Portal Hypertension occurs due to various causes (discussed) , and when it occurs , the body tries to compensate and decrease the portal pressure by opening of Porto-Systemic shunts leading to the formation of Varices at the following sites :
1. Oesophageal & Gastric varices
- They develop as anastomosis between Left & Short Gastric veins (Portal ) and Azygos vein (Systemic) .
-These Varices may rupture causing Haematemesis or Melena ,, and my cause bleeding per rectum in severe cases .
- In cases of mild , repeated bleeding in these varices , the patient develops Anemia .
- They may be Asymptomatic , but they have to be searched for by investigations in every case of liver cirrhosis in order to take prophylactic measures to prevent the first bleeding e.g Bandage .
2. Rectal Varices
-They develop as a result of anastomosis between Superior Haemorrhoidal vein (Portal ) and Middle & Inferior Haemorrhoidal veins (Systemic) .
- They have Low incidence of bleeding .
3. Recanalisation of the Para-Umbilical vein
-The Para-Umbilical vein is present in the round ligament of the liver .
- It connects the left Portal with the superior and inferior epigastric veins .
- Opening of this anastomosis will lead to development of Dilated veins radiating from the umbilicus which is called " Caput Medusa " and it will also cause a soft murmur to be heard between the umbilicus and Xiphisternum "Venous Hum " .
4. Other varices
- Detected by Ultrasonography or during operation .
a- Between the Liver (Portal ) and Diaphragm (systemic ).
b- Between the Spleen (Portal ) and Diaphragm or Kidney (systemic ).
c- Between theDuodenum & Colon (Portal ) and Abdominal wall (systemic ).
Complications of Portal Hypertension
1. Variceal bleeding : Hematemesis , melena & Anemia .
2. Congestive Gastropathy
4. Hepatic Encephalopathy : due to passing of Toxins through porto-systemic shunts , so bypass detoxification in the liver .
5. HyperSplenism with resulting Thrombocytopenia mainly .