Blood supply to the liver

The portal vein of the liver (BB, portal vein) is a large trunk into which blood flows from the spleen, intestines, and stomach. Then it moves to the liver. The organ provides the cleansing of the blood, and it again goes into the general channel.

The anatomical structure of the portal vein is complex. The trunk has many branches to venules and other blood channels of various diameters. 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 changes in blood flow through the portal vein system.

The changed dimensions of the portal vein allow you to diagnose certain pathologies. Its normal length is 6–8 cm, and its diameter is not more than 1,5 cm.

Most often, the following portal vein pathologies are found:

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

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BB thrombosis

The portal vein thrombosis is a severe pathology, in which blood clots form in its lumen, preventing its outflow after cleansing. If untreated, an increase in vascular pressure is diagnosed. As a result, portal hypertension develops.

The main reasons for the formation of pathology are usually attributed to:

  • cirrhosis of the liver;
  • gastrointestinal cancers;
  • inflammation of the umbilical vein during catheter placement in infants;
  • digestive system inflammation;
  • injuries and surgery of the spleen, liver, gall bladder;
  • impaired blood clotting;
  • infection.

Rare causes of thrombosis include: gestational period, prolonged use of oral contraceptives. Symptoms of the disease are: severe pain, nausea attacks ending with vomiting, dyspeptic disorders, fever, hemorrhoidal bleeding (sometimes).

The following symptoms are typical for a progressive chronic form of thrombosis, with partial preservation of the portal vein patency: fluid accumulation in the abdominal cavity, enlarged spleen, pain/heaviness in the left hypochondrium, expansion of the esophagus veins, which increases the risk of bleeding.

An echogram is one of the research methods used.

The main way to diagnose thrombosis is an ultrasound scan. On the monitor, a blood clot is defined as a hyperechoic (dense) formation that fills both the venous lumen and branches. Small blood clots are detected during endoscopic ultrasound. CT and MRI techniques can identify the exact causes of the pathology and identify associated pathologies.

Pathology develops against the background of congenital malformations of the veins – narrowing, complete/partial absence. In this case, a cavernoma is found in the portal vein trunk region. It represents a lot of small vessels, to some extent compensating for the violation of the blood circulation of the portal system.

Cavernous transformation detected 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.

Portal hypertension is a pathological condition characterized by an increase in pressure in the portal system. Becomes the cause of blood clots. The physiological norm of pressure in the portal vein is not higher than 10 mm Hg. Art. Increasing this indicator by 2 or more units becomes the reason for the diagnosis of portal hypertension.

The blood supply system of the abdominal organs is quite complicated. This is due to a number of functions that are performed by the digestive tract organs and their high sensitivity to the absence of blood – ischemia. The large abundance of blood vessels that supply the intestines and stomach is associated with a number of factors:

  1. Intestinal motility requires a constant influx of nutrients and oxygen to ensure adequate muscle contraction.
  2. The absorption of proteins, fats and carbohydrates, as well as water, occurs through the intestinal wall precisely into the system of veins of the intestine and the lymphatic vessels passing nearby.

The portal vein is a large vessel that collects blood from all unpaired abdominal organs (such as the duodenum 12, small and large intestines, stomach and spleen), lies in the thickness of the hepatoduodenal ligament and carries blood directly to the liver.

Due to this anatomical structure, this vessel collects blood, which is absorbed in different parts of the gastrointestinal tract, and brings it to the liver, which allows you to cleanse human blood of toxins and other unwanted metabolites that enter the human body with food and water. Thus, blood from the digestive tract can not get into the general bloodstream, bypassing the main filter of the body – the liver.

In Latin, which body researchers and doctors use for anatomical terms, the portal vein is called vena portae. From this term comes the name of a number of pathological processes characteristic of this vessel – portal hypertension, portal thrombosis, portal cirrhosis, etc.

Actually, the portal vein is anatomically arranged quite simply – it is a thick vascular trunk that enters the liver. Such a vein has a very thick wall with a developed adventitious (connective tissue) layer, which allows it to withstand a number of pathologies to withstand pressure several times higher than the norm for such vessels.

When studying the anatomy of the vessel, the study of pathological processes, etc., the portal vein is not considered in isolation, but they say that there is a portal vein system.

At the level of the pancreatic head, the portal vein receives two powerful vascular trunks – the superior and inferior mesenteric veins, which carry blood from the intestines, as well as the splenic vein.

Portal vein system

Further, the left and right gastric venous trunks flow into the vessel, almost at the level of its entry into the liver gate. In the liver, the vessel breaks up into small branches that surround structural units such as liver lobules, forms the central vessels of the lobule, which then carry the blood purified by the liver into the lower vena cava and the right sections of the human heart.

The development of such anastomoses looks like an increase in the vasculature of the anterior abdominal wall (“jellyfish head”), hemorrhoidal nodes with the corresponding clinical picture.

Therefore, pathologies such as portal vein thrombosis, gastrointestinal tract tumors, heart failure, and all the causes that lead to cirrhosis of the liver should be diagnosed in a timely manner, all measures taken to prevent the development of portal hypertension and, as a result, a number of complications that lead to death.

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Gate (portal) vein of the liver is the norm and violations. Common diseases. Methods for detecting pathologies and methods for their treatment.

The name of this vein comes from the word “gate”. It combines blood from the digestive tract and delivers it to the liver. There, the blood is purified and returned to the bloodstream.

I was probably one of those “lucky ones” who had to survive almost all the symptoms of a sick liver. For me it was possible to compile a description of the diseases in all details and with all the nuances!

In order to verify the importance of the liver, experiments were conducted on animals to remove it. Death occurred within a few hours after that. So the detoxification function of the liver was finally proven. And the organ provides the portal (vein) portal vein with work.

The portal vein (v. Portae) begins with the capillary network of unpaired organs located in the abdominal cavity of mammals:

  • intestines (more precisely – the mesentery, from which two branches of the mesenteric veins – the lower and the upper one);
  • spleen;
  • stomach;
  • the gallbladder.

The allocation for these organs of a separate venous system is due to the absorption processes occurring in them. The substances that enter the gastrointestinal tract are broken down into constituents (for example, proteins – into amino acids).

But there are substances that are little transformed into the digestive tract. These are, for example, simple carbohydrates, inorganic chemical compounds. Yes, and during the digestion of proteins there is waste – nitrogenous bases.

All this is absorbed in the capillary network of the intestines and stomach.

Regarding the spleen, its second name is the red blood cell cemetery. Worn red blood cells are destroyed in the spleen, while releasing toxic bilirubin.

5464884486 - Blood supply to the liver

In fact, the portal vein is formed by the accession of two rather large mesenteric veins to the splenic vein. The upper and lower mesenteric veins that collect blood from the intestines accompanying the arteries of the same name provide the portal vein with blood from the intestines (with the exception of the distal parts of the rectum).

The site of venae portae formation is most often located between the posterior surface of the pancreatic head and the parietal sheet of the peritoneum. It turns out a vessel with a length of 2-8 cm and a diameter of 1,5-2 cm. Then it passes through the thickness of the hepatic-duodenal ligament until it flows into the organ in the same bundle with the hepatic artery.

  • portal vein – the leading vessel, which is formed from the splenic and superior mesenteric veins;
  • hepatic veins – a system of discharge paths.
  1. Thrombosis (extra- and intrahepatic);
  2. Portal hypertension syndrome (LNG) associated with liver disease;
  3. Cavernous transformation;
  4. Purulent inflammatory process.
  • The stomach.
  • The front wall of the abdomen and veins located near the navel.
  • Esophagus.
  • The veins of the rectum.
  • Inferior vena cava.
  • portal vein – the leading vessel, which is formed from the splenic and superior mesenteric veins;
  • hepatic veins – a system of discharge paths.

Portal vein anastomoses

Between the sheets of the pancreatoduodenal ligament, the gastric, para umbilical, and prepiloric veins flow into the BB. In this area, BB is located behind the hepatic artery and common bile duct, together with which it follows to the gate of the liver.

At the gates of the liver, or not reaching one and a half centimeters, there is a division into the right and left branches of the portal vein, which enter both hepatic lobes and there break up into smaller venous vessels. Reaching the hepatic lobule, venules braid it from the outside, enter inside, and after the blood is neutralized by contact with hepatocytes, it enters the central veins leaving the center of each lobule. The central veins collect into larger ones and form the hepatic, carrying blood from the liver and flowing into.

Changing the size of the explosive is of great diagnostic value and can talk about various pathologies – cirrhosis, venous thrombosis, pathology of the spleen and pancreas, etc. The length of the portal vein of the liver is normally about 6-8 cm, and the lumen diameter is up to one and a half centimeters.

The portal vein system does not exist in isolation from other vascular pools.
Nature provides for the possibility of dumping “excess” blood into other veins if there is a violation of hemodynamics in this department. It is clear that the possibilities of such a discharge are limited and cannot last indefinitely, but they make it possible to at least partially compensate for a patient with severe diseases of the hepatic parenchyma or thrombosis of the vein itself, although sometimes they themselves become the cause of dangerous conditions (bleeding).

