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Upper GI Tract > Portal Hypertension > Flashcards

Portal Hypertension Flashcards

1
Q

How are the causes of portal hypertension divided?

A

Pre-hepatic
Hepatic
Post-hepatic

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2
Q

What are the pre-hepatic causes of portal hypertension? (1)

A

Portal vein thrombosis (e.g. pancreatitis)

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3
Q

What are the hepatic causes of portal hypertension? (3)

A

Cirrhosis (80%)
Schisto
Sacrcoidosis

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4
Q

What are the post hepatic causes of portal hypertension? (4)

A

Budd-Chiari
RHF
Constrictive pericarditis
Tricuspid regurg

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5
Q

Blood in the left and short gastric veins is shifted to…

Causing what…?

A

Inf oesophageal veins

Oesophageal varices

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6
Q

Blood in the peri-umbilical veins is shifted to the…

causing what..?

A

superficial abdo wall veins

Caput medusa

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7
Q

Blood in the sup. rectal veins is shifted to the…

Causing what…?

A

Inf and mid rectal veins

Haemorrhoids

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8
Q

Why does encephalopathy occur in portal hypertension?

A
  • decreased hepatic metabolic function
  • diversion of toxins into systemic system
  • ammonia accumulates and pass into brain
  • astrocytes clear it causing glutamate to become glutamina
  • rising glutamine = osmotic inbalance = cerebral oedema
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9
Q 
How does portal hypertension encephalopathy present?
A\_\_\_\_\_\_\_
A\_\_\_\_\_
C\_\_\_\_\_\_\_
D\_\_\_\_\_\_
C\_\_\_\_\_\_\_\_\_ A\_\_\_\_\_\_\_
S\_\_\_\_\_\_\_
A 
Asterixis
Ataxia
Confusion
Dysarthria
Constructional Apraxia
Seizures
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10
Q

How do you investigate portal hypertension encephalopathy

A

Test plasma Ammonia (NH4)

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11
Q

What is the pneumonic for remembering the 4 main sequelae of portal hypertension

A 
SAVE
Splenomegaly
Ascites
Varices
Encephalopathy
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12
Q

What are the five F’s of abdo distension?

A 
Fat
Fluid
Faeces
Fetus
Flatus
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13
Q

What are the six causes of ascites?

A 
Portal hypertension (back-pressure of fluid)
Hypoalbuminaemia
Neoplasia (peritoneal or visceral)
Inflammation (pancreatitis)
Nephrotic Syndrome
Infection (TB peritonitis)
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14
Q

How do you differentiate between ascites caused by portal HTN and hypoalbuminaemia?

A

Serum Ascites Albumin Gradient (SAGG)

>1.1g/dL = Portal HTN, nephrotic syndrome, CLD (transudate)
<1.1g/dL = Tumours, pancreatitis (exudates)
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15
Q

Treatment of ascites?

A

Treat the cause (bacterial, malignancy, etc)
Reduce fluid and Na+ intake
Spironolactone/furosemide
Paracentesis

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Upper GI Tract (17 decks)

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