portal hypertension Flashcards
what is portal hypertension ?
pathological increase of portal venous pressure gradient above 5mmHG
when is portal hypertension clinically significant ?
at 10 mmHg
at what level of portal hypertension do varices begin to form ?
at 10 to 12 mmHG
what are varices ?
portosystemic shunts
what is the main cause of portal hypertension ?
liver cirrhosis
what is the anatomical classification of PHT ?
pre-hepatic , intra-hepatic and post hepatic causes
also known as
pre-sinusoidal, sinusoidal and post sinusoidal
what are the causes of pre sinusoidal PHTN?
veno-occlusive disease
alcoholic central hyaline sclerosis
what are the causes of sinusoidal PHTN ?
cirrhosis
Noncirrohotic PHT
what are the causes of post sinusoidal PHTN ?
schistomasiasis
early primary biliary cirrhosis
sarcoidosis
what is the normal portal pressure ?
5-10 mmHG
what is the main cause of noncirrohotic portal hypertension ?
hypercoaguable state
what is the gold standard technique for the detection of PHT ?
measurement of the HVPG
what are the clinical signs of portal hypertension ?
splenomegaly
oesophageal varicies
ascites
portovenous collaterals
what is the management of portal hypertension ?
vasoconstrictors band ligation for the varicies sclerotherapy b-blocker liver transplantation devascularization
what is the best step in management in the case of an actively bleeding varicies ?
somatostatin (octeotride)
how do we stop further bleeding of varicies ?
endoscopy
what can be done in terms of prophylactic care to stop the bleeding of varicies ?
prophylactic band ligation n
prophylactic b-blocker
sequence of events of a bleeding varicies patient :
ICU | give blood | somatostatin (octeotride) | injection sclerotherapy or band ligation | give carvidolol and maintain on beta blockers
if none of this works out proceed with TIPS
TIPS failed ? perform a liver transplant
