Portal hypertension Flashcards
Define portal hypertension
Abnormally high pressure within the hepatic portal vein
Clinically significant defined as hepatic venous pressure gradient >10mmHg
Aetiology of portal hypertension
most common + 3
Cirrhosis
Pre hepatic
Hepatic
Post hepatic
Aetiology of portal hypertension - pre hepatic
4
(blockage of portal vein before the liver) Congenital stenosis Portal vein thrombosis Splenic vein thrombosis Extrinsic compression
Aetiology of portal hypertension - hepatic
4
Cirrhosis
Chronic hepatitis
Schistosomiasis
Myeloproliferative disease
Aetiology of portal hypertension - post hepatic
3
(blockage of hepatic veins or venules)
Budd-Chiari syndrome (hepatic vein obstruction)
Constrictive pericarditis
Right heart failure
Epidemiology of portal hypertension
Common consequence of cirrhosis
Presenting symptoms of portal hypertension - features of liver disease
(4)
Jaundice
History of alcohol abuse
Risk factors for viral hepatitis
FH (e.g. haemochromatosis)
Presenting symptoms of portal hypertension - complications of portal hypertension
(5)
Haematemesis of melaena Lethargy, irritability, changes in sleep - hepatic encephalopathy Abdominal distention - ascites Abdominal pain & fever - SBP Pulmonary involvement
Signs of portal hypertension on physical examination
3
Caput medusae
Splenomegaly
Ascites
Signs of liver failure on physical examination
9
Jaundice Spider naevi Palmar erythema Confusion Asterixis Feto hepaticus Enlarged or small liver Gynaecomastia Testicular atrophy
Investigations for portal hypertension
5
Bloods Specific tests Imaging HVPG (hepatic venous pressure gradient) Liver biopsy
Investigations for portal hypertension - bloods
5
LFTs U&Es Blood glucose FBC Clotting screen - prolongation of PT is one of earliest signs of liver failure
Investigations for portal hypertension - specific tests
5
Ferritin - haemochromatosis Hepatitis serology Autoantibodies (e.g. anti smooth muscle antibodies in autoimmune hepatitis) α1-antitrypsin levels Caeruloplasmin - Wilson’s disease
Investigations for portal hypertension - imaging
4
Abdo US - check liver & spleen size & assess portal blood flow
Doppler US - assess direction of flow in blood vessels
CT/MRI - if others inconclusive
Endoscopy - check oesophageal varices
Investigations for portal hypertension - liver biopsy
If indicated
Management of portal hypertension
general + 6
Difficult to treat portal hypertension specifically, so focussed on underlying cause where possible
Conservative - salt restriction & diuretics
Treatment of oesophageal varices if [resent
Non selective β blockers - reduces portal pressure & risk of variceal bleeding
Terlipressin - reduce portal venous pressure
TIPS - surgical shunt between hepatic portal vein & hepatic vein to ease congestion
Liver transplant
Complications of portal hypertension
6
Bleeding from oesophageal varices
Ascites -
SBP
hepatorenal syndrome
hepatic hydrothorax
Pulmonary complications -
portopulmonary hypertension
hepatopulmonary syndrome
Liver failure
Hepatic encephalopathy
Cirrhotic cardiomyopathy
Define hepatorenal syndrome
Life threatening condition w/ rapid deterioration in kidney function in individuals w/ cirrhosis or fulminant liver failure
Define hepatic hydrothorax
Transudative pleural effusion in patients w/ portal hypertension without any underlying primary cardiopulmonary cause
Hepatopulmonary syndrome is a triad of:
hepatic dysfunction hypoxaemia extreme vasodilation (intrapulmonary vascular dilatation)
Prognosis of portal hypertension
2
Depends on underlying cause
Variceal haemorrhages hae 40% 1 yr mortality
