Daily treatment of some patients with portal hypertension, a very interesting phenomenon is that some of these patients do not know what is portal hypertension, remember can not remember, think also can not understand …… today I will give you a science, what is called “portal hypertension The actual “portal hypertension”. The name “portal hypertension” is a slightly abbreviated one, and its full name is “portal hypertension”. Literally, it can be understood as “hypertension” of the “portal vein”. The term “portal hypertension” means “a syndrome caused by increased pressure in the portal vein”. This makes it much easier to understand. First of all, we need to know what is “portal vein”? Second, we need to know what is the normal pressure in the portal vein? How high is the increased pressure inside the portal vein? Again, what are the “syndromes” caused by increased portal vein pressure? Once these questions are understood, the concept of portal hypertension is basically understood. Daily diagnosis and treatment of some patients with portal hypertension, a very interesting phenomenon is that some of these patients do not know what is portal hypertension, remember is not remember, think is not understand …… today I will give you a science, what is called “portal hypertension “The The portal vein system – Figure 1 The portal vein system – Figure 2 From the “portal vein system – Figure 1” we can see the labeling of each blood vessel, we see that the veins of the gastrointestinal tract eventually converge to the portal vein trunk of the liver, and the blood inside the portal vein flows from the portal vein trunk to the liver, then to the hepatic vein, and finally from the hepatic vein into the inferior vena cava, and then to the heart for distribution throughout the body. Then it flows to the heart and is distributed throughout the body. We can see that the portal trunk collects the return blood from the gastrointestinal tract, and the increased pressure in the portal trunk is called portal hypertension. What causes increased pressure in the portal vein? As we can see from the image of the portal system, anything that obstructs the flow of blood from the portal vein to the liver and inferior vena cava will result in obstructed blood return and increased portal pressure. As we can see from the diagram, if the blood flow is obstructed before the portal vein joins the liver, the resulting increase in portal pressure is called “prehepatic portal hypertension”. If there is a change in the liver that causes the portal blood flow to increase in pressure as it flows through the liver, such as cirrhosis, then this is called “hepatic portal hypertension”. If the portal blood flow is obstructed after it flows out of the liver, such as in the case of Buga syndrome, the result is increased portal pressure, which is called “post-hepatic portal hypertension”. Whether it is prehepatic, hepatic or posthepatic portal hypertension, the essence is that the return of blood to the portal vein is obstructed, resulting in increased pressure, the difference is that the site of obstruction of portal blood flow is different. What is the normal portal vein pressure? The normal portal vein pressure is 13-24 cmH2O, and we call it portal hypertension when the portal vein pressure is higher than this value range. So how do we know if our portal pressure is high? The most direct way is to measure the pressure inside the portal vein. However, in reality, it is difficult to measure the pressure inside the portal vein directly with an instrument, and it is an invasive operation with the risk of bleeding. That’s why we don’t routinely measure the pressure in the portal vein directly in clinical practice. We can measure the hepatic venous pressure gradient (HVPG) to reflect the magnitude of the portal vein pressure; the normal range of HVPG is 3-5 mmHg, but HVPG >5 mmHg is said to be an increase in portal vein pressure; HVPG is also an invasive operation, which requires a pressure tube to be passed through the jugular vein to the hepatic vein, which can cause some damage to the person. HVPG is not measured in routine examinations, but the width of the main trunk of the portal vein and the main trunk of the splenic vein is measured indirectly by ultrasound or CT to determine whether there is portal hypertension. If the width of the main trunk of the portal vein is >1.3 cm or the diameter of the splenic vein is >1.0 cm, we say that there is portal hypertension. Many patients clinically know that they have portal hypertension only through ultrasound. What are the “syndromes” of portal hypertension? Increased portal vein pressure can lead to a number of clinical symptoms, the most common of which are varicose veins formed by branches of the portal vein, such as esophagogastric fundic varices and abdominal wall varices. Shunt channels are formed between the portal vein and the vena cava, such as: splenorenal shunt, gastric renal shunt, etc. There is also splenomegaly hypersplenism, which shows a significant increase in the size of the spleen and a significant decrease in white blood cells and platelets. Some patients also exhibit intractable ascites. See “Portal Venous System – Figure 2” for an example of esophagogastric fundic varices and splenomegaly with hypersplenism.