【正文】 n, which increases the pressure inside it. This condition is called portal hypertension. 1. Splenomegaly This splenomegaly is congestive One of the most mon findings with portal hypertension is splenomegaly, as seen here. The spleen is enlarged from the normal 300 grams or less to between 500 and 1000 gm. 1. Splenomegaly Hypersplenism Blood Decreased number of red blood cells (anemia) Decreased number of white blood cells (leukopenia) Decreased number of platelets (thrombocytopenia) A tendency to bleed (coagulopathy) 食管靜脈曲張 （ Oesophageal Varices ） 腹壁靜脈曲張 痔靜脈曲張 rectal hemorroid 臨床表現(xiàn) 失代償期 二、 門脈高壓 Collateral shunting The enlarged blood vessels, called varices, have thin walls and carry high pressure, and thus are more likely to burst. If they do burst, the result is a serious bleeding problem in the upper stomach or esophagus that requires immediate medical attention. Oesophageal varices. Normal oesophageal mucosa shows long, thin, evenly spaced lines. Varices show as filling defects in the regular contour of the oesophagus, with the corkscrew sign (arrow), most often in the lower third but the entire oesophagus may be involved. Hepatic cirrhosis is the monest cause of portal hypertension. Blood from gastrooesophageal collaterals reaches the superior vena cava system. Hypertension in the gastrooesophageal venous vessels lead to gastrooesophageal varices. Haemorrhages following varices rupture may be a slow ooze with melena or a sudden haematemesis. The mortality of bleeding varices is about 40% with each episode. Portal hypertension results from the abnormal blood flow pattern in liver created by cirrhosis. The increased pressure is transmitted to collateral venous channels. Sometimes these venous collaterals are dilated. Seen here is caput medusae which consists of dilated veins seen on the abdomen of a patient with cirrhosis of the liver. B. Distention of Abdominal wall vein C. Rectal hemorrhiod 二、 門脈高壓 (Ascitis)形成原因： 10mmHg plasma colloid osmotic pressure decrease Increased hepatic lymph(5 more) D. Arteriolar visodilatation:This stimulate reninangiotetion and antidureitc hormone Ascites and umbilical hernia. This patient with alcoholic cirrhosis presented with massive abdominal distension due to ascites. Other noteworthy features here include the umbilical hernia with a bluish tinge (almost certainly due to portosystemic collateral circulation) and profound musclewasting. 二、 門脈高壓 hepatic hydrothorax ：hepatopulmonary syndrome無肺部疾病、肺內(nèi)血管短路、 肺內(nèi)血管擴張 ,低氧血癥 /肺泡 動脈氧梯度增加 三聯(lián)癥 . Sumarry for portal hypertetion Portal hypertention: sac Collateral shunting or collateral circulation: ear Complications Bleeding esophageal varices(Variceal bleeding) Hepatic encephalopathy Abdominal fluid retention (ascites) and infection of the fluid (bacterial peritonitis) Liver cancer (hepatocellular carcinoma) Kidney failure (hepatorenal syndrome) Dilutional hyponatremia varices have thin walls and carry high pressure, and thus are more likely to burst. If they do burst, the result is a serious bleeding problem in the upper stomach or esophagus that requires immediate medical attention. Symptoms vomiting vomiting blood black, tarry stools decreased urine output symptoms of cirrhosis paleness lightheadedness 肝性腦病 Hepatic encephalopathy The liver of a person with cirrhosis also has trouble removing toxins, which may build up in the blood. These toxins can dull mental function and lead to personality changes and even a Early signs of toxin accumulation in the brain may include neglect of personal appearance, unresponsiveness, fetfulness, trouble concentrating, or changes in sleeping habits. Hepatorenal syndrome occurs when there is a decrease in kidney function in a person with a liver disorder. This is often exhibited by: Absent or low urine production, less than 400 cc/day Very low urine sodium concentration Low serum sodium Fluid retention in