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Variations of the Portal Vein Diameter in Adult Sudanese Population , (Ultrasonography Study )

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Variations of the Portal Vein Diameter in Adult Sudanese Population , (Ultrasonography Study ) The National Ribat University Faculty of Graduate Studies and Scientific Research Variations of the portal vein diameter in Adult Sudanese Population , (ultrasonography Study ) . A thesis submitted for Requirements of Partial Fulfillment of the Degree of M.Sc in Human and Clinical Anatomy. By: Abdallah Greeballah Abdallah Mohammed . Supervisor: Prof . TAHIR OSMAN ALI . Acknowledgement First of all, I would like to thank so much our almighty god for giving me strength, good health and knowledge in making this study. I would like to give my sincere thanks to my supervisor:, Prof . TAHIR OSMAN ALI the dean of faculty of graduate studies and scientific research for his patience in guiding me throughout the research period. I would also like to thank Dr.Kamal Eldin Elbadawi Babiker, dean of faculty of medicine for giving a hand and advice throughout the course. Also, I would like to give special thanks to Dr. Yassier seddig for generous cooperation to facilitate my study. I would like to acknowledge and thank The National Ribat University for giving me this chance of studying. Dedication I would like to dedicate this thesis and everything I do to my mother. to my father .. to my sisters Namarig ,Nusiba , Nuha and Emtethal . to my best friends Dr.Mohammed Basheir , Dr. Iman Elgaili , Abstract Background: The hepatic portal vein, a short, wide vein, is formed by the superior mesenteric and splenic veins posterior to the neck of the pancreas. It ascends anterior to the IVC as part of the portal triad in the hepatoduodenal ligament . At or close to the porta hepatis, the hepatic artery and hepatic portal vein terminate by dividing into right and left branches; these primary branches supply the right and left livers, respectively Material and methods: The study includes 65 sequential patients of both sexes and different age, 30 females and 35 males, who underwent abdominal ultrasound for various reasons, at Antalia diagnostic cener (Khartoum state), ultrasound was done investigating portal vein diameter . Results: The results showed that the patients at the age of sixty years old, had stenosis in portal vein which are discovered accidently when they underwent abdominal ultrasound for various reasons. When comparing the study between men and women it was found that most abnormal variations are in men. Also it was found that the average diameter of portal vein 12. Conclusion : The study revealed a normal mean portal vein diameter ranging below 12 mm with a normal respirophasic variation (above the cutoff point for portal hypertension). مستخلص الدراسة خلفية : الوريد البابي الكبدي هو وريد قصير وعريض يتكون بإتحاد الوريد الطحالي والوريد المساريقي العلوي خلف البنكرياس. ويرتفع ﻷعلي أمام الوريد اﻷجوف السفلي كجزء من بوابه ثالوث في الرباط الكبدي اﻹثني عشر . عند بوابة الكبد ينقسم البابي و الشريان الكبدي إلي تفرعات ليغذوا النصف اﻷيمن والنصف اﻻيسر من الكبد. الﻤﻮاد وطرق الدراسة : أجريت هذه الدراسة علي 56 مريضا من فئات عمرية مختلفة 03 من اﻹناث و06 من الذكور خضعوا لموجات صويتة للبطن ﻷسباب مختلفة تم الكشف فيها عن الوريد البابي الكبدي في مركز أنطاليا التشخيصي في وﻻية الخرطوم و ذلك باستخدام الموجات فوق الصويته لتحديد قطره. النتائج : أظهرت النتائج أن المرضى الذين تزيد أعمارهم عن ستين سنه ظهر لديهم ضيق في الوريد البابي الكبدي الذي اكتشف عن طريق الصدفة عند فحصهم بالموجات الصوتية ﻷسباب طبية مختلفة عند مقارنة الدراسة بين الرجال والنساء وجد أن اﻷكثر عرضه لهذا الضيق هم من الرجال . كما أوجدت هذه الدراسة ان متوسط قطر الوريد البابي الكبدي 21 ملم. The contents Title Page Chapter I Introduction 1.1. Introduction 1 1.2. Justification 2 1.3. Objectives 2 1.3.1. General objective 2 1.3.2. Specific objective 2 Chapter 2 Literature Review 2.1. Literature Review 3 Chapter 3 Materials and Methods 3.1. Study Design 9 3.2. Study Area 9 3.4. Study Population 9 3.4.1.Inclusion Criteria 9 3.4.2.Exclusion Criteria 9 3.5. Sampling 10 3.5.2. Sample size 10 3.6. Data collection 10 3.7. Data analysis 10 3.8. Ethical consideration 10 Chapter 4 Results 4.1. Results 11 Chapter 5 Discussion 5.1. Discussion 17 6.1. Conclusion 19 6.2. Recommendations 20 Chapter 7 References References 21 Appendix 23 Lists of tables Table Title Page Table (4.1) Distribution of gender. 