The connection between the portal vein and other venous collectors of the body is due to anastomoses
, the localization of which is well known to surgeons who quite often face acute bleeding from anastomosing zones.

miogennaya regulyaciya pecheni - Blood supply to the liver

Anastomoses of the portal and vena cava are not expressed in a healthy body, since they do not bear any load. In pathology, when the flow of blood into the liver is difficult, the portal vein expands, the pressure builds up in it, and the blood is forced to look for other outflow pathways, which the anastomoses become.

These anastomoses are called portocaval, that is, the blood that was supposed to go to the BB goes into the vena cava through other vessels that combine both pools of blood flow.

The most significant portal vein anastomoses include:

  • The connection of the gastric and esophageal veins;
  • Anastomoses between the veins of the rectum;
  • Anastomosis of the veins of the anterior abdominal wall;
  • Anastomoses between the veins of the digestive system with the veins of the retroperitoneal space.

In the clinic, anastomosis between the gastric and esophageal vessels is of greatest importance. If the blood flow along the explosive is impaired, it is expanded, portal hypertension builds up, then the blood rushes into the flowing vessels – the gastric veins. The latter have a system of collaterals with esophagus, where venous blood that does not go to the liver is redirected.

Since the possibilities of discharging blood into the vena cava through the esophagus are limited, overloading them with excess volume leads to varicose expansion with the possibility of bleeding, often deadly. The longitudinally located veins of the lower and middle third of the esophagus do not have the ability to subside, but are at risk of injury when eating, gag reflex, and reflux from the stomach. Bleeding from varicose veins of the esophagus and the initial part of the stomach is not uncommon in cirrhosis.

From the rectum, venous outflow occurs both into the BB system (upper third) and directly into the lower hollow, bypassing the liver. With increasing pressure in the portal system, stagnation in the veins of the upper part of the organ will inevitably develop, from where it is discharged through collaterals into the middle vein of the rectum. Clinically, this is expressed in varicose hemorrhoids – hemorrhoids develop.

The third junction of the two venous pools is the abdominal wall, where the veins of the umbilical region take on the “excess” of blood and expand towards the periphery. Figuratively, this phenomenon is called the “head of the jellyfish” because of some external resemblance to the head of the mythical Medusa of the Gorgon, who had wriggling snakes instead of hair on her head.

Anastomoses between the veins of the retroperitoneal space and BB are not as pronounced as described above, it is impossible to trace them by external signs, they are not prone to bleeding.

  • Cirrhosis of the liver;
  • Malignant tumors of the intestine;
  • Inflammation of the umbilical vein during catheterization in infants;
  • Inflammatory processes in the digestive organs – cholecystitis, pancreatitis, intestinal ulcers, colitis, etc .;
  • Injuries surgical interventions (bypass surgery, removal of the spleen, gall bladder, liver transplant);
  • Blood coagulation disorders, including with some neoplasias (polycythemia, pancreatic cancer);
  • Some infections (tuberculosis of portal lymph nodes, cytomegalovirus inflammation).

Among the very rare causes of TBV are pregnancy and prolonged use of oral contraceptives, especially if a woman has crossed the 35–40-year-old limit.

Symptoms of TVB
consists of severe abdominal pain, nausea, dyspeptic disorders, vomiting. Perhaps an increase in body temperature, bleeding from hemorrhoids.

Chronic progressive thrombosis, when blood circulation in the vessel is partially preserved, will be accompanied by an increase in the typical picture of LNG – fluid will accumulate in the stomach, the spleen will increase, giving a characteristic severity or pain in the left hypochondrium, the esophagus veins will expand with a high risk of dangerous bleeding.

The main way to diagnose TBV is by ultrasound, while a thrombus in the portal vein looks like a dense (hyperechoic) formation, filling both the lumen of the vein and its branches. If the ultrasound is supplemented with dopplerometry, then the blood flow in the affected area will be absent. Cavernous degeneration of blood vessels due to the expansion of small-sized veins is also considered characteristic.

Small thrombi of the portal system can be detected by endoscopic ultrasound, and CT and MRI make it possible to determine the exact causes and find the likely complications of thrombosis.

The liver plays a major role in metabolism. The ability to perform its functions, in particular neutralization, directly depends on how the blood flows through it.

The peculiarity of the blood supply to the liver, unlike other internal organs, is that in addition to arterial, oxygenated, it receives venous blood rich in valuable substances.

The structural unit of the liver is a lobule, which has the shape of a faceted prism, in which hepatocytes are located in rows. A vascular triad of interlobular vein, artery and bile duct approaches each lobule, they are also accompanied by lymphatic vessels. In blood supply lobules secrete 3 channels:

  1. Influx to lobules.
  2. Circulation inside the lobules.
  3. Outflow from hepatic lobules.
  • stomach;
  • anterior abdominal wall;
  • the esophagus;
  • intestines;
  • inferior vena cava.

Normally, the hepatic vein, formed by the left branch of the portal vein, flows at the same level as the right, only on the left side. Its diameter is 0,5-1 cm.

The diameter of the vein of the caudate lobe in a healthy person is 0,3-0,4 cm. Its mouth is slightly lower than the place where the left vein flows into the inferior vena cava.

As you can see, the sizes of the hepatic veins differ from each other.

The right and left, passing in the liver, collect blood from the right and left hepatic lobes, respectively. Middle and caudate lobe vein – from the same lobes.

The portal system functions specifically. The reason for this is its complex structure. Many branches to the venules and other bloodstream channels leave the main trunk of the portal vein. That is why the portal system, in fact, constitutes another additional circle of blood circulation. It performs the purification of blood plasma from harmful substances such as decay products and toxic components.

The portal vein system is formed by combining large trunks of veins near the liver. From the intestines, the superior mesenteric and inferior mesenteric veins carry blood. The splenic vessel leaves the organ of the same name and receives blood from the pancreas and stomach. These large veins, merging, become the basis of the crow’s vein system.

Near the entrance to the liver, the vessel trunk, separating into branches (left and right), diverges between the lobes of the liver. In turn, the hepatic veins are divided into venules. A network of small veins covers all parts of the organ inside and out. After the contact of blood and soft tissue cells occurs, these veins will carry blood to the central vessels that exit from the middle of each lobe. After this, the central venous vessels are combined into larger ones, from which the hepatic veins are formed.

  1. Protein S or C. Deficiency
  2. Antiphospholipid syndrome.
  3. Changes in the body associated with pregnancy.
  4. Long-term use of oral contraceptives.
  5. Inflammatory processes occurring in the intestines.
  6. Connective tissue diseases.
  7. Various peritoneal injuries.
  8. The presence of infections – amoebiasis, hydatid cysts, syphilis, tuberculosis, etc.
  9. Tumor invasion of the veins of the liver – carcinoma or renal cell carcinoma.
  10. Hematologic diseases – polycythemia, paroxysmal nocturnal hemoglobinuria.
  11. Hereditary predisposition and congenital malformations of the hepatic veins.

The development of Budd-Chiari syndrome usually lasts from a few weeks to months. Against this background, cirrhosis and portal hypertension often develop.

For Budd-Chiari syndrome, a clear clinical picture is characteristic. This greatly facilitates the diagnosis. If the patient has an enlarged liver and spleen, there are signs of fluids in the peritoneal cavity, and laboratory tests indicate overestimated blood coagulation, first of all, the doctor begins to suspect the development of thrombosis. However, he must carefully study the patient’s history.

In addition to the fact that the doctor studies the medical history and conducts a physical examination, the patient must donate blood for general and biochemical analysis, as well as for coagulation. It is still necessary to pass a liver test.

Symptoms

Since the gates of the liver are deep in the body, it will not work to see the lymph nodes. Therefore, consider a list of symptoms that should alert you. We recommend that you contact a specialist as soon as possible if the following symptoms occur, since lymphadenopathy can spread quickly throughout the body, and you need to be examined as soon as possible:

  • fever;
  • excessive sweating, especially at night;
  • feeling of febrile chills;
  • pain and discomfort in the liver;
  • when feeling, it is felt that the organ is enlarged;
  • unrelated to diets or sports activities weight loss.

The lymph nodes of the liver gates are connected by other nodes and form, in essence, a single system, a group

In the event that unilateral hepatic obstruction has developed, no special symptoms are observed. directly depends on the stage of development of the disease, the place in which the thrombus formed, and the complications that arose.

Often, Budd-Chiari syndrome is characterized by a chronic form, which is not accompanied by symptoms for a long time. Sometimes signs of hepatic thrombosis can be detected by palpation. The disease itself is diagnosed solely as a result of an instrumental study.

Chronic blockage is characterized by symptoms such as:

  • Light pain in the right hypochondrium.
  • Sensation of nausea, sometimes accompanied by vomiting.
  • Change in skin color – yellowing is manifested.
  • Sclera of the eyes turn yellow.

The presence of jaundice is not necessary. In some patients, it may be absent.

Symptoms of acute blockage are more pronounced. These include:

  • Suddenly begun vomiting, in which blood gradually begins to appear as a result of a rupture in the esophagus.
  • Severe pains that are epigastric in nature.
  • A progressive accumulation of free fluids in the peritoneal cavity, which occurs due to venous stasis.
  • Acute pain throughout the abdomen.
  • Diarrhea.

In addition to these symptoms, the disease accompanies an enlargement of the spleen and liver. For acute and subacute forms of the disease, liver failure is characteristic. There is also a fulminant form of thrombosis. It is extremely rare and dangerous in that all the symptoms develop very quickly, leading to irreparable consequences.

