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Hipertensión Portal

Hipertensión Portal. Dr. Michel Baró A. Hemorragia digestiva. Várices esofágicas. Hipertensión portal. Peritonitis bacteriana espontánea. ascitis. Insuficiencia renal. Patogenia de la cirrosis hepática. Patogenia de la HT portal: Fístulas de Eck. The portal venous system. Shunts:.

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Hipertensión Portal

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  1. Hipertensión Portal Dr. Michel Baró A

  2. Hemorragia digestiva Várices esofágicas Hipertensión portal Peritonitis bacteriana espontánea ascitis Insuficiencia renal

  3. Patogenia de la cirrosis hepática

  4. Patogenia de la HT portal: Fístulas de Eck

  5. 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

  6. 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)

  7. Natural history of esophageal varices

  8. Endoscopic images of esophageal varices (A)

  9. Endoscopic images of esophageal varices (B)

  10. Large varices of stigmata of recent bleeding (A)

  11. Factors affecting risk of esophageal variceal hemorrhage (A)

  12. Classification of gastric varices (C)

  13. Active hemorrhage from an esophageal varix

  14. Portal hypertensive gastropathy (B)

  15. Cardiovascular and renal physiology in cirrhosis: renal sodium and water retention HT portal pre-hepática raramente da lugar al desarrollo de ascitis

  16. Continuation of the cirrhotic process (A)

  17. Continuation of the cirrhotic process (B)

  18. The peripheral arterial vasodilatation hypothesis

  19. The importance of nitric oxide or endothelial-derived relaxing factor as vasodilator (A)

  20. The importance of nitric oxide or endothelial-derived relaxing factor as vasodilator (B) Vasodilatación

  21. Hepatic dysfunction and sodium retention Excreción Na urinario

  22. 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

  23. Effector mechanisms of renal sodium retention in cirrhosis

  24. Antinatriuretic and antidiuretic factors

  25. Natriuretic and diuretic factors

  26. Schematic representation of the hepatic sinusoidal bed

  27. Schematic representation of sinusoidal portal hypertension 900 mL/día máx

  28. Outline of stages of renal sodium retention ANF—atrial natriuretic factor PNE—plasma norepinephrine PRA—plasma renin activity

  29. Patient with ascites

  30. Ascites-related hernia

  31. Umbilical hernia due to ascites

  32. Scrotal and penile edema

  33. Pleural effusion

  34. Chylous ascitic fluid

  35. Peritoneal carcinomatosis

  36. Cirrhotic patient with tense ascites

  37. Large complicated umbilical hernia

  38. Bulging of flanks

  39. Abdominal ultrasound

  40. Sampling of ascitic fluid

  41. Ascitic fluid analysis

  42. Differential diagnosis of ascites

  43. Sodium balance in cirrhosis with ascites

  44. Diuretic therapy

  45. Diuretics used in ascites

  46. Definition of refractory ascites

  47. The development of ascites in patients with cirrhosis is associated with a poor prognosis (A)

  48. Survival of patients with progressive functional renal failure (B)

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