3: Abdominal Wall, Contents, Blood Supply and Hepatic Portal System
Introduction - Overview - Identification - Summary - Imaging - Clinical Case Study
Alcoholic Cirrhosis of the Liver

A 63-year-old male with a long history of chronic alcoholism was admitted to the hospital in a serious condition. He was bleeding from the mouth, apparently suffering from malnutrition and frequently lapsed into a comatose state. Careful examination revealed that he had hemorrhoids and blood in the stools. The patient was placed on intravenous feeding and later, when he was able to take solid food, was given a high protein diet generously supplemented with vitamins and minerals. Bleeding was initially arrested by a ballon inserted into the esophagus and inflated. This served to compress the hemorrhaging blood vessels. Liver tests and a needle biopsy of liver tissue revealed severely subnormal functions of this organ and histological evidence of a ubiquitous replacement of normal tissue by fat and connective tissue. As a result, there was impedance of the normal flow of venous blood through the liver, leading to an increase in blood pressure in the hepatic portal vein (portal hypertension). He was released from the hospital 10 days later with the firm admonition by his physician to abstain from all alcoholic intake whatsoever and to maintain a properly balanced nutritional diet.

QUESTIONS

  1. What would happen to venous portal blood if it could not easily pass through the liver due to portal hypertension?
  2. What anatomical structure or lack there of, could account for your answer above.
  3. What specific venous portal-caval relationship could account for bleeding from the mouth and blood in the stools?
  4. How does the above answer account for hemorrhoids?