Portal Hypertension Flashcards
What is portal hypertension?
Pressure gradient b/w hepatic vein pressure and wedged hepatic vein pressure (corrected sinusoidal pressure) >5mmHg.
What triggers the pressure gradient in portal hypertension?
3 sites of increased resistance (pressure = flow x resistance)
- Presinusoidal
- Sinusoidal
- Post sinusoidal
What are pre sinusoidal causes of portal hypertension?
Portal vein thrombosis, schistosomiasis, sarcoidosis.
What are sinusoidal causes of portal hypertension?
Cirrhosis, alcoholic hepatitis.
What are post-sinusoidal causes of portal hypertension?
- RHF
- Hepatic vein thrombosis
- Veno-occlusive disease
- Constrictive pericarditis
What are the complications of portal hypertension?
- GI bleeding (from varices)
- Ascites
- Hepatic encephalopathy
- Thrombocytopenia
- Renal dysfunction
- Sepsis
- Arterial hypoxaemia
What are the signs of portal hypertension?
- Oesophageal varices
- Melaena
- Splenomegaly
- Ascites
- Haemorrhoids
Management of portal hypertension?
- B blockers
- Nitrates
- Shunts (e.g. TIPS)
What does TIPS stand for?
Transjugular intrahepatic portosystemic shunt (TIPS)
Why are B blockers used in portal HTN?
Non-selective B blockers (propranolol, nadolol) decrease risk of bleeding from varices.
What does the TIPS procedure involved?
-Shunt between portal and hepatic veins via transjugular vein catheterisation and percutaneous puncture of portal vein. Shunt usually remains open
What are the complications of the TIPS procedure?
Hepatic encephalopathy, deterioration of hepatic function.
When is TIPS contraindicated?
Severe hepatic dysfunction.