The portal portal vein system of the liver – anatomy, diagnosis of pathologies and treatment

The lymph nodes of the liver gates are connected by other nodes and form, in essence, a single system, group. Therefore, problems in the liver part of the gate affect other nodes, they can also begin to increase, become inflamed and suppurate. Therefore, doctors pay close attention to other lymph nodes.

Existing diagnostic methods:

  • palpation (palpation) of all lymph nodes to them the identification of enlarged;
  • checking tonsils, whether they are enlarged or not;
  • biopsy of the contents of the node (not the most pleasant, but necessary procedure, during which biological material is taken from the lymph node);
  • Ultrasound of the lymphatic system;
  • computed tomography of the abdominal and thoracic cavities;
  • sometimes an x-ray of the bone apparatus;
  • biochemical and clinical blood analysis;
  • analysis of human immunodeficiency virus (HIV) infection.

The most effective treatment for this type of oncology remains surgery. Operation by methods of shunting or stenting of ducts. Stenting is a surgical procedure in which a special metal or plastic frame, a stent, is introduced into the lumen of the bile duct.

Thanks to this intervention, the patient immediately experiences an improvement in his condition – the natural outflow of bile is normalized, important trace elements in the body are preserved, and the gastrointestinal tract is restored. Many patients, instantly feeling improvement, believe that they completely got rid of the disease. However, this is not so, alas, the disease persists, and you must still carefully monitor your health.

The portal vein is formed when three others merge: the superior and inferior mesenteric, splenic veins. It performs the most important functions for the digestive system, and also plays one of the main roles in the blood supply to the liver and detoxification. Left unattended pathology of the vessel lead to serious consequences for the body.

The portal vein system is a separate circle of blood circulation in which toxins and harmful metabolites are removed from the plasma. That is, it is part of the very main filter in the human body. Without this system, toxic components would enter the heart through the inferior vena cava and spread throughout the circulatory system.

The portal vein is incorrectly called the “collar vein”. The name is derived from the word “gate”, not “collar”.

Vessel anatomy

When the liver tissue is affected due to illness, there is no additional filter for blood coming from the digestive system. This creates the conditions for intoxication of the body.

Most human organs are arranged so that arteries supplying them with nutritious blood are suitable for them, and veins with used blood come from them. The liver is otherwise arranged. It includes both artery and vein. From the main vein, blood is distributed through the small liver vessels, thereby creating venous blood flow.

Massive venous trunks are involved in the creation of the portal system. The vessels are connected near the liver. The mesenteric veins carry blood from the intestines. The splenic vein comes from the spleen. It combines the veins of the stomach and pancreas. Trunks connect behind the pancreas. This is the starting point of the portal circulatory system.

hepar 2 3 - Blood supply to the liver

If the normal size of the portal vein is changed, this gives reason to talk about the course of the pathology. It can be expanded with thrombosis, cirrhosis, and disturbances in the functioning of the digestive organs. The norm of length is 6-8 cm, the diameter of the lumen is 1,5 cm.

The portal vein system interacts closely with other vascular systems. If a hemodynamic pathology occurs, human anatomy provides for the possibility of distributing “excess” blood to other veins.

The body uses this ability for severe liver diseases, the inability of the body to fully perform its functions. However, thrombosis can cause dangerous internal bleeding.

The portal vein is involved in a number of pathological conditions, including:

  • Extrahepatic and intrahepatic thrombosis;
  • Portal hypertension;
  • Inflammation;
  • Cavernous transformation.

Each of the pathologies in a certain way affects the state of the main vessel and the body as a whole.

Thrombosis

Thrombosis is a dangerous condition in which blood clots appear inside the vein that impede the normal movement of blood flow towards the liver. Thrombosis is the cause of high blood pressure in the vessels.

limfouzel v vorotah pecheni - Blood supply to the liver

Portal vein thrombosis develops with the following pathologies:

  • Cirrhosis;
  • Oncology;
  • Inflammation of the umbilical vein;
  • With cholecystitis, ulcerative colitis, pancreatitis;
  • Internal injuries;
  • Clotting problems;
  • Infections.

Rarely, thrombosis develops after taking oral contraceptives, especially after the age of 40 years.

Symptoms of thrombosis include:

  • Nausea;
  • Sharp pains;
  • Vomiting;
  • Enlarged spleen;
  • Intestinal disorders.

With chronic thrombosis in the abdomen, fluid accumulates, an increase in the size of the spleen is observed, the veins of the spleen expand, and there is a risk of bleeding.

The diagnosis of portal vein thrombosis is carried out using ultrasound. A blood clot is visualized as a dense body covering the lumen. In this case, blood flow in the affected area is absent. Endoscopic ultrasound can detect small blood clots, and MRI can see complications and determine the causes of blood clots.

A pathological vascular formation of many small intertwining vessels that can minimize poor circulation is called cavernous transformation. By external signs, the pathology is similar to a tumor, therefore it is called a cavernoma.

In a child, a cavernoma develops due to congenital anomalies, and in an adult, due to high pressure in the portal vessels.

In acute appendicitis, in rare cases, purulent inflammation develops – pylephlebitis.

With purulent inflammation, blood pressure rises, there is a risk of venous bleeding from the digestive system. If the infection enters the liver tissue, jaundice develops.

With inflammation of the portal vein, jaundice can develop

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The main way to detect the inflammatory process is laboratory tests. A blood test shows a significant increase in white blood cells, ESR increases. Reliably diagnose pylephlebitis helps ultrasound, MRI.

Ultrasound examination is a safe, cheap, affordable diagnostic method for the general public. It is applied to people of any age. With the help of a painless ultrasound, you can see changes in the structure of the portal vein, recognize pathologies, prescribe adequate and timely treatment.

Normally, the lumen of the vessel with ultrasound does not exceed 15 mm. With thrombosis, hyperechoic heterogeneous vein contents are visible. In some cases, the lumen is completely filled, which leads to the cessation of blood flow.

With portal hypertension, obvious signs of pathology will be an increase in the liver, the presence of fluid in the abdomen. An indirect sign is the formation of a cavernoma.

Another method of instrumental diagnostics is magnetic resonance imaging. During the course, the liver parenchyma and lymph nodes are clearly visible. Using MRI, it is possible to determine the causes of portal vein pathology.

For a comprehensive examination, clinical and biochemical blood tests are prescribed. They show a deviation from the norm in the number of white blood cells, enzymes, bilirubin. Of great importance for diagnosis is the initial history taking.

Treatment

krovosnabzhenie pech 3 - Blood supply to the liver

The main treatment for thrombosis and venous expansion is the use of anticoagulants. In the case of the inflammatory process, antibiotics are prescribed. Medicines are selected individually. Intravenous administration is practiced with a gradual reduction in dosage.

For the treatment of varicose veins, a conservative therapeutic technique is also used in which the injected drug allows the varicose vessel to be “glued together”. A sounding technique is also used.

Timely detected pathology and strict implementation of the doctor’s recommendations eliminates the risk of complications. The principles of rational and dietary nutrition, exercise therapy, and rejection of bad habits are practiced as prevention.

Judging by the fact that you are reading these lines now, a victory in the fight against liver diseases is not on your side yet .

  • ultrasound examination;
  • portal vein radiography;
  • contrast study of blood vessels;
  • computed tomography (CT);
  • magnetic resonance imaging (MRI).

All these studies make it possible to assess the degree of enlargement of the liver and spleen, the severity of vascular damage, and to locate the thrombus.

In medical practice, two methods of treating Budd-Chiari syndrome are used. One of them is medication, and the second – with the help of surgical intervention. The disadvantage of drugs is that it is impossible to recover completely with their help. They give only a short-term effect. Even in the case of a timely visit of a patient to a doctor and treatment with drugs, without the intervention of a surgeon, almost 90% of patients die within a short period of time.

The main goal of therapy is to eliminate the main causes of the disease and, as a result, restore blood circulation in the area of ​​thrombosis.

Liver blood supply scheme

Blood supply to the liver is carried out by a system of arteries and veins, which are interconnected and with the vessels of other organs. This organ performs a huge number of functions, including the disposal of toxins, the synthesis of proteins and bile, as well as the accumulation of many compounds. In the conditions of normal blood circulation, she does her job, which positively affects the condition of the whole organism.

The liver topography is represented by small lobules, which are surrounded by a network of small vessels. They have structural features due to which the blood is cleansed of toxic substances. When entering the gate of the liver, the main bringing vessels are divided into small branches:

  • shared
  • segmental
  • interlobular,
  • intralobular capillaries.

These vessels have a very thin muscle layer to facilitate blood filtration. In the very center of each lobule, the capillaries merge into the central vein, which is devoid of muscle tissue. It flows into the interlobular vessels, and they, respectively, into the segmental and lobar collecting vessels. Leaving the organ, the blood is disbanded along 3 or 4 hepatic veins. These structures already have a full muscle layer and carry blood to the inferior vena cava, from where it enters the right atrium.

The liver has a double blood supply: approximately 70% of the blood comes from the portal vein, the rest from the hepatic artery. Through the branches of the hepatic vein, blood is diverted to the inferior vena cava. The functioning of the liver is based on the complex interaction of these vessels.

Depending on the course of the vessels, the liver is divided into eight segments, which is of great importance from the surgical point of view, since segmentectomy rather than lobectomy is often preferred when choosing the type of surgical intervention.

