The pathology and pathenogenesis of portal hypertension

Abstract

Since the publication in 1947 of Professor Himsworth's monograph on "Disorders of the Liver" and the work on which it was based, renewed interest has been taken in the pathology of cirrhosis of the liver for the views put forward in these articles, while they do not completely explain the sequence of events leading to the development of human cirrhosis, provide a fresh basis on which to build further theories. It has been recognised for many years now that the changes in the liver are accompanied - some said preceded - by pathological changes in the portal venous system and in the spleen. Along with these changes there is congestion of the portal system of veins and the development between it and the systemic veins of anastomotic channels. Rupture and Uncontrollable bleeding from the collateral channels is a frequent cause of death in these cases (Preble, 1900) and recently surgeons have turned their attention to the problems which the presence of these varicosities-present.Similar oesophageal varicosities are found in the absence of cirrhosis of the liver where there is a block in the portal or splenic veins. These again are produced by long-continued congestion and gradual increase in pressure in the portal venous system, i.e., portal hypertension. This portal hypertension. as well as leading to the production of oesophageal varices, gives rise to splenomegaly and to changes in the portal and splenic veins. Portal hypertension. therefore, can be caused by cirrhosis of the liver or blockage of the portal or splenic veins and study of its pathology necessitates careful examination of the liver, portal and splenic veins and the spleen in each case. When this is done in the light of the recent developments and experimental work in the etiology of human cirrhosis and an understanding of the blood supply of the liver has been obtained, it is possible to consider the various theories which have been put forward to account for the development of portal hypertension.To help further in an understanding of the reasons why portal hypertension should occur in cases of cirrhosis of the liver, the vascular trees of several normal and cirrhotic livers were injected.