Portal Hypertension

00:01 Our topic of portal hypertension warrants its own discussion.

00:05 With portal hypertension understand that your circulation is moving from the GI or intestine towards the liver.

00:13 This portal vein will then enter your portal triad or porta hepatis.

00:17 And in zone one, you have one vein, the portal vein, you have one artery the hepatic artery, and a one duct called the bile duct.

00:24 Are we clear? You're moving from the intestine towards the liver.

00:29 You're moving from the liver, then towards the right atrium.

00:33 So, therefore, when we talk about portal hypertension, this is how clinically we categorize portal hypertension.

00:43 Pre-hepatic, post-hepatic, or in other words, post-sinusoidal.

00:51 Be very careful.

00:52 Do not confuse this with pre-hepatic, post-hepatic jaundice.

00:58 That you are terribly familiar with.

01:01 When you say pre-hepatic jaundice prototype, sickle cell disease.

01:06 Massive destruction of RBCs by the spleen, resulting in pre-hepatic jaundice.

01:13 Hepatic jaundice, mixed picture.

01:15 Post-hepatic jaundice, obstruction.

01:18 Example, choledocholithiasis or something like your primary sclerosing cholangitis.

01:24 Leave that separate. This is portal hypertension.

01:27 What's the right direction of your portal vein? From left to right.

01:31 And then from bottom to top.

01:33 Clear? So where is post-hepatic or post-sinusoidal, portal hypertension? Is it between the liver and the intestine? Or between the liver and the right atrium? The latter.

01:46 because moving in that direction towards the right atrium.

01:50 Take a look at your differentials now.

01:52 Post-hepatic includes IVC obstruction, in other words, inferior vena cava top of maybe thrombosis caused by what? Oh, any number of cases, such as maybe polycythemia vera, maybe paroxysmal nocturnal hemoglobinuria, or essential thrombocytosis.

02:11 I don't care what the cause of that excess platelet is, you may then cause obstruction in the inferior vena cava who gets damaged? Liver.

02:20 What zone? Zone 3.

02:22 What do you call that? Centrilobular congestion. Continue.

02:25 Eventually, it might then perish.

02:28 The liver might, resulting in post-hepatic portal hypertension.

02:34 Take a look at some of the other important differentials.

02:37 What's hepatic vein thrombosis called? Budd-Chiari.

02:41 Budd-Chiari.

02:42 Specifically about inaudible thrombosis.

02:44 Where are you? Post-hepatic.

02:48 Talking about hepatic.

02:50 This can be caused by anything causing distruction to hepatic venuels and endotherial cells.

02:56 So for example, veno-occlusion disease.

03:00 Post-sinusoidal was my topic for portal hypertension here.

03:05 If you're going to pre-hepatic.

03:07 Now you're between the intestine and the liver.

03:10 Take a look.

03:11 Pre-hepatic portal hypertension: Splenic or portal vein thrombosis.

03:17 Once again, anything that causes thrombosis such as polycythemia vera, such as PNH, such as essential thrombocythemia.

03:25 Then we have hepatic.

03:27 It could be schistosomiasis, sarcoidosis, and myeloproliferative disorders.

03:33 Now, usually when you think about portal hypertension, most of you will be thinking about, "Oh well, something caused damage to the liver." Resulting in cirrhosis. Sure.

03:42 And this is then referred to as being your hepatic portal hypertension, or sinusoidal.

03:47 At this point, you have learned three different types of portal hypertension.

03:53 Post-sinusoidal, aka, well, for the most for post-hepatic, but then you can have hepatic causes.

03:59 Pre-sinusoidal, pre-hepatic, and you can have hepatic causes of pre-sinusoidal portal hypertension.

04:07 Sinusoidal would mean within your sinus.

04:11 And you have cirrhosis, any cause that would be viruses, that would be alcohol, that would be would be NASH, autoimmune, so on and so forth, all the different causes of cirrhosis.

04:21 Portal hypertension, greater detail, there's absolutely no way that you would be missing any question because in your head, you have now divided portal hypertension into three different sectors.