Segment 1 (caudal lobe) is autonomous because it is supplied with blood both from the left and right branches of the portal vein, and from the hepatic artery, while the venous outflow from this segment is carried out directly into the inferior vena cava. With Budd-Chiari syndrome, thrombosis of the main hepatic vein leads to the fact that the outflow of blood from the liver occurs completely through the caudate lobe, which is significantly hypertrophied.

The liver is clearly visible on a panoramic radiograph of the abdominal cavity. Often they find an appendage of the right lobe directed to the area of ​​the right iliac fossa – the so-called Riedel lobe.

Front and bottom view of the liver, showing division into 8 segments. Segment 1 – caudate lobe.
Computed tomography of the liver. The image in axial projection through the upper arch of the liver allows you to see the separation of the hepatic parenchyma into segments.

1 – medial segment of the left lobe of the liver; 2 – the left hepatic vein; 3 – lateral segment of the left lobe of the liver;

4 – median hepatic vein; 5 – anterior segment of the right lobe of the liver; 6 – posterior segment of the right lobe of the liver;

7 – the right hepatic vein; 8 – aorta; 9 – the esophagus;

10 – stomach; 11 – spleen. Budd-Chiari syndrome: decreased absorption of colloid in the liver in the caudate lobe of the liver and increased absorption in the bones and spleen.

Technetium scintigraphy. Normal radiograph of the abdominal cavity, in the right hypochondrium, the Riedel lobe is visible

The hepatic artery, portal vein, and common hepatic duct in the gates of the liver are located nearby. The hepatic artery normally represents a branch of the celiac trunk, while the gall bladder is supplied with blood from the cystic artery; often meet the anatomical features of the structure of these vessels.

1 – portal vein; 2 – hepatic artery; 3 – celiac trunk;

4 – aorta; 5 – splenic vein; 6 – gastroduodenal artery;

7 – superior mesenteric vein; 8 – common bile duct; 9 – gall bladder;

10 – cystic artery; 11 -hepatic ducts

The method of direct percutaneous injection into the splenic pulp (splenovenography) was previously widespread, but at present it is rarely used even with an enlarged spleen and signs of portal hypertension. In infants with open umbilical vein, direct catheterization is possible with contrasting the system of the left portal vein.

In patients with portal hypertension, image quality may be poor due to hemodilution and a decrease in the concentration of contrast medium, which can be corrected by digital subtraction angiography. Immediately after the passage of the catheter through the right atrium and ventricle, it can be inserted into the hepatic veins.

The tip of the balloon expands, and the measured value (fixed hepatic venous pressure) practically corresponds to the pressure in the portal vein, which allows you to calculate the gradient of the specified parameter. The catheter is most easily guided through the right internal jugular vein, since in this case almost direct access is provided. A similar access technique is used for transvenous liver biopsy.

Ultrasound of a normal liver is used to evaluate its size and texture, filling defects, anatomy of the bile duct system and portal vein. Hepatic parenchyma and surrounding tissues can also be examined using computed tomography.

Ultrasound examination of anatomical structures in the gates of the liver.

The hepatic artery is located between the dilated common hepatic duct and portal portal vein.

When magnetic resonance cholangiopancreatography is used, T1 and T2 are the relaxation times of the medium. The signal from the liquid medium has a very low density (provides a dark color) on T, images and high density (with a light tint) on T2 images. With this research method, T2 images are used to obtain cholangiograms and pancreatograms. The sensitivity and specificity of the technique vary depending on the technique and indications.

If the suspicion of pathology is small, it is better to conduct magnetic resonance cholangiography and pancreatography, and if there is a high probability of surgical intervention, to prefer endoscopic retrograde cholangiography. In addition, periampullary formations often go unnoticed due to artifacts caused by the accumulation of air in the duodenum.

Unfortunately, the magnetic resonance imaging method is not sensitive enough for the early diagnosis of pathology of the bile ducts, for example, in the case of subtle lesions that are often found in primary sclerosing cholangitis. The TESLA scanning method for imaging the bile ducts is rarely used.

Computer or MRI are the best methods for examining liver pathology. Due to contrasting and obtaining images in the arterial and venous phase, diagnosis of both benign and malignant formations is possible. 3D-computer and MRI allow you to get an image of blood vessels. With additional use of MRC or TESLA images, cancer of the biliary tract can be diagnosed.

a – Magnetic resonance imaging, showing the portal vein system is normal. The superior mesenteric vein (shown by a short arrow) and its main branches are visible.

The portal vein (long arrow) extends further into the liver. The right lobe of the liver (R) is identified.

b, c – On the magnetic resonance imaging (b) in the middle sagittal projection, the aorta (shown by a long arrow), the celiac trunk (short arrow) and the root of the superior mesenteric artery (tip of the arrow) are determined.

RHD – right hepatic duct; LHD – left hepatic duct; CHD – common hepatic duct; 1 – “cystic duct” – cystic duct.

Computer or MRI can be used as the only research methods for detecting tumors, describing the anatomy of the vessels and determining the degree of damage to the biliary tract.

Isotopic scanning of the liver and spleen using 99mTc (a). HIDA scan showing normal absorption and excretion of the compound into the bile duct (b).

The study can be carried out in conjunction with stimulation of cholecystokinin to assess dysfunction of the gallbladder or sphincter of Oddi.

1 – surface markers of the chest; 2 – the liver; 3 – spleen

The radioisotope method of liver research is currently used much less frequently. This method of research determines the concentration of technetium in reticuloendotheliocytes (Kupffer cells), administered intravenously.

The laparoscopic method is rarely used for direct visual examination of the liver, however, it allows biopsy under visual control, since in this case the lower surface of the organ is clearly visible.

All these vessels have a thin muscle layer.

Penetrating into the lobule, the interlobular artery and vein merge into a single capillary network running along the hepatocytes to the central part of the lobule. In the center, the lobules of the capillaries collect in the central vein (it is deprived of the muscle layer). The central vein then flows into interlobular, segmental, lobar collecting vessels, forming 3-4 hepatic veins at the exit of the gate. They already have a good muscle layer, flow into the inferior vena cava, and it, in turn, enters the right atrium.

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Myogenic regulation

Prevention and traditional medicine

Alternative methods of treatment can help, but only if lymphadenopathy is at an initial stage. In the case of an already started disease, folk remedies will be useless, but it is permissible to use them as a prophylaxis. For example, the use of pure propolis has shown its effectiveness.

This is one of the most reliable ways to combat the disease, useful for prevention. In daily nutrition, you need to add 15 g of fresh propolis, which must be taken in equal doses three times a day one hour before a meal. Propolis should be taken for two to three months. An infusion of birch mushroom, chaga can also help.

All measures to prevent the development of Budd-Chiari syndrome are reduced to the fact that you need to regularly contact medical institutions in order to undergo, as a preventive measure, the necessary diagnostic procedures. This will help to timely detect and begin treatment of liver vein thrombosis.

There are no specific preventive measures of thrombosis. There are only measures to prevent relapse of the disease. These include taking blood thinning anticoagulants and undergoing examinations every 6 months after surgery.

Portal vein anastomoses

The movement of fluid through the vessels occurs due to the pressure difference. The liver constantly contains at least 1,5 liters of blood, which moves along large and small arteries and veins. The essence of the regulation of blood circulation is to maintain a constant amount of fluid and ensure its flow through the vessels.

Myogenic (muscle) regulation is possible due to the presence of valves in the muscle wall of blood vessels. With muscle contraction, the lumen of the vessels narrows and the fluid pressure increases. When they relax, the opposite effect occurs. This mechanism plays a major role in the regulation of blood circulation and is used to maintain constant pressure in different conditions: during rest and physical activity, in heat and cold, with increasing and decreasing atmospheric pressure and in other situations.

Myogenic regulation

  • interlobular veins;
  • arteries;
  • bile duct.

Features of the blood supply to the liver are that it receives blood not only from arteries, like other organs, but also from veins. Despite the fact that more blood flows through the veins (about 80%), arterial blood supply is no less important. The arteries receive blood saturated with oxygen and nutrients.

Vessel anatomy

Pathological syndrome is insidious in that it is difficult to detect, but at the same time it has serious complications in the absence of therapy. Have you done a full round of doctors (medical examination) in the last 5 years?

The portal vein is responsible for collecting blood from the organs of the gastrointestinal tract. The vascular canal is a connection of the superior, splenic and inferior veins.

The portal vein is one of the largest vascular channels in the body

The complex structure of the portal vein is noted. Doctors call it an extra circle to cleanse the blood of toxins. Without a portal vein, untreated blood would enter the venous and pulmonary circles, and the cardiac system.

The phenomenon is characteristic of those suffering from cirrhosis. Due to the lack of a filter, intoxication of the body is provoked. In the organs there are many arterial channels responsible for the transportation of blood cells, responsible for the saturation of oxygen and other substances. The venous channel carries away the spent blood.

A feature of the portal vein is that a venous vessel is located in the region of the liver. Blood cells enter the vein.

A circle of the circulatory system is created, the level of the body’s work is determined from its functioning.

In the body of a healthy person, these elements are not expressed, no load is applied to them. With the development of a pathological syndrome, the pressure on the anastomoses increases, the blood cells look for other venous channels.

