Portal Hypertension Flashcards

1
Q

Describe portal venous anatomy

A

Portal vein drains abdominal part of GI tract –> carries blood to liver –> venous sinusoids of liver

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2
Q

Where do porto-systemic anastomoses exist?

A

Cardia of stomach
Anus
Retroperitoneal organs
Paraumbilical veins of anterior abdominal wall

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3
Q

Why can portal hypertension occur?

A

No valves in system - blood from portal territory can flow back through system if liver obstructed

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4
Q

Define portal hypertension

A

Pressure in portal vein >10mmHg

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5
Q

How can the causes of portal hypertension be classified?

A

Pre-hepatic
Hepatic
Post-hepatic

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6
Q

What are the pre-hepatic causes of portal hypertension?

A

Portal vein thrombosis

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7
Q

What are the hepatic causes of portal hypertension?

A
Cirrhosis
Hepatitis
Idiopathic non-cirrhotic portal hypertension
Schistosomiasis
Congenital hepatic fibrosis
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8
Q

What are the post-hepatic causes of portal hypertension?

A

Budd-Chiari syndrome

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9
Q

What are the clinical manifestations of portal hypertension?

A
Variceal bleeding
Haemorrhoids/caput medusae
Ascites
Splenomegaly
Porto systemic encephalopathy
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10
Q

What is Budd-Chiari Syndrome?

A

Occlusion of hepatic veins w/ 3 key Sx (v. rare)

  • abdominal pain
  • ascites
  • hepatomegaly
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11
Q

How is acute variceal bleeding managed acutely?

A

A-E resus
Vit K & FFP to correct clotting
IV terlipressin (or somatostatin analogues)
IV antibiotic prophylaxis (decreases mortality)
Sengsten Blakemore tube if cannot get to theatre immediately and bleeding badly
Endoscopy and ligation
TIPs procedure if all else fails

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12
Q

What is the definitive management for varices resistant to banding?

A

Transjugular intrahepatic portosystemic shunting (TIPSS)

-can use surgical porto-caval shunts

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13
Q

What prophylaxis for bleeding varices is available?

A

Endoscopy +/- adrenaline & banding
Sclerotherapy
Non-selective b-blockers

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