外科-门静脉高压症.pptVIP

Chapter 51PORTAL HYPERTENSION Sections:1~6 ANATOMY, PHYSIOLOGY, AND PATHOPHYSIOLOGY OF PORTAL HYPERTENSION CLASSIFICASION OF PORTAL HYPERTENSION EVALUATION OF THE PATIENT WITH CIRRHOSIS COMPLICATION OF PORTAL HYPERTENSION VARICEAL HEMORRHAGE PORTOSYSTEMIC ENCEPHALOPATHY ASCITES Sections:1~6 ANATOMY, PHYSIOLOGY, AND PATHOPHYSIOLOGY OF PORTAL HYPERTENSION HISTORICAL REVIEW CLASSIFICASION OF PORTAL HYPERTENSION EVALUATION OF THE PATIENT WITH CIRRHOSIS COMPLICATION OF PORTAL HYPERTENSION VARICEAL HEMORRHAGE PORTOSYSTEMIC ENCEPHALOPATHY ASCITES Section 1: ANATOMY, PHYSIOLOGY, AND PATHOPHYSIOLOGY OF PORTAL HYPERTENSION ANATOMY: The liver is a unique organ in that it has a dual blood supply: portal vein and hepatic artery. The portal vein is formed from the confluence of the superior mesenteric and splenic veins The left gastric or coronary vein drains the distal esophagus and lesser curvature of the stomach, generally entering the portal vein near its origin. The splenic vein lies beneath the pancreas and is usually joined by the inferior mesenteric vein just before its confluence with the superior mesenteric vein. The hepatic artery, one of three major branches of the celiac artery (axis), lies medial to the common bile duct and portal vein in the hepatoduodenal ligament. Common variations include: origins of the right and left hepatic arteries from the superior mesenteric artery and of the left gastric artery ( both occur in nearly 20% of the population) PHYSIOLOGY: Hepatic blood flow averages 1500 ml/ m, which represents approximately 25% of the cardiac output. The portal vein contributes two thirds of the total hepatic blood flow, Hepatic arterial perfusion accounts for over one half of the livers oxygen supply. The volume of portal venous flow is indirectly regulated by vasoconstriction and vasodilation of the splanchnic arterial bed. In contrast, hepatic arterioles respond to circulating catecholamines and sympathetic nervous stimulation; t