With a change in the size of the portal vein, assumptions are made about the development of the disease. Normal volumes are considered to be lengths from 60 to 80 millimeters with a diameter of about 15 ml.

In practice, several priority anastomoses in the portal system are highlighted.

  1. Channels connecting the gastric tract and esophagus.
  2. Anastomosis of the rectum.
  3. Canals in the front of the abdomen.
  4. Anastomosis in the area of ​​the digestive tract and canals of the retroperitoneal region.

With an increase in the anastomoses of the gastric tract and esophagus, the blood cells are sent to the venous duct of the stomach. Veins have collaterals through which blood is sent to bypass the hepatic system.

With increased load, the risk of hemorrhage increases. Due to the longitudinal location of the vessels in the esophagus, there is the possibility of damage during the consumption of food or vomiting. Frequent hemorrhages cause cirrhosis.

In case of violation of the outflow from the venous channels of the rectum with increasing pressure in the portal vein, stagnation in the upper region of the liver is provoked. Blood cells penetrate the colon, resulting in progressive inflammation of the hemorrhoids.

The connection between the retroperitoneal space and the portal system is not pronounced. External clinical signs and bleeding are absent.

This pathological syndrome is characterized by slow blood flow in the portal vein. The resulting clots of blood cells make it difficult to transport fluid to the liver system. Hypertension is provoked.

In medical practice, provoking factors are distinguished:

  1. Malignant tumor in the intestines or cirrhosis.
  2. Inflammation of the umbilical venous canal during catheterization in a baby.
  3. Pathologies of an inflammatory nature in the digestive system.
  4. Injuries resulting from surgical treatment.
  5. The development of problems with coagulation.
  6. Diseases of an infectious nature can provoke thrombosis of the portal system.

Pathological syndrome develops in women in the process of bearing a child or when using oral methods of contraception, provided that they are used for a long time.

Clinical signs of thrombosis are considered painful sensations in the gastrointestinal tract, vomiting, and diarrhea. There is a chance of rectal bleeding.

In the case of the chronic nature of the pathological syndrome, the spleen increases, the venous channels in the esophagus expand, which is characterized by increased risks of hemorrhage.

Examination in a medical institution is required for hyperhidrosis at night, a sharp decrease in weight. With an enlarged lymph node, a competent course of treatment is required.

To make a diagnosis, the patient is assigned an ultrasound scan. A clot of blood cells is filled with a portal vein. With the help of Doppler research, it is possible to detect the absence of blood flow in the affected area.

The disease is characterized by an increase in pressure in the portal vein, develops against a background of thrombosis and systemic pathological syndromes of the liver system.

Hypertension is diagnosed as a result of blocking the blood circulation process, which leads to an increase in pressure. Blocking occurs in different areas of the portal vein. Normally, the pressure indicators in the portal vein are 10 millimeters of mercury, with an increase in these indicators to 20 millimeters, assumptions are made about the development of portal hypertension. The work of the anastomosis begins.

Provocative factors stand out:

  1. Different types of hepatitis and cirrhosis.
  2. Altered structures of the heart system.
  3. Thrombosis of the portal system or venous channel of the spleen.
  4. Liver vein thrombosis.

Clinical signs are a feeling of nausea and heaviness in the right side, the shade of the skin changes to yellow, the patient’s weight decreases, and fatigue progresses.

With increasing pressure, the spleen becomes larger. Blood cells cannot leave the venous canal of the area; fluid forms in the abdomen.

Diagnosis involves an ultrasound scan of the abdominal region. There is an increase in the liver system and spleen, the presence of fluid. Dopplerometry is used to determine the diameter of the channels, the speed of transportation of the blood cells.

Inflammation

Pinephlebitis implies the purulent inflammatory nature of the lesion of the portal system, provokes the development of thrombosis, exacerbation of appendicitis. In the absence of therapy, the necrotic process of the liver tissue begins. It ends with the death of the patient.

It is impossible to distinguish characteristic signs, which complicates the diagnosis of a pathological syndrome. Pinephlebitis is diagnosed after the death of the patient. Thanks to new diagnostic procedures, it is possible to determine the kind of pathological syndrome.

After carrying out diagnostic procedures, the level of leukocytes is established, due to which a verdict is issued on the presence of a purulent inflammatory process. Diagnosis is possible after ultrasound and MRI.

Diagnostics

An ultrasound examination is prescribed for the diagnosis of pathological syndrome of the portal system. Cheap and affordable diagnostic technique with few contraindications. The procedure is not accompanied by pain, it is permissible to use even for the smallest patients.

The Doppler technique allows you to determine the nature of the transport of blood cells, due to modern technologies it is possible to obtain a three-dimensional image of the vascular channel. In the diagnosis, the patency of the vessel plays an important role.

With hypertension, an ultrasound scan shows an increased diameter of the venous channels and liver, and the presence of fluid in the abdominal region. Due to Doppler, slow blood flow is detected.

Myogenic regulation

Baking Art. Turns over 30% of liverworm. It rises from the common liver arteria and carries fresh blood, saturated with oxygen. When entering the liver, it is divided into left and right branches. The right-hand side of the net serves the right proportion, and the left side of the left-hand side, the square and the left part of the bible.

Convert 70% of liverworm. This vein transmits blood from the gastrointestinal tract. Gates of food are absorbed after digestion of food in the gut. Like the liver artery, it is divided into the right and left branches with a similar distribution of red-light. The vein of blood from the liver returns to the heart through the liver vein.

Yellow system

The main arteries of the liver

Arterial blood enters the liver from vessels that originate from the abdominal aorta. The main organ artery is the hepatic. In its course, it gives blood to the stomach and gall bladder, and before entering the gate of the liver or directly on this site is divided into 2 branches:

  • the left hepatic artery, which carries blood to the left, square and tail lobes of the organ;
  • the right hepatic artery, which supplies blood to the right lobe of the organ, and also gives off a branch to the gallbladder.

The arterial system of the liver has collaterals, that is, areas where neighboring vessels are combined through collaterals. It can be extrahepatic or intraorgan associations.

Large and small veins and arteries take part in the blood circulation of the liver

Blood sources

Arterial (about 30%) comes from the abdominal aorta through the hepatic artery. It is necessary for the normal functioning of the liver, to perform complex functions.

At the gate of the liver, the artery is divided into two branches: going to the left supply the left lobe, going to the right – the right.

From the right, it is larger, a branch leaves to the gall bladder. Sometimes from the hepatic artery leaves a branch to a square fraction.

Venous (about 70%) enters the portal vein, which is collected from the small intestine, colon, rectum, stomach, pancreas, spleen. This explains the biological role of the liver for humans: dangerous substances, poisons, drugs, and processed products come from the intestines to render them harmless and decontaminated.

Venous (about 70%) enters the portal vein, which is collected from the small intestine, colon, rectum, stomach, pancreas, spleen. This explains the biological role of the liver for humans: dangerous substances, poisons, drugs, and processed products come from the intestines to render them harmless and decontaminated.

Liver functions in the human body

The liver is the largest gland of the body. As a rule, they talk about the liver in connection with the digestive system, however, it plays a huge role in maintaining the metabolism, and toxins are neutralized in it. Such involvement of the liver in various processes occurring in the body explains the great attention that is usually paid to maintaining its health.

The liver is located in the abdominal cavity under the diaphragm. It is located in the right hypochondrium, however, since its size is quite large (the mass of a healthy liver can be up to 1800 grams), it reaches the left hypochondrium, where it is in contact with the stomach.

This gland consists of large lobes, and its tissue forms lobules. A lobule is a collection of liver cells in the form of a multifaceted prism. The lobules are literally entangled in a network of vessels and bile ducts. Lobules are separated from each other by connective tissue, which in a healthy liver is developed quite poorly. The cells of this gland are involved in the neutralization of toxins that come with the blood stream, as well as in the production of bile and the formation of other compounds necessary for the body.

The main functions of the liver are:

  • Metabolism. In the liver, proteins are broken down into amino acids, the most important compound, glycogen, is synthesized, into which excess glucose is processed and fat metabolism occurs (the liver is sometimes called the “fat depot”). In addition, vitamins and hormones are metabolized in the liver.
  • Detoxification. As we mentioned, various toxins and bacteria are neutralized in the liver, after which their decomposition products are excreted by the kidneys.
  • Synthesis. In this gland, bile is synthesized, consisting of bile acids, pigments and cholesterol. Bile is involved in the digestion of fats, the absorption of vitamins, and stimulates intestinal motility.

