Portal Hypertension

Question 1

What are the causes of portal hypertension divided into. (3)

Answer 1

Pre hepatic.
Hepatic.
Post hepatic.

Question 2

What are the pre-hepatic causes of portal hypertension.

Answer 2

Thrombosis (portal or splenic vein).

Question 3

What are the hepatic causes of portal hypertension. (6)

Answer 3

Presinudoidal. 
Cirrhosis (80%).
Schistosomiasis (commonest worldwide). 
Sarcoidosis. 
Myeloproliferative diseases. 
Congenital hepatic fibrosis.

Question 4

What are some post hepatic causes of portal hypertension. (4)

Answer 4

Budd-Chiari syndrome.
Right heart failure (rare).
Constrictive pericarditis.
Veno-occlusive disease (ie IVC obstruction). .

Question 5

What is a potential consequence of portal hypertension.

Answer 5

The collaterals at the gastro-oesophageal junction (varices) are superficial and tend to rupture.

Question 6

What two vessels for the portal vein. (2)

Answer 6

The portal vein is formed by the union of the superior mesenteric and splenic veins.

Question 7

How is portal hypertension classified.

Answer 7

According to the location of obstruction.

Question 8

What are the main sites of collateral vein formation if the pressure in the portal vein is raised. (6)

Answer 8

Rectum. 
Gastro-oesophageal junction. 
Left renal vein. 
Diaphragm. 
Retroperitoneum. 
Anterior abdominal wall via the umbilical vein.

Question 9

How often are rectal varices found in patients with portal hypertension.

Answer 9

30% of patients.

Question 10

What is portal hypertension. (2)

Answer 10

Portal vascular resistance is increased in chronic liver disease (due to fibrosis of liver itself).
This causes abnormal blood flow patterns and increased resistance to blood flow (portal hypertension results).

Question 11

How do patients tend to present in prehepatic causes of hypertension. (3)

Answer 11

With bleeding.
At a young age.
Normal liver function.

Question 12

How is portal vein blockage diagnosed.

Answer 12

Ultrasound with Doppler imaging.

Question 13

What are the clinical features of portal hypertension. (6)

Answer 13

Often asymptomatic.
Splenomegaly tends to be the only clinical indication of portal hypertension.
Other features may include:
Haematemesis or melaena from rupture of gastro-oesophageal varices or portal hypertensive gastropathy.
Ascites.
Breathlessness due to porto-pulmonary hypertension.
Encephalopathy.

Question 14

What percentage of patients with cirrhosis will develop oesophageal varices.

Answer 14

90% will develop them over 10 years.

Question 15

What are oesophageal varices likely to bleed. (3)

Answer 15

Large.
Red signs on endoscopy.
Severe liver disease.

Question 16

What drugs are used to treat oesophageal varicies. (2)

Answer 16

Terlipressin.

Somatostatin.

Question 17

What are the most common sites for varices to develop. (3)

Answer 17

Caput medusae (around umbilical vein). 
Anorectal varices. 
Oesophageal varicies.