonomic input and chemical mediators many of which are released by local vascular endothelium
- Intrahepatic portal hypertension develops as a result of anatomic changes in the cirrhotic liver that cause sinusoidal narrowing and loss of compliance
- Reflex SMA vasoconstriction and portosystemic shunting up-regulate VEGF eNOS and iNOS with resultant vasodilation
- There is secondary: ADH secretion with retention of free water; renal salt retention; renal afferent arteriolar vasoconstriction
- Affected individuals develop progressive volume overload with associated afterload reduction and increases in cardiac output (hyperdynamic circulation)
- Fluid is forced off the surface of the liver and accumulates in the abdominal cavity as ascites
- Blood is shunted around the liver through latent venous connections that become varices
- Renal function is impaired (hepatorenal syndrome)
- Volume overload may cause secondary pulmonary hypertension
- Affected individuals may also develop primary pulmonary hypertension due to anatomic alterations of pulmonary microvasculature (porto-pulmonary hypertension)
- The ability of the heart to respond to stress is impaired
- Patients develop intrapulmonary shunts that cause hypoxemia (hepatopulmonary syndrome)
- The only real remedy for these problems is orthotopic liver transplantation
Links
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Talk Citation
Reinus, J. (2011, January 11). Portal hypertension [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 15, 2019, from https://hstalks.com/bs/1917/.Publication History
Financial Disclosures
- Prof. John Reinus has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.