Thus, normal metabolism (metabolism) in the body is impossible without proper liver function. And that is why it is necessary to know what factors cause liver diseases in order to avoid their development. The most dangerous are the following:

  • Alcohol abuse
    In the liver, the main metabolism of ethanol – the alcohol contained in alcoholic beverages – occurs. With small amounts of alcohol consumption, liver cells manage to cope with its processing. When a reasonable dose is exceeded, ethanol contributes to liver cell damage – the accumulation of fat in them (fatty hepatosis, or fatty degeneration), inflammation (alcoholic hepatitis) and destruction. At the same time, excessive formation of connective tissue in the liver (fibrosis, and later cirrhosis and even cancer) occurs.
    A patient with alcoholic liver damage may complain of weakness, a general decrease in tone and appetite, and digestive upset. Gradually, these symptoms worsen, they are joined by tachycardia, jaundice and others. However, very often in the early stages of alcoholic liver disease, no pain may occur.
  • Improper diet
    The abundance of fatty foods and reduced locomotor activity lead to the fact that fat metabolism is disturbed in the body. As a result, fat begins to accumulate in the liver cells, causing their degeneration (steatosis). This leads to the fact that the active formation of free radicals begins – particles that carry an electric charge and pose a danger to cells. Foci of inflammation and necrosis appear in the liver, connective tissue grows, and eventually cirrhosis can develop.
    Improper nutrition causes diseases such as non-alcoholic fatty disease, cirrhosis, and liver cancer.
  • Violation of the rules for taking drugs and the effects of toxic substances
    Uncontrolled medication leads to an increased load on the liver, because most of the drugs are processed in it. It is believed that drug damage to the liver accounts for up to 10% of all side effects that drugs have on the body, and its symptoms may appear 90 days after completion of administration. There are other substances that are dangerous toxins to the liver, such as industrial and plant poisons.
    Substances that have a toxic effect on the liver cause the destruction of cell membranes, lead to malfunctioning of hepatocytes (liver cells), can cause hepatitis and liver failure. Patients complain of pain in the liver, weakness, general malaise; jaundice may develop.
  • Virus attack
    The effect of viruses on the liver is dangerous primarily the development of viral hepatitis. This is an inflammatory disease of the liver, which, depending on the type of virus that caused it, can even lead to death. Often the disease is asymptomatic. Sometimes patients complain of malaise, fever, pain in the right hypochondrium, jaundice. In case of severe hepatitis, liver tissue necrosis may begin.

Due to the heavy load that lays on the liver, this gland is quite vulnerable: we have listed only the main negative factors that affect it, in fact, there are much more. In total, there are about 50 pathologies of this gland, and, as noted in the European Association for the Study of the Liver, about 30 million Europeans are currently suffering from its chronic diseases.

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We list again the main types of pathological changes in the liver:

  • hepatosis (fatty liver, steatosis)
  • hepatitis;
  • fibrosis
  • cirrhosis;
  • liver failure;
  • cancer and others.

Please note: According to researchers, in Russia about 40% of patients with liver diseases have risk factors for alcohol damage to this organ.

Disorders of the liver can characterize non-specific symptoms (characteristic of other diseases), therefore, it is not always possible to draw an unambiguous conclusion that the patient was faced with a liver disease. Patients note poor health, decreased appetite, lethargy, stool disorders, frequent colds, an increased tendency to allergic reactions, skin itching, irritability (toxins that are not neutralized in the liver have a negative effect on the brain).

Among the specific signs of violation can be identified:

  • pain in the right hypochondrium;
  • a feeling of heaviness, discomfort in the abdomen, nausea;
  • feeling of bitterness in the mouth.

The brightest sign indicating the presence of liver disease, of course, is jaundice – a change in the color of the skin and mucous membranes. This is due to the accumulation of bilirubin in the blood.

Since the symptoms of liver disease are not always specific, when these symptoms appear, an examination is necessary. Early diagnosis will help your doctor prescribe an effective treatment and restore liver function as much as possible.

A gastroenterologist is involved in the treatment of pathologies. For an accurate diagnosis, he directs the patient to a biochemical blood test to detect the levels of ALT (alanine aminotransferase), LDH (lactate dehydrogenase) and AST (aspartate aminotransferase) in it. These indicators make it possible to judge the presence of inflammation in the liver. By the content of other substances in the blood: GGT (gamma-glutamyltranspeptidase), bilirubin, alkaline phosphatase (alkaline phosphatase), one can judge the presence of stagnation of bile.

Also, the patient must pass a urinalysis, during which the bilirubin content is measured.

On an ultrasound of the liver, the doctor evaluates its size: in the presence of steatosis and inflammation of the iron, it increases, and the tissues acquire a heterogeneous structure. Modern ultrasound diagnostic technology – elastography – makes it possible to measure the so-called elasticity of liver tissue and allows you to determine the degree of fibrosis. In addition to ultrasound, magnetic resonance imaging or computed tomography can be prescribed for diagnosis.

If the doctor needs to accurately determine the stage of the disease (for example, cirrhosis or fibrosis), a liver biopsy is performed – tissue sampling for examination.

One of the first steps towards maintaining liver health is to control the diet: the presence of a large number of fatty foods, alcohol, fried and refined foods negatively affect the health of the gland. Meals should not be plentiful, it is better to eat 4-5 times a day in moderate portions.

All these measures are effective, but not always sufficient. That is why in some cases, doctors may advise taking medications that support the liver and help restore damaged cells.

It consists of a very soft fabric, its structure is granular. It is located in a glisson capsule of connective tissue. In the area of ​​the portal of the liver, the glisson capsule is thicker and is called the portal plate. Above the liver is covered with a sheet of peritoneum, which is tightly fused with the connective tissue capsule. There is no visceral sheet of the peritoneum at the site of attachment of the organ to the diaphragm, at the entry of blood vessels and the exit of the biliary tract.

In the center of the lower part of the organ are the Glisson gates – the exit of the biliary tract and the entrance of large vessels. Blood enters the liver through the portal vein (75%) and the hepatic artery (25%). The portal vein and hepatic artery in approximately 60% of cases are divided into right and left branches.

The crescent and transverse ligaments divide the organ into two unequal size lobes – the right and left. These are the main lobes of the liver, in addition to them, there is also a tail and a square one.

The liver consists of parenchyma and stroma

The parenchyma is formed from lobules, which are its structural units. In their structure, the slices resemble prisms inserted into each other.

The stroma is a fibrous membrane, or glisson capsule, made of dense connective tissue with partitions of loose connective tissue that penetrate the parenchyma and divide it into lobules. It is pierced by nerves and blood vessels.

The liver is usually divided into tubular systems, segments and sectors (zones). Segments and sectors are separated by grooves – furrows. Division is determined by branching of the portal vein.

Tubular systems include:

  • Arteries.
  • The portal system (branches of the portal vein).
  • Caval system (hepatic veins).
  • Biliary tract.
  • Lymphatic system.

Tubular systems, in addition to the portal and caval, go next to the branches of the portal vein parallel to each other, form bundles. They are joined by nerves.

Features of the circulatory system of the liver

Blood enters the liver from the portal vein and hepatic artery; 2/3 of the blood volume flows through the portal vein and only 1/3 through the hepatic artery. However, the importance of the hepatic artery for the vital functions of the liver is great, since arterial blood is rich in oxygen.

Arterial blood supply to the liver
carried out from the common hepatic artery (a. hepatica communis), which is a branch of truncus coeliacus. Its length is 3–4 cm, diameter 0,5–0,8 cm. The hepatic artery directly above the pylorus, not reaching 1-2 cm to the common bile duct, is divided into a. gastroduodenalis and a.

hepatica propria. Own hepatic artery (a. Hepatica propria) passes upward in the hepatoduodenal ligament, while it is located to the left and somewhat deeper than the common bile duct and in front of the portal vein. Its length varies from 0,5 to 3 cm, the diameter is from 0,3 to 0,6 cm. The own hepatic artery in its initial section gives up a branch – the right gastric artery and before entering the liver gate or directly at the gate is divided into the right and left branch.

Right hepatic artery
supplies mainly the right lobe of the liver and gives the artery to the gallbladder.

Arterial anastomoses of the liver are divided into two systems: extraorgan and intraorgan. The extraorganic system is formed mainly by branches extending from a. hepatica communis, aa. gastroduodenalis and hepatica dextra. The intraorgan system of collaterals is formed due to anastomoses between the branches of the liver’s own artery.

Venous system of the liver
It is represented by veins leading and draining blood. The main adductor vein is the portal vein. The outflow of blood from the liver occurs through the hepatic veins flowing into the inferior vena cava.

Portal vein
(vena portae) is most often formed from two large trunks: the splenic vein (v. lienalis) and the superior mesenteric vein (v. mesenterica superior).

Fig. 2
. Scheme of segmental division of the liver: A – diaphragmatic surface; B – visceral surface; B – segmental branches of the portal vein (projection onto the visceral surface). I – VIII – segments of the liver, 1 – right lobe; 2 – the left lobe.

The largest tributaries are the veins of the stomach (v. Gastrica sinistra, v. Gastrica dextra, v. Prepylorica) and the inferior mesenteric vein (v. Mesenterica inferior) (Fig. 3). The portal vein most often begins at the level of the II lumbar vertebra behind the head of the pancreas. In some cases, it is located partially or completely in the thickness of the gland parenchyma, has a length of 6 to 8 cm, a diameter of up to 1,2 cm, and there are no valves in it.

Portal vein
associated with numerous vena cava anastomoses (portocaval anastomoses). These are anastomoses with veins of the esophagus and veins of the stomach, rectum, umbilical veins and veins of the anterior abdominal wall, as well as anastomoses between the roots of the veins of the portal system (upper and lower mesenteric, splenic, etc.

Portocaval anastomoses are especially pronounced in the rectal region, where v. rectalis superior, which flows into v. mesenterica inferior, and vv. rectalis media et inferior related to the inferior vena cava system. On the anterior abdominal wall there is a pronounced connection between the portal and caval systems via vv.

