2012-9-27 Consequences of portal hypertension Ascites Overflow theory abdominal wall varices Ascites enin angiotension aldosterone system RAAS Kallikrein-kinin system, Adenosine onal synthesis of PGs(PGE2 ? Renal tubular RAAS, Angiotension ll 一ET ↑ Plasma re Consequences of portal hypertension Pathology of Liver Cirrhosis Splenomegaly Other Organs vein varices: mucosal edema and stasis hypersplenism: anemia, leukopenia, peptic ulcer formation thrombocytopenia glomerulonephritis(membranous, anti-glumerulat ne, mesangial proliferative ilation of spenic sinus; proliferation of splenic pulp dilation of spleen artery, varicosity of splenic vein lomerulosclerosis, kidney tubules degenerative endophlebitis atrophy and degeneration2012-9-27 8 abdominal wall varices Consequences of portal hypertension Ascites Theories of ascites formation • Underfilling theory • Overflow theory • Arterial vasodilation theory Ascites • Sodium retention --- Renin angiotension aldosterone system (RAAS) --- sympathetic nerve system , norepinephrine --- Intrarenal factors Kallikrein-kinin system, Adenosine • Water retention --- Antidiuretic hormone (ADH) --- Impaired renal synthesis of PGs (PGE2 ) • Renal vasoconstriction -- RAAS, Angiotension II -- SNS -- ADH -- ET Consequences of portal hypertension Splenomegaly  Splenomegaly hypersplenism: anemia, leukopenia, thrombocytopenia spleen：splenomegaly; congestion; blood stasis, dilation of spenic sinus; proliferation of splenic pulp; dilation of spleen artery; varicosity of splenic vein; endophlebitis Pathology of Liver Cirrhosis Other Organs  Gastrointestinal vein varices；mucosal edema and stasis； peptic ulcer formation  Renal： glomerulonephritis（membranous, anti-glumerular basement membrane, mesangial proliferative glomerulonephritis） Glomerulosclerosis, kidney tubules degenetative necrosis  Endocrine gland atrophy and degeneration