portal hypertension Flashcards
by definition at what pressure does portal hypertension start at ?
5 mmhg
when is portal hypertension clinically significant ?
10 mmhg
when does the development of varicies happen ?
10 - 12 mmhg
what is the main cause of portal hypertension ?
cirrhosis
what are the anatomical classifications of PHT ?
pre hepatic
inta-hepatic
post hepatic
what is the portal vein anatomically formed from ?
from the superior mesenteric vein and the splenic veins
what are the main sites of collaterals ?
gastroesophageal
anterior abdominal wall through the umbilical vein
rectum
left renal vein
diaphragm
retroperitoneal
what is the pathology behind ascites ?
increased portal venous pressure and decreased serum albumin
what type of ascites is caused by portal hypertension ?
transudate
what are the clinical signs for portal hypertension ?
splenomegaly/hypersplenism
esophageal varicies
ascites
portovenous collaterals
what is the most used method for determining HVPG ?
US doppler
what is the gold standard for the measurement of HVPG ?
angiography
whatt is thr most appropriate managemeent for activley bleeding variciess ?
1- resuscitate the patient
2- restore the blood volume, if they need only ( if ischemic target is 8 if not targett is 10 )
3- give somatostatin ( octreotide)
4- band ligation using endoscopy
5- give carvedilol and maintain on beta blockers and continue on endoscopy
if all fails use TIPS
if TIPS fail - liver transplantation
what two veins are connected in TIPS ?
portal and hepatic veins , through entry from the jugular vein
