Portal Hypertension Flashcards
What is the pathophysiology behind portal hypertension
Increased intrahepatic resistance to the passage of blood flow through the liver d/t cirrhosis
Increased splanchnic blood flow d/t vasodilation w/in splanchnic vascular bed
What are the three subcategories of portal htn and the causes
Prehepatic: Portal vein thrombosis, splenic vein thrombosis, massive splenomegaly (banti’s syndrome)
Hepatic: cirrhosis
Postheaptic: budd-chiari syndrome, inferior vena cava webs, pericarditis, cardiomyopathy, CHF
Complications of portal htn
Varices, ascites, hpyersplenism
Symptoms of portal htn
Varices, hypersplenism leading to thrombocytopenia, ascites
Portal HTN diagnostics
Thrombocytopenia, ascites, enlarged spleen, encephalopathy
CT or MRI to identify nodular liver
Endoscopy for varices
Elevated Hepatic venous pressure gradient >5mmhg
Treatment for portal htn
Treat cause
BB To reduce HVPG
What is the pathophysiology behind esophageal varices
Portal vein system drains blood from stomach, pancreas, spleen, and gallbladder
Obstruction in portal vein causes esophageal varices
What is the diagnostic for esophageal varices
EGD
At what HPVG are esophageal varies likely to hemhorrage
> 12
What is the primary prophylaxis for esophageal varices
Routine EGD with banding
BB nonselective
What is the prevention for rebleeding of esophageal varices
Repeat EGD with banding and ligation
How to manage an acute esophageal hemorrhage
IVF and blood product
Octreotide/ sandostatin
Varices banding vs injection
What is TIPS procedure and when is it indicated
Essentially a shunt
It is only indicated when EGD and medical therapy fails or as a bridge to transplant
