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2nd Year - Alimentary Diseases > 3.3. Liver + Biliary Tree Disease - Portal Hypertension and Variceal Haemorrhage > Flashcards

3.3. Liver + Biliary Tree Disease - Portal Hypertension and Variceal Haemorrhage Flashcards

1
Q

What causes Variceal Haemorrhage?

A

Hepatic Portal Hypertension

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2
Q

What are the 3 types of Hepatic Portal Hypertension?

A
  1. Pre-Hepatic Portal Hypertension
  2. Intrahepatic Portal Hypertension
  3. Post-Hepatic Portal Hypertension
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3
Q

What is the cause of Pre-Hepatic Portal Hypertension?

A

A Portal Vein Thrombosis

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4
Q

What are the causes of Intrahepatic Portal Hypertension?

A
  1. Liver Cirrhosis
  2. Non-Cirrhotic Portal Hypertension
  3. Schistosomiasis
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5
Q

What are the causes of Post-Hepatic Portal Hypertension?

A
  1. Inferior Vena Cava Obstruction
  2. Constrictive Periarditis
  3. Right Heart Failure
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6
Q

What is the Overall Pathology of Portal Hypertension?

A

An increase in Intrahepatic Blood Pressure

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7
Q

What is the method of action of a Pre-Hepatic Portal Hypertension?

A

The Blockage of the Hepatic Portal Vein, before the Liver, means there is a back-up of pressure throughout the entire Portal System

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8
Q

What is the method of action of a Intrahepatic Portal Hypertension?

A

The Distortion of the Liver architecture results in the obstruction of blood flow, and the back-up of pressure throughout the entire Portal System

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9
Q

What is the method of action of a Post-Hepatic Portal Hypertension?

A

Due to a the back up of pressure as the blood leaves the Liver, there is a back up of pressure throughout the Portal System

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10
Q

How does Liver Cirrhosis distort the Liver (Intrahepatic)?

A

The is a restricted path for the blood flow, but the same volume of blood passing through

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11
Q

How does Non-Cirrhotic Portal Hypertension distort the Liver (Intrahepatic)?

A

There is mild Portal-Tract Fibrosis

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12
Q

How does Schistosomiasis distort the Liver (Intrahepatic)?

A

This is a disease caused by parasitic Flatworms, which causes extensive “Pipe-Stem” fibrosis

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13
Q

How does Inferior Vena Cava Obstruction cause a back up of pressure within the Liver (Post-Hepatic)?

A

There is a reduced outflow from the Hepatic Veins, and the pressure backs up from there

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14
Q

How does Constrictive Pericarditis / Right Heart Failure cause a back up of pressure within the Liver (Post-Hepatic)?

A

There is a Reduced intake from the Heart, and the pressure backs up from there

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15
Q

What are the Clinical Features of Portal Hypertension?

A
  1. Asymptomatic (Until Rupture)
  2. Splenomegaly
  3. Ascites
  4. Encephalopathy
  5. Breathlessness
  6. Haematemesis
  7. Melena
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16
Q

What causes Splenomegaly?

A

The Portal Hypertension also causes a back-log of pressure onto the Spleen

17
Q

What causes Ascites?

A

Blood entering into the Peritoneal Cavity upon a rupture (Variceal Hemorrhage)

18
Q

What causes Encphalopathy?

A

The Livers inability to deal with Noxious Substances to the Brain

19
Q

What causes Breathlessness?

A

The Porto-Pulmonary Hypertension (Hepatopulmonary Syndrome)

20
Q

What causes Haematemesis / Melena?

A

Blood entering into the Alimentary Lumen upon a rupture (Variceal Hemorrhage)

21
Q

What is the Best Management of Portal Hypertension?

A

Prophylactic Measures against Bleeding

22
Q

What is included in the Prophylactic Measures?

A
  1. Beta-Blockers
  2. Variceal Banding
  3. Transjugular Intrahepatic Portocaval Shunt
23
Q

Does a Beta-Blocker prevent Varicies from forming?

A

No

24
Q

What is the Management of an Acute Variceal Bleed?

A

1a) Vasoconstriction Therapy
OR
1b) Resuscitation (+ Ascitic Tap, Prophylactic Antibiotics etc)
2. Urgent Endoscopy with Banding (or Injection Sclerotherapy)

25
Q

What happens if there is an early re-bleed?

A

Repeat Endoscopic Therapy

26
Q

If the Bleeding stops after the Repeated Endoscopic Therapy (After the Re-Bleed), what happens next?

A

There will be assessment for Prophylactic Measures

27
Q

What happens if the Endoscopic Therapy Fails (After the Re-Bleed)?

A
  1. A Sengstaken Tube is temporarily inserted
    2a) Transjugular Intrahepatic Portocaval Shunt is inserted
    OR
    2b) Surgery with an Injectable Adhesive is used

2nd Year - Alimentary Diseases (41 decks)

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