Portal Hypertension Features, clinical picture & complications

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 .

  • Between the Liver (Portal ) and Diaphragm (systemic ).
  • Between the Spleen (Portal ) and Diaphragm or Kidney  (systemic ).
  • Between theDuodenum & Colon (Portal ) and Abdominal wall  (systemic ).

Complications of Portal Hypertension

  1. Variceal bleeding : Hematemesis , melena & Anemia .
  2. Congestive Gastropathy 
  3. Ascites 
  4. Hepatic Encephalopathy : due to passing of Toxins through porto-systemic shunts , so bypass detoxification in the liver .
  5. HyperSplenism with resulting Thrombocytopenia mainly .
Portal Hypertension Features, clinical picture  & complications
Dr.Tamer Mobarak


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