Cirrhosis and portan hypertension Flashcards

1
Q

Complications of cirrhosis

A

Portal hypertension
Variceal haemorrhage
Primary Biliary Cirrhosis

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2
Q

What veins join to form portal vein

A

Superior mesenteric vein

Splenic veins

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3
Q

Normal pressure of portal vein

A

5-8mmHg (small gradient across the liver)

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4
Q

What vein transports blood from liver to inferior vena cava

A

Hepatic vein

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5
Q

Pre-hepatic causes of portal hypertension

A

Portal vein thrombosis

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6
Q

Intra-hepatic causes of portal hypertension

A

Cirrhosis (80% UK)
Schistosomiasis (commonest worldwide)
Sarcoidosis

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7
Q

Post-hepatic causes of portal hypertension

A
Right HF (rare)
Constrictive pericarditis
IVC obstruction
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8
Q

What is most common cause of hepatic portal hypertension worldwide

A

Schistosomiasis

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9
Q

Pathophysiology of portal hypertension

What causes 1st increase in BP, then decrease in BP, then 2nd increase in BP

A

1st INCREASE:
Liver injury and fibrogenesis (e.g. due to cirrhosis)
Contraction of activated myofibroblasts (mediated by endothelin, nitric oxide and prostaglandins) contributes to increased resistance to blood flow (vasoconstriction)
Causes portal hypertension
DECREASE:
→ splanchnic vasodilation
→ drop in BP
2nd INCREASE:
→ increased cardiac output to compensate for BP
→ salt and water retention to increase blood volume and compensate
→ hyperdynamic circulation (high circulatory volume) /increased portal flow
→ Formation of collaterals between the portal and systemic systems e.g. in the lower oesophagus and gastric cardia

Microvasculature of gut becomes congested and gives rise to portal hypertensive gastropathies and colopathies

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10
Q

Sites of collaterals/varices as a result of portal hypertension

A
  • Gastro-oesophageal junction - superficial and tend to rupture
  • Rectum (30%)
  • Left renal vein
  • Diaphragm
  • Retroperitoneum
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11
Q

Portal hypertension clinical presentation

A

Often asymptomatic

Only clinical sign = splenomegaly (unspecific)

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12
Q

Portal hypertension clinical presentation if chronic liver disease present

A
  • Haematemesis and melaena from ruptured gastro-oesophageal varice or portal hypertensive gastropathy
  • Clubbing
  • Palmar erythema
  • Dupuytren’s contracture (one or more fingers bending into palm of hand)
  • Spider naevi
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