portal hypertension

Question 1

what is portal hypertension ?

Answer 1

pathological increase of portal venous pressure gradient above 5mmHG

Question 2

when is portal hypertension clinically significant ?

Answer 2

at 10 mmHg

Question 3

at what level of portal hypertension do varices begin to form ?

Answer 3

at 10 to 12 mmHG

Question 4

what are varices ?

Answer 4

portosystemic shunts

Question 5

what is the main cause of portal hypertension ?

Answer 5

liver cirrhosis

Question 6

what is the anatomical classification of PHT ?

Answer 6

pre-hepatic , intra-hepatic and post hepatic causes
also known as
pre-sinusoidal, sinusoidal and post sinusoidal

Question 7

what are the causes of pre sinusoidal PHTN?

Answer 7

veno-occlusive disease

alcoholic central hyaline sclerosis

Question 8

what are the causes of sinusoidal PHTN ?

Answer 8

cirrhosis

Noncirrohotic PHT

Question 9

what are the causes of post sinusoidal PHTN ?

Answer 9

schistomasiasis
early primary biliary cirrhosis
sarcoidosis

Question 10

what is the normal portal pressure ?

Answer 10

5-10 mmHG

Question 11

what is the main cause of noncirrohotic portal hypertension ?

Answer 11

hypercoaguable state

Question 12

what is the gold standard technique for the detection of PHT ?

Answer 12

measurement of the HVPG

Question 13

what are the clinical signs of portal hypertension ?

Answer 13

splenomegaly
oesophageal varicies
ascites
portovenous collaterals

Question 14

what is the management of portal hypertension ?

Answer 14

vasoconstrictors 
band ligation for the varicies 
sclerotherapy 
b-blocker
liver transplantation
devascularization

Question 15

what is the best step in management in the case of an actively bleeding varicies ?

Answer 15

somatostatin (octeotride)

Question 16

how do we stop further bleeding of varicies ?

Answer 16

endoscopy

Question 17

what can be done in terms of prophylactic care to stop the bleeding of varicies ?

Answer 17

prophylactic band ligation n

prophylactic b-blocker

Question 18

sequence of events of a bleeding varicies patient :

Answer 18

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