[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-272649-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-272649-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","absite-review-hpbtransplant-liver-anatomy-and-portal-hypertension","ABSITE Review - HPB/TRANSPLANT - Liver Anatomy and Portal Hypertension","","Liver-focused HPB/Transplant ABSITE review covering portal triad orientation, liver segmentation with Cantlie’s line, and key portal and arterial vasculature relationships. Summarizes portal hypertension physiology using HVPG and pressure-gradient concepts, classification by vascular level, and typical variceal sites. Provides medical and procedural management options including TIPS and shunt types, plus clinical reasoning for recurrent variceal bleeding after failed TIPS. Concludes with practical imaging/clinical pearls for abscesses and benign liver lesions, including hydatid, amoebic, pyogenic patterns, hemangioma risks, and adenoma/FNH differentiation.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/exam/","Exam",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/absite-review-hpbtransplant-liver-anatomy-and-portal-hypertension/272649/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/absite-review-hpbtransplant-liver-anatomy-and-portal-hypertension/272649.png","ImageObject",300,407,{"name":42,"@type":43},"Sage","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-15",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What structures form the portal triad and how are they oriented?","Question",{"text":63,"@type":64},"The portal triad includes the hepatic artery proper, the common bile duct, and the portal vein. Medial is hepatic artery proper, lateral is common bile duct, and posterior is the portal vein.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How is portal hypertension assessed and classified?",{"text":68,"@type":64},"Portal hypertension is assessed using HVPG (hepatic vein pressure gradient) with HVPG ≥ 6 mm Hg. It is classified into pre-sinusoidal, sinusoidal (e.g., cirrhosis/hepatitis), and post-sinusoidal causes (e.g., Budd-Chiari).",{"name":70,"@type":61,"acceptedAnswer":71},"For esophageal variceal bleeding after failed or stenosed TIPS, what is the best definitive option?",{"text":72,"@type":64},"Best definitive management is liver transplant. Medical therapy is more useful for prevention, and balloon temporization is more suited for short-term control.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},272649,1790599575,{"code":4,"msg":82,"data":83},"success",[84,88,92,95,99,104,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":93,"slug":94},70,"exam",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},"Comic",60,"comic",{"id":100,"doc_module":4,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},6,"Technology",50,"technology",{"id":105,"doc_module":4,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},7,"Healthcare",40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":55,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":33,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145},687197207057,"https://ap-avatar.wpscdn.com/davatar_29158cc5080c5b710cf443261637dec0","ABSITE Review: HPB/TRANSPLANT  \nRachel Kim  \nIndiana University School of Medicine  \nLiver  \nAnatomy  \n􀂃 Orientation of portal triad:  \n􀂃 Medial: Hepatic artery proper Lateral: Common bile duct Posterior: Portal vein  \n􀂃 Division between Right and Left liver  \n􀂃 Cantlie’s line – connects GB fossa to IVC  \n􀂃 Segments and partial hepatectomies:  \n􀂃 Right: V – VIII  \n􀂃 Anterior segments: V and VIII  \n􀂃 Posterior segments: VI and VII  \n􀂃 Left: II – IV  \n􀂃 Lateral segments: II and III  \n􀂃 Medial segments: IVa and IVb  \n􀂃 Caudate: I  \n􀂃 Extended Right: Right + Left medial (IVa & b)  \n􀂃 Extended Left: Left + Right anterior (V & VIII)  \nImage source: International Liver Transplantation Society ( [ilts.org](ilts.org))  \nAnatomy-Vasculature  \n􀂃 Portal system (2/3 of blood supply)  \n􀂃 Confluence of SMV and splenic  \n􀂃 Arterial system (1/3 of blood supply)  \n􀂃 Supplies most hepatic tumors  \n􀂃 Hence hepatic artery infusion pumps or TACE  \n􀂃 Most common replaced RIGHT: SMA  \n􀂃 Travels posterior to pancreas and CBD  \n􀂃 Most common replaced LEFT: Left gastric  \n􀂃 Travels in gastrohepatic ligament  \n􀂃 Drainage: Hepatic veins  \n􀂃 Right, middle, left  \n􀂃 80% -middle confluences with left before IVC  \nPortal