An Innovative Case Report: Obesity and Portal Hypertension
Authors: Anderson Zachary B. , Thompson Brent 
Published: April 2020

Background

Obesity is a growing epidemic in the United States, affecting an increasing proportion of the adult population. It’s become increasingly important that healthcare professionals are adequately educated about the multi‐faceted nature of obesity in order to best serve their obese patients. It’s crucial that health professions students understand the pathophysiology of obesity, as well as common comorbidities associated with the chronic nature of obesity. There is a strong relationship between obesity and Non‐Alcoholic Fatty Liver Disease, which may lead to cirrhosis of the liver with resultant portal hypertension. Here we apply an innovative teaching method to present a case report for an obese donor with a medical history including cirrhosis of the liver and renal failure. This module is designed to engage and educate health professions students in a way that will have a lasting impact on their appreciation for the health risks of obesity.

Methods

Taking an innovative approach, we completed dissection of an obese donor with known history of cirrhosis of the liver. This dissection was documented with photography and video demonstrations. These images were used as a visual hook for a SoftChalk educational module focused on portal hypertension as a comorbidity of obesity. This module includes lecture material, quizzes, as well as photographic and video demonstrations to allow students to visualize the effects of obesity on the liver and portal venous system.

Results

Through dissection of the obese donor, we were able to visualize an enlarged liver which supports the diagnosis of underlying liver disease. In the vascular system, we were able to visualize an enlarged Superior Mesenteric vein and Splenic vein, the two veins that form the Hepatic Portal vein. An enlarged spleen was also visualized, which may be expected due to Splenic vein congestion. The Azygos system of veins and posterior intercostal veins were also dilated, as well as various superficial abdominal veins. These dilated veins allow for students to visualize the compensations of portal‐caval anastomoses in response to portal hypertension.

Conclusions

The use of obese donors is innovative in that most programs avoid use of morbidly obese donors in the gross anatomy lab, therefore most students have never had a chance to appreciate what morbid obesity looks like (it is not a cosmetic issue). In addition to the educational value of the project, this project affords the opportunity to honor the wishes of obese donors who wish to donate their body to medical education. This educational module allows for a visual learning experience highlighting the relationship between obesity and portal hypertension, which can be utilized as supplemental material in a variety of medical school courses, such as Gastrointestinal and Cardiovascular pathology‐based courses as well as Medical Gross Anatomy. Future directions include expanding the number of modules available, and systematically evaluating the effectiveness of the modules before integrating them into multiple courses. This approach may help advance obesity education in order to best serve patients diagnosed with obesity.