Gate vein of the liver and its pathology

The portal vein of the liver( BB, portal vein) is a large trunk that receives blood from the spleen, intestineand stomach. Then it moves to the liver. The organ ensures the purification of blood, and it again enters the general course.

Portal portal system

Anatomic structure of the portal vein is complex. The trunk has a number of branches to the venules and other blood channels of different diameter. The portal system is another circle of blood flow, the purpose of which is to purify blood plasma from decay products and toxic components.

A number of diseases are reflected in the change in blood flow through the portal vein system

The changed sizes of the portal vein allow to diagnose certain pathologies. Its normal length is 6-8 cm and the diameter is no more than 1.5 cm.

Possible pathologies

The most common pathologies of the portal vein are:

• thrombosis;
• portal hypertension;
• cavernous transformation;
• is pylephlebitis.

Thrombosis BB

Thrombosis of the portal vein is a serious pathology, in which in its lumen formed blood clots that prevent its outflow after purification. In the absence of treatment, an increase in vascular pressure is diagnosed. As a result, portal hypertension develops.

The main reasons for the formation of pathology are usually:

• cirrhosis of the liver;
• malignant neoplasms of the gastrointestinal tract;
• Inflammation of the umbilical vein during the placement of catheters in infants;
• inflammation of the digestive system;
• trauma and surgery of the spleen, liver, gallbladder;
• bleeding disorder;
• infection.

To rare reasons for the development of thrombosis include: the period of gestation, prolonged intake of oral contraceptives. Symptoms of the disease are: severe pain syndrome, attacks of nausea, resulting in vomiting, dyspeptic disorders, fever, hemorrhoidal bleeding( sometimes).

For the progressive chronic form of thrombosis - with partial preservation of the portal vein - the following symptoms are typical: fluid accumulation in the abdominal cavity, enlarged spleen size, soreness / feeling of heaviness in the left hypochondrium region, widening of the esophagus, which increases the risk of bleeding.

Echogram - one of the methods used to study

The main way to diagnose thrombosis is to perform an ultrasound scan. On the monitor, the thrombus is defined as a hyperechoic( dense) formation, filling both the venous lumen and branches. Thrombi of small size are detected during endoscopic ultrasound. The methods of CT and MRI allow us to identify the exact causes of pathology and to identify associated pathologies.

Cavernous transformation

Pathology develops on the background of congenital malformations of vein formation - constriction, complete / partial absence. In this case, a cavernoma is found in the region of the portal vein. It is a set of small sosudikov, to a certain extent compensating for the circulatory disturbance of the portal system.

Cavernous transformation, revealed in childhood, is a sign of congenital disturbance of the structure of the vascular system of the liver. In adults, cavernous formation indicates the development of portal hypertension, provoked by hepatitis or cirrhosis.

Syndrome of portal hypertension

Portal hypertension is a pathological condition characterized by increased pressure in the portal system. It causes the formation of blood clots. The physiological norm of pressure in the portal vein is no higher than 10 mm Hg. Art. An increase in this indicator by 2 or more units is the reason for diagnosing portal hypertension.

Provoking pathology factors become:

• cirrhosis;
• thrombosis of hepatic veins;
• hepatitis of various origin;
• severe cardiac pathology;
• disturbances of metabolic processes;
• blood clots of splenic veins and portal vein.

The clinical picture of portal hypertension is as follows: dyspeptic symptoms;heaviness in the region of the left hypochondrium, jaundice, weight loss, general weakness.

A characteristic sign of the syndrome is an increase in the volume of the spleen. The cause is venous congestion. Blood can not leave the body due to a blockage of the venous spleen. In addition to splenomegaly, there is fluid accumulation in the abdominal cavity, as well as varicose veins of the lower part of the esophagus.

Ultrasound diagnosis allows to differentiate the pathology of

In the course of ultrasound examination, enlarged liver and spleen, fluid accumulation are revealed. The dimensions of the portal vein and blood flow are assessed using dopplerography. Portal hypertension is characterized by an increase in its diameter, as well as an enlargement of the superior mesenteric and splenic veins.

