Astavalence

PathoSchema by Astavalence · Portal Hypertension Simulator

Portal pressure model

14mmHg

Clinically significant pressure territory.

Portal pressure map Portal hypertension is a pressure problem that turns into collateral veins, variceal bleeding, splenic enlargement, ascites, encephalopathy and renal dysfunction.

Current mechanism

Portal hypertension overview

Blood from the gut, stomach and spleen should pass through the liver before entering systemic venous circulation. Portal hypertension appears when inflow faces excessive resistance, classically from cirrhosis.

Liver resistance68% Splanchnic inflow58%

Particle code

Portal venous bloodgut and spleen to liver

Systemic escapeportosystemic shunting

Variceal pressurebleeding risk

Ascites fluidperitoneal accumulation

Ammonia bypassencephalopathy path

Renal retention signalsodium and water conservation

What students must read from the picture

Core equation

Portal pressure rises when flow faces resistance. In cirrhosis, the liver becomes a high resistance filter. Splanchnic vasodilation then increases inflow, so pressure sustains itself and complications accumulate.

Clinical reasoning

Mechanism note

Use the sliders and watch what changes in real time. Higher pressure should enlarge the spleen, make varices more prominent and visibly increase ascites.

Complication map

Varicesfragile collaterals at oesophageal, gastric, rectal and umbilical sites

Ascitesportal pressure plus sodium and water retention

Splenomegalyback pressure enlarges spleen and traps platelets

Encephalopathyportal blood bypasses hepatic detoxification

Renal dysfunctioneffective arterial underfilling drives renal vasoconstriction

SBP riskinfected ascites is a major decompensation pathway

Exam pearls

Portal HTNdevelops when portal inflow meets increased resistance

Clinically significantdecompensation risk rises when pressure is high enough to generate collaterals and ascites

Variceal bleedpressure plus fragile wall, not simple ulcer disease

Low plateletsoften a clue to splenic sequestration

Ascites logicsalt restriction, diuretics, paracentesis and albumin when needed

TIPS trade-offdecompresses pressure but may worsen encephalopathy

Rule: pressure causes backflow, shunting causes bypass, and circulatory compensation causes fluid retention.

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