Hipertensiуn Portal

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Hipertensión Portal

• Dr. Michel Baró A

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Hemorragia digestiva
Várices esofágicas
Hipertensión portal
Peritonitis bacteriana espontánea
ascitis
Insuficiencia renal
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Patogenia de la cirrosis hepática
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Patogenia de la HT portal Fístulas de Eck
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The portal venous system
Shunts

• the gastroesophageal junction
• the anal canal
• the falciform ligament
• the splenic venous bed and the left renal vein
• the retroperitoneum

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Measurement of portal hypertension
Flujo hepático 1350 mL/min (27 del gasto
cardíaco) Contenido sanguíneo hepático 450 mL
(función de reservorio)
Presión del sinusoide hepático y vena porta
WHVP FHVP (5 mmHg)
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Natural history of esophageal varices
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Endoscopic images of esophageal varices (A)
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Endoscopic images of esophageal varices (B)
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Large varices of stigmata of recent bleeding (A)
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Factors affecting risk of esophageal variceal
hemorrhage (A)
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Classification of gastric varices (C)
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Active hemorrhage from an esophageal varix
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Portal hypertensive gastropathy (B)
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Cardiovascular and renal physiology in
cirrhosis renal sodium and water retention
HT portal pre-hepática raramente da lugar al
desarrollo de ascitis
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Continuation of the cirrhotic process (A)
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Continuation of the cirrhotic process (B)
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The peripheral arterial vasodilatation hypothesis
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The importance of nitric oxide or
endothelial-derived relaxing factor as
vasodilator (A)
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The importance of nitric oxide or
endothelial-derived relaxing factor as
vasodilator (B)
Vasodilatación
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Hepatic dysfunction and sodium retention
Excreción Na urinario
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The role of cirrhotic cardiomyopathy
Hipertrofia Disfunción diastólica en
reposo Disfunción sistólica de stress
Retención de Na
Endotoxinas NO Ac. biliares
Tono simpático
Retención de Na
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Effector mechanisms of renal sodium retention in
cirrhosis
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Antinatriuretic and antidiuretic factors
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Natriuretic and diuretic factors
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Schematic representation of the hepatic
sinusoidal bed
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Schematic representation of sinusoidal portal
hypertension
900 mL/día máx
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Outline of stages of renal sodium retention
ANFatrial natriuretic factor PNEplasma
norepinephrine PRAplasma renin activity
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Patient with ascites
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Ascites-related hernia
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Umbilical hernia due to ascites
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Scrotal and penile edema
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Pleural effusion
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Chylous ascitic fluid
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Peritoneal carcinomatosis
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Cirrhotic patient with tense ascites
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Large complicated umbilical hernia
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Bulging of flanks
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Abdominal ultrasound
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Sampling of ascitic fluid
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Ascitic fluid analysis
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Differential diagnosis of ascites
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Sodium balance in cirrhosis with ascites
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Diuretic therapy
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Diuretics used in ascites
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Definition of refractory ascites
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The development of ascites in patients with
cirrhosis is associated with a poor prognosis (A)
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Survival of patients with progressive functional
renal failure (B)
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Pathogenesis of Spontaneous Bacterial Peritonitis
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Clinical features of spontaneous bacterial
peritonitis
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Gram stain of ascitic fluid (A)
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Gram stain of ascitic fluid (B)
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Organisms isolated in spontaneous bacterial
peritonitis
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Deterioration of renal function and the course of
spontaneous bacterial peritonitis
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Recurrence of spontaneous bacterial peritonitis
(A)
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Recurrence of spontaneous bacterial peritonitis
(B)
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Recurrence of spontaneous bacterial peritonitis
(C)
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Recurrence of spontaneous bacterial peritonitis
(D)
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Norfloxacin for reducing risk of spontaneous
bacterial peritonitis recurrence
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Prognosis