Portal Hypertension Flashcards
The portal vein is formed of both?
Splenic and superior mesenteric vein
The portal vein enters the liver at?
Ports hepatitis
The normal portal venous pressure is between…?
5-10mmHg
How do we measure the HVPG (hepatic venous pressure gradient)?
Via hepatic catheterization
What’s the normal HVPG?
Smaller than or equal to 5
What is the HVPG value where we deem clinically significant portal hypertension?
Greater than 10
What is WHVP?
Wedged hepatic venous pressure, it’s an estimate of pressure within the portal venous system
A rise in portal venous pressure but normal WHVP and HVGP mean?
Presinusoidal PH
What are the 2 most common symptoms of Portal Hypertension?
Upper GI bleeding and dyspepsia (discomfort after meals)
PH should be suspected when we see…?
GI bleeding, ascites, or splenomegaly
The diagnosis of PH is established when we find?
Dilated abdominal wall veins or varices
What’s a Doppler ultrasound?
Measures the blood flow in the portal and hepatic veins to detect stenosis or thrombosis
When there’s upper GI bleeding what do we do?
An upper GI endoscopy
In terms of lab tests, there is one most consistently associated with PH of any cause, what is it?
A reduced platelet count, due to the hypersplenism induced by splenomegaly
Vasoconstrictors are the first treatments for PH, targeting the increased splanchnic blood flow, which one do we prescribe?
Terlipressin
Terlipressin and its sister octreotide are prescribed to treat what complication of PH?
Acute bleeding episode
What do we prescribe to treat PH more long term like to prevent variceal bleeding to begin with?
NSBBs
Contraindications of Terlipressin?
Severe arterial hypertension and coronary heart disease
What is Octreotide’s method of working?
It inhibits the hormones that induce splanchnic vasodilatation
What are the NSBBs we prescribe?
Propranolol and nadolol
When should NSBBs be discontinued?
Patients with cirrhosis