11 Table (4.2) Age group distribution among study 12 individuals. Table (4.3) Portal vein diameter 13 Table (4.4) Crosstable between PVD and gender 26 Table (4.5) Crosstable between PVD and age 26 Table (4.6) Statistical parameter 25 List of figures 4.1 Gender distribution of study group 11 4.2 Age distribution 12 4.3 Portal vein diameter 13 1 Figure (1) 14 2 Figure (2) 14 3 Figure (3) 14 List of abbreviations Abbreviations List PV Portal vein PVD Portal vein diameter P HTN Portal hypertension CLD Chronic liver disease US Ultrasound CT Computed tomography Chapter one Introduction Introduction: 1.1 Background :- Mean portal vein diameter is considered as the best indicator for portal hypertension. However, the cutoff point differs from study to study (above 10–15 mm) despite the existence of normal mean portal vein diameter between 10–15 mm in different settings. This implies the existence of limited evidence on normal portal vein diameter for all populations in all countries prior to setting the cutoff points. Therefore, the aim of this study was sonographic assessment of mean portal vein diameter among patients with liver problem referred to the Department of Radiology in Antalia Health Cente. (1) The normal portal vein diameter (PVD) can vary normally between 7 to 15 mm while normal portal venous pressure lies between 5 and 10 mmHg (14 cm of H2O). If portal venous pressure is more than 15 mmHg (30 cm of H2O), then it might indicate portal hypertension. A portal vein diameter greater than 13 mm is assumed to be the cutoff point for portal hypertension in the appropriate clinical setting. On the contrary, a portal vein diameter greater than 10 mm was also considered as portal hypertension . (2) 1.2. Justification :- Sudan is a one of the developing country and most of population work in rural area in farms and near to lakes .and they lack health awareness about protecting themselves . The most one that affect the portal vein is bilharzia and alcohol leading to portal hypertension and liver cirrhosis that lead to death ,so measurement of mean portal vein diameter in normal Sudanese population will provide to clinician best indicator for diagnosis and treatment of portal vein problems . 1.3. Objectives 1.3.1. General objective: To estimate the Mean Portal Vein Diameter Using Sonography among patients Coming to Radiology Department of Antalia Health Center in 2017 . 1.3.2. Specific objectives: to : Identify the course of portal vein . compare the diameter among gender. Measure the diameter of portal vein . Compare the variations with data from other studies. Chapter Two Literature review Literature review: 2.1. Gross anatomy: The hepatic portal vein, a short, wide vein, is formed by the superior mesenteric and splenic veins posterior to the neck of the pancreas. It ascends anterior to the IVC as part of the portal triad in the hepatoduodenal ligament (3). At or close to the porta hepatis, the hepatic artery and hepatic portal vein terminate by dividing into right and left branches; these primary branches supply the right and left lobes , respectively. Within the right and left livers, the simultaneous secondary branchings of the hepatic portal vein and hepatic artery supply the medial and lateral divisions of the right and left lobes , with three of the four secondary branches undergoing further (tertiary) branchings to supply independently seven of the eight hepatic segments.. (3) The portal venous system drains blood to the liver from the abdominal part of the alimentary canal (excluding the anus), the spleen, the pancreas and the gall-bladder and its ducts. The distal tributaries of this system correspond to, and accompany, the branches of the coeliac and the superior and inferior mesenteric arteries enumerated above; only proximally does the arrangement differ. The inferior mesenteric vein ascends above the point of origin of its artery to enter the splenic vein behind the pancreas. The superior mesenteric vein joins the splenic vein behind the neck of the pancreas in the transpyloric plane to form the portal vein, which ascends behind the first part of the duodenum into the anterior wall of the foramen of Winslow and thence to the porta hepatis. Here the portal vein divides into right and left branches and breaks up into capillaries running between the lobules of the liver. These capillaries drain into the radicles of the hepatic vein through which they empty into the inferior vena cava. (4) The portal vein drains blood from the abdominal part of the gastrointestinal tract from the lower third of the esophagus to halfway down the anal canal; it also drains blood from the spleen, pancreas, and gallbladder. The portal vein enters the liver and breaks up into sinusoids, from which blood passes into the hepatic veins that join the inferior vena cava. The portal vein is about 2 in. (5 cm) long and is formed behind the neck of the pancreas by the union of the superior mesenteric and splenic veins . It ascends to the right, behind the first part of the duodenum, and enters the lesser omentum It then runs upward in front of the opening into the lesser sac to the porta hepatis, where it divides into right and left terminal branches. The portal circulation begins as a capillary plexus in the organs it drains and ends by emptying its blood into sinusoids within the liver.
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