Portal hypertension syndrome

Portal hypertension syndrome - a syndrome characterized by increased pressure in the portal vein pool, the natural extension of the rotary shaft portoka-anastomoses, ascites, splenomegaly. Distinguish form extrahepatic portal hypertension when the obstruction to blood flow is localized in hepatocellular departments of the portal vein (a-obstructive) or in vneorgannyh departments hepatic veins (B - suprarenal), intrahepatic (obstruction to blood flow is localized in the liver itself) and mixed forms of portal hypertension. There are also acute and chronic syndromes of portal hypertension.

The crux of the blood flow in the portal vein leads to an expansion of its anastomoses, while at the obstructive form of portal hypertension is mainly being established portoportalnye way of collateral circulation (bypassing the space constraints), and for domestic and suprarenal form - portocaval (from the portal vein in the lower and upper hollow ): there is varicose veins of the esophagus and stomach, hemorrhoidal plexus, the superficial veins dilate, diverging in different directions from the navel (Medusa head symptom). Due to the stagnation of blood, increasing the pressure in the portal vein, and hypoalbuminemia formed ascites, increased spleen.

Symptoms within. At an early stage asymptomatic, in more recent cases, characterized by the appearance of ascites, enlargement of hemorrhoids and subcutaneous umbilical veins (in the form of "Medusa head"), repeated occurrence of hemorrhoids or profuse esophageal-gastric bleeding; the latter often are the cause of death of patients.

Diagnosis (indirectly) confirmed by contrast radiography of the esophagus (found varicose veins it). More accurate is the measurement of the pressure in the esophageal veins (through esophagoscope), but more often carried splenomanometriya; portal hypertension pressure in the spleen (identical to that of the portal vein) increases from 300 to 600 70-150 mm water. Art. and more. Less for the same purpose carried transumbilikalnuyu portomano meter. Special radiographic techniques -splenoportografiya transumbilikalnaya portogepatografiya- and, where necessary, make it possible to specify the level and (presumably) the cause of violations of portal blood flow.

The course and prognosis are determined by the nature of the disease, caused by portal hypertension and associated complications, the most formidable of which is the esophageal-gastric bleeding. Rapid removal of a large amount of ascites and the appointment of high doses of diuretics, patients with chronic liver disease with portal hypertension syndrome can trigger the occurrence of hepatic coma. In the absence of surgical treatment of patients who have observed esophageal-gastric bleeding, live no more than 1-1.5 years.

Surgical treatment (often imposing portocaval or splenorenal anastomosis). In patients with portal hypertension contraindicated exercise.