Portal HTN

Question 1

What is the definition of portal HTN?

Answer 1

hepatic venous pressure gradient > 6mmHg

- > 12 is associated with complications

Question 2

What are the causes of portal HTN?

Answer 2

Prehepatic

• portal vein thrombosis
• splenic vein thrombosis

Hepatic
- cirrhosis

posthepatic

• budd chiari
• right sided heart failure
• constrictive pericarditis

Question 3

What are the clinical features of portal HTN?

Answer 3

• paraumbilical veins & epigastric veins -> caput medusa
• rectal veins -> hemorrhoidal or anorecal varices
• veins of gastric fundus & distal 1/3rd of the esophagus -> esophageal & gastric varices -> hematemesis & melena
• congestive splenomegaly -> thrombocytopenia
• ascites

Question 4

What investigations should be done is suspected portal HTN?

Answer 4

• Paracentesis -> SAAG > 1.1 & ascetic albumin < 2.5mg/dl
• abdominal ultrasound -> splenomegaly & ascites
• duplex ultrasonography -> portal vein thrombosis
• EGD on a regular basis -> if positive for varices: BAND LIGATION

Question 5

What is the first line medication for portal HTN?

Answer 5

nonselective beta blockers -> propranolol

Question 6

What are the indications for TIPS?

Answer 6

• persistent, recurring, or treatment resistant upper GI bleed
• refractory ascites
• acute thrombosis of portal vein
• patients with hepatorenal syndrome who are not eligible for or awaiting liver transplants

Question 7

How should upper GIT bleed be managed?

Answer 7

RESUSCITATION -> two 16 gauge peripheral intravenous catheter
-> isotonic crystalloids (NS or RL)
PHARMA -> octreotide
EGD -> within 12 hours of admission -> band ligation
PROPHYLAXIS -> IV ceftriaxone until bleeding stops
AMS -> endotracheal intubation to avoid aspiration