Hepatic veins
(vvhepaticae) are the abducent vascular system of the liver. In most cases, there are three veins; right, middle and left, but their number can increase significantly, reaching 25. The hepatic veins flow into the inferior vena cava below the place where it passes through the hole in the tendon of the diaphragm into the chest cavity.

Fig. 3
. The portal vein and its large branches (according to L. Schiff). P – portal vein; C – vein of the stomach; IM – inferior mesenteric vein; S – splenic vein; SM – superior mesenteric vein.

In most cases, the inferior vena cava passes through the posterior part of the liver and is surrounded by parenchyma on all sides.

Gate hemodynamics
characterized by a gradual drop from high pressure in the mesenteric arteries to the lowest level in the hepatic veins. It is essential that the blood passes through two capillary systems: capillaries of the abdominal organs and the sinusoidal bed of the liver. Both capillary networks are interconnected by the portal vein.

Blood of the mesenteric arteries under a pressure of 120 mm RT. Art. enters the network of capillaries of the intestine, stomach, pancreas. The pressure in the capillaries of this network is 15 – 10 mm Hg. Art. From this network, blood enters the venules and veins that form the portal vein, where normally the pressure does not exceed 10 – 5 mm Hg. Art. From the portal vein, blood is sent to the interlobular capillaries, from there it enters the hepatic vein system and passes into the inferior vena cava. The pressure in the hepatic veins ranges from 5 mmHg. Art. to zero.

Thus, the pressure drop in the portal channel is 120 mm RT. Art. Blood flow may increase or decrease with changes in the pressure gradient. G.S. Magnitsky (1976) emphasizes that the portal blood flow depends not only on the pressure gradient, but also on the hydromechanical resistance of the vessels of the portal channel, the value of which is determined by the total resistance of the first and second capillary systems.

A change in resistance at the level of at least one capillary system leads to a change in the total resistance and an increase or decrease in portal blood flow. It is important to emphasize that the pressure drop in the first capillary network is 110 mm Hg. Art., and in the second – only 10 mm RT. Art. Therefore, the capillary system of the abdominal organs, which is a powerful physiological valve, plays the main role in changing the portal blood flow.

The liver has a major role in the metabolic processes occurring in the body. The quality of organ functions depends on its blood supply. Hepatic tissue is enriched with blood from an artery, which is saturated with oxygen and beneficial substances. Valuable fluid enters the parenchyma from the celiac trunk. Venous blood, saturated with carbon dioxide and coming from the spleen and intestines, leaves the liver through the portal vessel.

Liver anatomy includes two structural units called lobules, which look like a faceted prism (faces are created by rows of hepatocytes). Each lobule has a developed vascular network, consisting of an interlobular vein, artery, bile duct, and lymphatic vessels. The structure of each lobule suggests the presence of 3 blood channels:

  • for the inflow of blood serum to the lobules;
  • for microcirculation within a structural unit;
  • to drain blood from the liver.

25-30% of the blood volume circulates through the arterial network under pressure up to 120 mm Hg. Art., along the portal vessel – 70-75% (10-12 mm RT. Art.). In sinusoids, the pressure does not exceed 3-5 mm RT. Art., in the veins – 2-3 mm RT. Art. If an increase in pressure occurs, excess blood is released into the anastomoses between the vessels. Arterial blood after working off is sent to the capillary network, and then sequentially enters the system of hepatic veins and accumulates in the lower hollow vessel.

Blood circulation in the liver is 100 ml/min., But with pathological vasodilation due to their atony, this value can increase to 5000 ml/min. (about 3 times).

The interdependence of arteries and veins in the liver determines the stability of blood flow. With an increase in blood flow in the portal vein (for example, against the background of functional hyperemia of the gastrointestinal tract during digestion), the rate of advancement of red fluid through the artery decreases. And, conversely, with a decrease in blood circulation in a vein, perfusion in the artery increases.

Histology of the circulatory system of the liver suggests the presence of such structural units:

  • main vessels: hepatic artery (with oxygenated blood) and portal vein (with blood from unpaired peritoneal organs);
  • branched network of vessels that flow into each other through lobar, segmental, interlobular, around lobular, capillary structures with a connection at the end into an intralobular sinusoidal capillary;
  • a discharge vessel is a collective vein that contains mixed blood from a sinusoidal capillary and directs it into the submandibular vein;
  • vena cava, designed to collect purified venous blood.

If for some reason the blood cannot move at normal speed through the portal vein or artery, it is redirected to the anastomoses. A feature of the structure of these structural elements is the possibility of communication of the blood supply system of the liver with other organs. True, in this case, the regulation of blood flow and redistribution of red fluid is carried out without purification, therefore, it does not linger in the liver and immediately enters the heart.

The portal vein has anastomoses with the following organs:

  • stomach;
  • the front wall of the peritoneum through the umbilical veins;
  • esophagus;
  • rectal section;
  • the lower part of the liver itself through the vena cava.

Therefore, if a distinct venous pattern appears on the stomach, resembling the head of a jellyfish, varicose veins of the esophagus, rectal section are detected, it should be argued that the anastomoses work in an enhanced mode, and in the portal vein there is a strong excess of pressure that prevents the passage of blood.

25-30% of the blood volume circulates through the arterial network under pressure up to 120 mm Hg. Art., along the portal vessel – 70-75% (10-12 mm RT. Art.). In sinusoids, the pressure does not exceed 3-5 mm RT. Art., in the veins – 2-3 mm RT. Art. If an increase in pressure occurs, excess blood is released into the anastomoses between the vessels. Arterial blood after working off is sent to the capillary network, and then sequentially enters the system of hepatic veins and accumulates in the lower hollow vessel.

Vessel anatomy

Myogenic

Excessive exercise, pressure fluctuations negatively affect the tone of the liver tissue.

  • exogenous factors, such as physical activity, rest;
  • endogenous factors, for example, with pressure fluctuations, the development of various diseases.

Features of myogenic regulation:

  • providing a high degree of autoregulation of hepatic blood flow;
  • maintaining a constant pressure in the sinusoids.

Excessive exercise, pressure fluctuations negatively affect the tone of the liver tissue.

Humoral

Hormonal disorders can adversely affect the functions and integrity of the liver.

  • Adrenalin. It is produced under stress and acts on the a-adrenoreceptors of the portal vessel, causing relaxation of the smooth muscles of the intrahepatic vascular walls and a decrease in pressure in the bloodstream.
  • Norepinephrine and angiotensin. Equally affect the venous and arterial system, causing a narrowing of the lumen of their vessels, which leads to a decrease in the amount of blood entering the organ. The process starts by increasing vascular resistance in both channels (venous and arterial).
  • Acetylcholine. The hormone helps to expand the lumen of the arterial vessels, which means it can improve the blood supply to the organ. But at the same time there is a narrowing of the venules, therefore, the outflow of blood from the liver is disrupted, which provokes the deposition of blood into the hepatic parenchyma and a jump in portal pressure.
  • Metabolism products and tissue hormones. Substances expand arterioles and constrict portal venules. There is a decrease in venous circulation against a background of an increase in the rate of flow of arterial blood with an increase in its total volume.
  • Other hormones – thyroxine, glucocorticoids, insulin, glucagon. Substances cause an increase in metabolic processes, while blood flow is increased against the background of a decrease in portal inflow and an increase in arterial blood flow. There is a theory of the effect of adrenaline and tissue metabolites on these hormones.

The liver is a vital gland of human external secretion. Its main functions include the neutralization of toxins and their removal from the body. In the case of liver damage, this function is not performed and harmful substances enter the bloodstream. With the flow of blood, they flow through all organs and tissues, which can lead to serious consequences.

Since there are no nerve endings in the liver, a person may not even suspect for a long time that there is any disease in the body. In this case, the patient goes to the doctor too late, and then the treatment no longer makes sense. Therefore, you must carefully monitor your lifestyle and regularly undergo preventive examinations.

The portal vein (BB, portal vein) is one of the largest vascular trunks in the human body. Without it, the normal functioning of the digestive system and adequate blood detoxification are impossible. The pathology of this vessel does not go unnoticed, causing serious consequences.

The portal portal vein system of the liver collects blood from the abdomen. The vessel is formed by connecting the superior and inferior mesenteric and splenic veins. In some people, the inferior mesenteric vein flows into the splenic vein, and then the connection of the superior mesenteric and splenic veins form the trunk of the explosive.

Hormonal disorders can adversely affect the functions and integrity of the liver.

  • Adrenalin. It is produced under stress and acts on the a-adrenoreceptors of the portal vessel, causing relaxation of the smooth muscles of the intrahepatic vascular walls and a decrease in pressure in the bloodstream.
  • Norepinephrine and angiotensin. Equally affect the venous and arterial system, causing a narrowing of the lumen of their vessels, which leads to a decrease in the amount of blood entering the organ. The process starts by increasing vascular resistance in both channels (venous and arterial).
  • Acetylcholine. The hormone helps to expand the lumen of the arterial vessels, which means it can improve the blood supply to the organ. But at the same time there is a narrowing of the venules, therefore, the outflow of blood from the liver is disrupted, which provokes the deposition of blood into the hepatic parenchyma and a jump in portal pressure.
  • Metabolism products and tissue hormones. Substances expand arterioles and constrict portal venules. There is a decrease in venous circulation against a background of an increase in the rate of flow of arterial blood with an increase in its total volume.
  • Other hormones – thyroxine, glucocorticoids, insulin, glucagon. Substances cause an increase in metabolic processes, while blood flow is increased against the background of a decrease in portal inflow and an increase in arterial blood flow. There is a theory of the effect of adrenaline and tissue metabolites on these hormones.

