Portal hypertension Flashcards
what 4 things is portal hypertension associated with
gastro oesophageal varices
ascites
hypersplenism
hepato-renal syndrome
definition of portal hypertension
patho increase in portal pressure characterised by a pressure gradient between the portal vein and inferior vena cava above 5mmHg
> 10 ca: varices
12: bleeding, ascites
presinusoidal causes
portal vein thrombosis-acute pan, thrombophilia
schisto-periportal fibrosis (normal liver function)
toxins
primary biliary cirrhosis
sinusoidal causes
cirrhosis
acute alcoholic hepatitis
cytotoxic drugs
Vit A toxicity
postsinusoidal causes
veno-occlusive disease (Budd Chiari syndrome)
pathophysiology
cirrhosis-structural damage caused by fibrosis, increased resistance to flow
also functional-endothelial cell dys, imbalance between vasodil and vasocons
sodium retention, ascites and hepatorenal syndrome
screening for patients with PH
varices-half will have, 1/3 will bleed
HCC
primary prophylaxis for varices
propanolol (non-selective) or carvedilol
banding not usually included but only used if beta blocker not tolerated, or very large varices, advanced disease
what should Hb be?
> 8g/dl
when do you give platelets
<50
when do you give FFP
INR >1.5
After resus, what do you do?
Endoscopic techniques like banding or sclerotherapy
also give A/B: spon bact peritonitis, asp pneumonia, UTIs (ceft, ampi because not hepatotoxic)
give lactulose-hepatic enceph
once stable: CT scan liver (best), portal vein thromb, HCC, Hep B studies, schisto serology, long term follow up
what does octreotide do
somatostatin analogue, 72 hrs continuous infusion
decreases splanchnic blood flow, intrahepatic vasodil
when do you use sclerotherapy instead of band
gastro (difficult to band oesoph)
many complications though
uncontrolled bleeding plan
balloon tamponade-sen starken blakemore? inserted through mouth
denis stent-often migrate BUT dont need to be intubated