Hypertension  \n􀂃 HVPG ( Hepatic Vein Pressure Gradient) ≥ 6 mm Hg  \n􀂃 Wedged pressure – free hepatic vein pressure  \n􀂃 Essentially, gradient between PV and IVC  \n􀂃 Classified into  \n􀂃 Pre-sinusoidal (e.g. schistosomiasis)  \n􀂃 Sinusoidal (e.g. cirrhotic states, hepatitis)  \n􀂃 Post-sinusoidal (e.g. Budd-Chiari)  \n􀂃 Varices: splanchnic meets systemic drainage  \n􀂃 Distal esophagus/proximal stomach  \n􀂃 Umbilical (caput medusae)  \n􀂃 Rectum (IMV and pudendal)  \n􀂃 Retroperitoneal  \n􀂃 Management  \n􀂃 Medical: beta blockers (ppx), vasopressin and octreotide (acute)  \n􀂃 Interventional/Procedural  \n􀂃 Shunts –  \n􀂃 TIPS  \n􀂃 Selective shunts (e.g. splenorenal or “Warren”)– will not relieve ascietes  \n􀂃 Nonselective shunts (e.g. portocaval)  \nQuestion \\#1  \n58 YOM with cirrhosis previously had a TIPS, which is now stenosed and no longer functional. He develops hypotension and melena, EGD demonstrates esophageal variceal bleeding, which cannot be controlled endoscopically. IR is unable to embolize because of multiple points of bleeding. What is the best method to prevent recurrent variceal bleeding?  \nA. Liver transplant  \nB. Octreotide drip and beta-blockers  \nC. Partial esophagectomy  \nD. Balloon tamponade  \nQuestion \\#1  \n58 YOM with cirrhosis previously had a TIPS, which is now stenosed and no longer functional. He develops hypotension and melena, EGD demonstrates esophageal variceal bleeding, which cannot be controlled endoscopically. IR is unable to embolize because of multiple points of bleeding. What is the best method to prevent recurrent variceal bleeding?  \nA . Liver transplant  \nB. Octreotide drip and beta-blockers  \nC. Partial esophagectomy  \nD. Balloon tamponade  \nBest definitive management for patient who failed TIPS would be transplant  \nMedical therapies are more useful for prevention. Balloon therapies more helpful for short-term temporization  \nPartial esophagectomy does not resolve underlying portal hypertension  \nPyogenic: “cluster sign”, wall enhancement  \nHydatid:  \n“water lily sign” – floating, undulating membrane  \nAmoebic:  \nWall enhancement, More frequently single  \nAbscesses  \n􀂃 Pyogenic  \n􀂃 Most common: polymicrobial (GNRs)  \n􀂃 Most common single agents: \\#1-E. Coli, \\#2-K. pneumoniae, \\#3-S. anginosus  \n􀂃 Most common cryptogenic (no obvious/identified organism): K. pneumoniae  \n􀂃 Treatment: antibiotics +/-drainage (>2-3 cm)  \n􀂃 Parasitic/Hydatid  \n􀂃 Echinococcal (Echinococcus granulosus) cysts  \n􀂃 Treatment  \n􀂃 \u003C5 cm: albendazole or mebendazole  \n􀂃 >5 cm: consider excision  \n􀂃 Avoid spillage! (Can lead to anaphylaxis and seeding)  \n􀂃 For large or complex multicystic lesions not amenable to surgery: Puncture-Aspiration-Injection-Reaspiration (PAIR)  \n􀂃 Amoebic  \n􀂃 Most common: Entamoeba histolytica  \n􀂃 Region: South and Central Ame","cbCaiqvd9QDFFEiz","https://ap.wps.com/l/cbCaiqvd9QDFFEiz","pdf",6733550,45,"English","# Anatomy\n## Orientation of portal triad and liver segmentation\n# Anatomy - Vasculature\n## Portal system and arterial supply\n# Portal Hypertension\n## HVPG, classification, and varices\n## Management options\n# Clinical Question: Variceal bleeding after TIPS failure\n## Best method to prevent recurrent bleeding\n# Liver Lesions\n## Abscesses (pyogenic, parasitic/hydatid, amoebic)\n## Benign liver lesions (hemangioma, hepatic adenoma, FNH)\n## Malignant liver lesions (metastases, HCC, cholangiocarcinoma)","[{\"question\":\"What structures form the portal triad and how are they oriented?\",\"answer\":\"The portal triad includes the hepatic artery proper, the common bile duct, and the portal vein. Medial is hepatic artery proper, lateral is common bile duct, and posterior is the portal vein.\"},{\"question\":\"How is portal hypertension assessed and classified?\",\"answer\":\"Portal hypertension is assessed using HVPG (hepatic vein pressure gradient) with HVPG ≥ 6 mm Hg. It is classified into pre-sinusoidal, sinusoidal (e.g., cirrhosis/hepatitis), and post-sinusoidal causes (e.g., Budd-Chiari).\"},{\"question\":\"For esophageal variceal bleeding after failed or stenosed TIPS, what is the best definitive option?\",\"answer\":\"Best definitive management is liver transplant. Medical therapy is more useful for prevention, and balloon temporization is more suited for short-term control.\"}]","ABSITE Review - HPB/TRANSPLANT - Liver Anatomy and Portal Hypertension | PDF",1789466685,113]