Portal Hypertension

Question 1

Management of portal hypertension

Answer 1

PREVENT variceal bleeding from occurring

Question 2

How do varices form?

Answer 2

Blood shuts away from the liver and pools elsewhere
But the vessels are not made to accommodate large vol
Ends up distending and blood pools == prone to bleed

Question 3

How do you diagnose portal HTN

Answer 3

presence of varices = endoscopy (often done when admitted for ascites)

Portal HTN = SAAG≥1.1 g/dL (serum alb - ascitic)

Question 4

What is the goal of portal HTN treatment

Answer 4

Prevention worsening (does not stop development of varices)
Prevent enlargement of varices
Prevent variceal bleeding

Question 5

Portal HTN treatment

Answer 5

If varices: Nonselective betablocker (Pro,Car,Na)
Start low go slow
Titrate to BPM 60 (HR)

Question 6

How do nonselective beta blockers help portal HTN?

Answer 6

• B1 block = decrease HR and CO to reduce portal pressure
• B2 block = decrease splenic vasodilation

Question 7

When do we hold beta blockers?

Answer 7

Hypotension (<90/<60)
bradycardia HR <60

Question 8

How do we treat patients with portal htn if they do not have varices ?

Answer 8

No beta blocker
supportive care

Question 9

Propanolol

Answer 9

20-40mg BID

Question 10

Nadolol

Answer 10

20-40 mg QD

Question 11

Carvedilol

Answer 11

3.125 mg BID