Portal Hypertension Syndrome

At the moment, answers the questions: A. Olesya Valeryevna, candidate of medical sciences, teacher of a medical university

The hepatic artery is a branch
celiac trunk. She goes up
the edge of the pancreas to the initial
the duodenum
then goes up between the leaves
small stuffing box, located in front
from the portal vein and medial to the general
bile duct, and at the gates of the liver
divided into right and left branches.

Her
the branches are also the right gastric
and gastroduodenal artery. Often
there are additional branches.
Topographic anatomy carefully
studied on donor liver. In case of abdominal trauma or catheterization
hepatic artery possibly her
bundle. Hepatic embolization
arteries sometimes leads to development
gangrenous cholecystitis
.

Rarely diagnosed in life
the patient; clinical description
the pictures are few. Clinical manifestations
associated with a background disease
for example with bacterial endocarditis,
periarteritis nodosa, or determined
the severity of the operation
upper abdominal cavity.
Epigastric pain on the right
occurs suddenly and is accompanied
shock and hypotension.

Is celebrated
pain on palpation of the right
upper quadrant of the abdomen and edge
the liver. Jaundice is rapidly growing. Usually
leukocytosis, fever,
and a biochemical blood test
-signs of cytolytic syndrome.
Prothrombin time increases sharply,
bleeding appears.

Hepatic
arteriography.
With her help
hepatic obstruction can be detected
arteries. In portal and subcapsular
areas develop intrahepatic
collaterals. Extrahepatic collaterals
with neighboring bodies are formed in
ligamentous apparatus of the liver [].

Infarctions are usually rounded or
oval, occasionally wedge-shaped,
located in the center of the body. IN
early period they come to light as
hypoechoic foci with ultrasound
research (ultrasound) or fuzzy
delimited areas of low
density on computed tomograms,
not changing upon introduction
contrast medium.

Later heart attacks
look like drain pockets with clear
the borders. Magnetic resonance
tomography (MRI) allows you to identify
heart attacks as areas of low
signal intensity at T
1-weighted images and with
high intensity on T2-weighted
images.
large infarction is possible
formation of a “little pool” of bile, sometimes
containing gas.

Treatment
should be aimed at eliminating
causes of damage. For prophylaxis
secondary infection with hypoxia
liver use antibiotics. Main
the goal is to treat acute
hepatic cell failure.
In case of artery injury, apply
percutaneous embolization.

Damage to the hepatic artery with
liver transplant

In case of damage to the bile ducts
due to ischemia speak of ischemic
cholangitis
.Is he
develops in patients undergoing
liver transplant with thrombosis
or stenosis of the hepatic artery or
occlusion of the near-ductal arteries | 8 [.
Diagnosis is difficult because
biopsy specimen picture
may indicate obstruction
biliary tract without signs of ischemia.

After liver transplantation, thrombosis
hepatic artery detected with
using arteriography. Doppler
research does not always reveal
changes, besides the correct assessment
its results are difficult [b].
High Reliability Shown
spiral CT.

Hepatic Artery Aneurysms

Hepatic artery aneurysms occur
rarely and make up a fifth of all
aneurysm of visceral vessels. They are
may be a complication of bacterial
endocarditis, periarteritis nodosa
or arteriosclerosis. Among the reasons
the role of mechanical damage increases
e.g. due to traffic
incidents or medical interventions,
such as biliary tract surgery,
liver biopsy and invasive
X-ray studies.

False aneurysms occur in patients
with chronic pancreatitis and
pseudocyst formation
Hemobilia is often associated with false
aneurysms. Aneurysms are
congenital, intra- and extrahepatic,
from pinhead to
grapefruit. Aneurysms are detected with
angiography or accidentally detect
during surgery or
with autopsy.

Clinical
Manifestations
varied. Only
in a third of patients there is a classic
triad: jaundice | 24 |, abdominal pain and
hemobilia. Common symptoms are
stomach ache; period from their appearance
before rupture of the aneurysm can reach
5 months

In 60-80% of patients with a cause
the first visit to a doctor happens
rupture of a modified vessel with expiration
blood into the abdominal cavity, biliary tract
or gastrointestinal tract and development
hemoperitoneum, hemobilia or bloody
vomiting

Ultrasound allows you to put a preliminary
diagnosis;
it is confirmed by hepatic
arteriography and CT with contrast
(see Figure 11-2). Pulse
Doppler ultrasound reveals
blood flow turbulence in aneurysm
.

Treatment.
RџSЂRё
intrahepatic aneurysms are used
vessel embolization under control
angiography (see Fig. 11-3 and 11-4). In patients with aneurysms
common hepatic artery necessary
surgical intervention. Wherein
the artery is bandaged above and below the site
aneurysms.

Hepatic arteriovenous fistula

Common causes of arteriovenous
fistulas are blunt abdominal trauma,
liver or tumor biopsy, usually
primary liver cancer. In patients with
hereditary hemorrhagic
telangiectasia (disease
Randu-Weber-Osler) discover
multiple fistulas that can
lead to congestive heart
insufficiency.

With large sizes of the fistula, you can
listen to the noise above the upper right
quadrant of the abdomen. Hepatic
arteriography allows you to confirm
diagnosis. As a therapeutic measure
usually use embolization
gelatin foam.

In patients who have sclerotherapy
with the help of pharmaceutical preparations and the Sengstaken-Blakemore probe was not successful, one can resort to the application of a portocaval anastomosis. The end-to-side portocaval anastomosis is very effective for stopping bleeding from the esophagus varicose veins, since it causes good decompression of the portal vein system and. partially sinuses.

Patient
, which is shown the urgent application of portocaval anastomosis, must be in a satisfactory condition in order to tolerate this intervention, since it is accompanied by high mortality. However, as was shown during sclerotherapy, mortality among patients of group C (according to the classification of Child-Pugh) is approximately equal to mortality when applying a portocaval anastomosis.

Portocaval Bypass
“Side by side” is indicated for incessant bleeding from varicose veins of the esophagus, combined with severe ascites and Budd-Chiari syndrome.

N-mesocaval shunt
in which a Gore-Tech prosthesis is inserted between the portal and inferior vena cava with a diameter of 10-12 mm and a length of 4 cm. In case of portal vein thrombosis, bypass grafting between the superior mesenteric vein and the vena cava is indicated. This shunting is undoubtedly less effective than direct portocaval shunting, in addition, thrombosis develops in approximately 30% of cases. During bleeding from varicose veins, distal splenorenal bypass cannot be performed.

In patients with cirrhosis
, once having bleeding, in 70% of cases there is a likelihood of relapse, which leads to a significant increase in mortality (up to 50-70%). For the treatment of patients with portal hypertension who had one or more bleeding, endoscopic sclerotherapy of esophageal varicose nodes is most suitable.

This technique gives good results with fewer complications and residual effects than shunting. If sclerotherapy is ineffective, a distal splenorenal anastomosis is applied according to Dean Warren. Distal and splenorenal anastomosis changes the blood circulation of the esophagus, stomach and spleen in the direction of the left renal vein, keeping the portal blood flow intact.

This operation less often leads to the development of hepatic encephalopathy. However, it was shown that over time, due to the development of collaterals, the results become similar to those when applying a portocaval anastomosis. For this reason, at present it is considered necessary to isolate the entire splenic vein to the gates of the spleen in order to bandage most of the bringing veins. This undoubtedly increases the duration of the operation, but slows down the appearance of collaterals.

Do not perform surgery
Warren patients with ascites, as it tends to increase existing ascites or even cause it.

The possibility of liver transplantation
should be considered only in young patients with severe cirrhosis complicated by bleeding from varicose veins of the esophagus. Therefore, it is not advisable for such patients to perform portocaval bypass surgery or other surgical interventions at the gates of the liver: this can interfere with transplantation, and sometimes even make it impossible.

Diagnosis of blockage of the liver vessels

Hepatic vein thrombosis is called liver disease. It causes a violation of internal blood circulation and the formation of blood clots that block the outflow of blood from the organ. Official medicine also calls this Budd-Chiari syndrome.

Partial or complete narrowing of the gaps of the blood vessels resulting from a thrombus is characteristic of hepatic vein thrombosis. Most often it occurs in those places where the mouth of the vessels of the liver is located and they flow into the vena cava.

If there are any obstacles to the outflow of blood in the liver, the pressure in the blood vessels rises and the hepatic veins expand. Although the vessels are very elastic, too high a pressure can lead to rupture, resulting in internal bleeding with a possible fatal outcome.

The question of the origin of hepatic vein thrombosis has not been closed so far. Experts in this matter were divided into two camps. Some consider liver vein thrombosis to be an independent disease, while others claim that it is a secondary pathological process caused by a complication of the underlying disease.

The first case is thrombosis, which arose for the first time, that is, we are talking about the disease of Badda-Chiari. The second case includes Budd-Chiari syndrome, which manifested itself due to a complication of the primary disease, which is considered the main one.

Due to the complexity in the division of measures for the diagnosis of these processes, it is customary to call the blood circulation disorders of the liver not a disease, but a syndrome.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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