Portal hypertension Flashcards
Define and give the pathophysiology with causes of portal hypertension
It’s elevated portal vein pressure due to obstruction of blood flow in the portal system. Causes are prehepatic (portal vein thrombosis, splenic vein thrombosis), hepatic (cirrhosis, metastasis,, schistosomiasis, biliary malignancy), post hepatic (hepatic vein thrombosis Budd Chiari, right HF). The subsequent backup of blood flow results in formation of portosystemic anastomoses and signs symptoms of portal HTN
Portosystemic collaterals and their clinical. Manifestations
Left gastric vein to esophageal veins- esophageal varices. Umbilical vein to epigastric- caput medusa. Superior hemorrhoidal vein to middle and inferior hemorrhoidal- hemorrhoids. Vein of retzius to retroperitoneal lumbar veins- retroperitoneal varices
Signs and symptoms of portal HTN
Splenomegaly (most common)
Esophageal varices, caput Medusa, hemorrhoids -> hematemesis and hematochezia
Signs and symptoms of cirrhosis: jaundice, Palmer erythema, spider angiomata, ascites, asterixis, hepatic encephalopathy, truncal obesity and peripheral wasting
Most common cause of portal HTN worldwide and in US? Treatment?
Worldwide is schistosomiasis
US it is cirrhosis.
Drugs: non selective BB carvedilol
Transjugular intrahepatic portosystemic shunt it’s a stent btw hepatic and portal veins
Indications of TIPS:
Recurrent/refractory ruptured esophageal varices.
Complication of portal HTN refractory to medical treatment
Initial management of ruptured esophageal varices and diagnosis?
Similar to all upper GI bleeding: two large bore IV cannulas, give IV fluids, intubate to protect from aspiration, administer Foley catheter, send CBC.
Upper GI endoscopy to rule out other causes of upper GI bleed
Definitive treatment for ruptured esophageal varices
Endoscopic sclerotherapy, endoscopic band ligation, somatostatin or vasopressin
If bleeding continues, consider balloon tamponade (sengstaken blakemore tube)
If bleeding continues or recurs, perform TIPS
