A swollen liver and spleen (hepatosplenomegalia) followed by vomiting blood (haemathemesis) could indicate enlarged veins in the esophageal mucosa (esophageal varices) caused by portal hypertension. Portal hypertension is a pathologic condition wherein vein blood collected from the abdominal organs by the portal veins. The portal veins take blood to the secondary capillary system, rather than to the heart. During portal hypertension, the portal veins can't transport blood through the liver into the "inferior vena cava", or the large vein that carries deoxygenated blood from the lower half of the body into the heart. Blood in the vena porte and its branches stagnates causing an increase in blood pressure localized to portal circulation (portal hypertension). There are some alternative ways for the blood from the vena porte to reach the inferior vena cava (the blood then bypasses the liver). These types of alternative routes are called "porto-caval anastomoses". Anastamoses are vein systems that communicate between blood vessels from different circulatory systems. In this case, between the vena porte and the inferior vena cava. One porto-caval anastomoses is located in the mucosa of the lower third of the esophagus where the veins from the esophagus communicate with the veins from the cardia (part of the stomach). The veins (found between the esophagus and stomach), become enlarged due to increased blood flow. These veins can be easily damaged by stomach acid and pressure during vomiting because they are placed in the mucosa. When damaged, the body expels blood by vomiting. Portal hypertension is usually caused by liver diseases like cirrhosis. Cirrhosis is due to chronic hepatitis or alcohol abuse.
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