Portal HTN and Oesophageal Varices Flashcards
What is Portal htn
Complication of Cirrhosis increasing pressure in portal vein
What are the three types of causes for portal HTN
Prehepatic
Intrahepatic
Post hepatic
What is Prehepatic cause of Portal HTN
Portal vein thrombosis
What is an intra hepatic cause of Portal HTN
Cirrhosis
Schistomiasis
What is a Post hepatic cause of Portal HTN
Budd Chiari (Hepatic vein obstruction)
RHF
Constrive Pericarditis
What is the pathology of Portal HTN
Normal pressure = 5-8mmHg
-Cirrhosis increases resistance = Splanchinc dilation and increased CO
-Fluid overload in portal vein
-Collateral blood shunt to GO veins = Oesophageal varices
@cardia and low esophagus
Where do Oesophageal varices typically present
Cardia
Lower Oesophagus
How does a patient w/ Portal HTN present
Asymptomatic until rupture of varices
What is an oesophageal varices
Result of Portal HTN @Cardia and lower oesophagus
How does a patient present with Oesophageal varices (with and without rupture)
Without = Asymptomatic Ruptured = Haematemesis
What is a differential for oesophageal varies rupture
Mallory Weis tear (Mucosa)
Presents - Acute with increased abdo pressure and retching (After alcohol)
How are oesophageal varices diagnosed
OGD of Upper GI
How OV Ruptures acutely treated
Resuscitation until Haemo stable
Blood Transfusion
How is bleeding of ruptured OV treated
IV Terupressin
Variceal banding
TiPPS (Decrease portal pressure)
How is bleeding prevented in OV Rupture
Beta Blocker w/ Nitrates
Repeat variceal banding
Liver transplant