Pileflebitis

Among inflammatory processes, purulent inflammation of the portal vein - pylephlebitis - takes the leading place. The provoking factor is most often acute appendicitis. In the absence of treatment, necrosis of the liver tissue ends, resulting in the death of a person.

The disease does not have a characteristic symptomatology. The clinical picture is as follows:

• strong fever;chills;
• signs of poisoning;
• severe abdominal pain;
• internal hemorrhage in the region of the esophagus and / or stomach;
• jaundice caused by damage to the liver parenchyma.

Laboratory studies show an increase in white blood cell concentration, an increase in the rate of erythrocyte sedimentation. Such a shift in the indices indicates an acute purulent inflammation. Confirm the diagnosis is possible only with the help of ultrasound, MRI and CT.

Symptoms of portal vein pathologies and possible complications

The disease occurs in acute and chronic form, which affects the current symptoms. For the acute form, the following symptoms are typical: development of severe pain in the abdomen, fever to significant levels, fever, increased spleen volume, development of nausea, vomiting, diarrhea.

Symptomatic develops simultaneously, which leads to a severe deterioration of the general condition. The chronic course of the disease is dangerously complete absence of any symptomatology. The disease is diagnosed completely accidentally during a planned ultrasound examination.

In the absence of adequate therapy, the development of intestinal ischemia is possible, which is expressed in the death of its tissues as a result of occlusion of mesenteric vessels

Absence of pathological symptoms causes the start of compensatory mechanisms. To protect yourself from pain, nausea and other manifestations, the body starts the process of vasodilation - an increase in the diameter of the hepatic artery and the formation of a cavernoma.

As the condition worsens, the patient develops certain symptoms: weakness, loss of appetite. Portal portal hypertension is especially dangerous for a person. It is characterized by the development of ascites, an increase in subcutaneous veins located on the anterior abdominal wall, as well as varicose veins of the esophagus.

The chronic stage of thrombosis is characterized by inflammation of the portal vein. Symptoms of the condition may be:

• blunt incessant pain in the abdomen;
• long-holding subfebrile temperature;
• enlargement of the liver and spleen.

Diagnostic Measures

The basic diagnostic technique, which allows to detect changes in the portal vein, remains ultrasound. The study can be assigned to women in the situation, children and patients of advanced age. Doppler ultrasound, used in conjunction with ultrasound, helps to assess the speed and direction of blood flow. Normally, it should be directed towards the organ.

With the development of thrombosis in the lumen of the vessel, a hyperechoic( dense) heterogeneous formation is detected. It can fill both the entire lumen of the vessel, and overlap it only partially. In the first case, the movement of blood completely stops.

One of the most common liver vessel pathologies

With the development of the syndrome of portal hypertension, the widening of the vascular lumen is revealed. In addition, the medic reveals an enlarged liver, fluid accumulation. Dopplerography will show a decrease in blood flow velocity.

A cavernoma becomes a possible sign of portal hypertension. The patient is obliged to prescribe the conduct of the FGD with the purpose of assessing the condition of the esophagus anastomosis. In addition, esophagoscopy and roentgenology of the esophagus and stomach can be recommended.

In addition to an ultrasound examination, a computer tomography technique with a contrast agent can be used. The advantage of using CT is the visualization of the liver parenchyma, lymph nodes and other formations located in close proximity.

Angiography is the most accurate technique for diagnosing portal vein thrombosis. Instrumental research is complemented by blood testing. Clinical interest is represented by the parameters of leukocytes, hepatic enzymes, bilirubin.

Treatment of pathology

Treatment of the disease involves an integrated approach and includes the use of medications, surgery. Drug therapy includes the following methods:

• drugs from the anticoagulant group - prevents the formation of thrombi and improves the patency of vessels;
• thrombolytics - dissolve the existing thrombi, releasing the lumen of the portal vein.

Drugs are prescribed by the attending physician, based on the current symptomatology of

. In the absence of a therapeutic result from the selected drug therapy, a person is prescribed surgical treatment. Overhepatic angioplasty or thrombolysis may be performed.

The main complication of surgical treatment is bleeding of the esophagus and development of intestinal ischemia. Any pathology of the portal vein of the liver is a serious condition requiring an appointment adequate to the state of therapy.