Portal Hypertension

Question 1

Describe the portal venous anatomy?

Answer 1

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

When pressure becomes raised; collaterals form within the systemic circulation.

Question 2

What is portal hypertension and what are the causes?

Answer 2

Increased pressure within the portal venous system.

Prehepatic: blockage before the liver, portal/splenic vein stenosis or compression

Hepatic: due to distortion of the liver architecture aka cirrhosis

Post Hepatic: Blockage of hepatic veins or venules
Severe RHF
Constrictive pericarditis

Question 3

In portal hypertension where are the collateral circulations formed?

Answer 3

Gastro-oesophageal junction
Rectum
Left Renal Vein
Diaphragm
Retroperitoneum

Question 4

What are the signs of portal hypertension?

Answer 4

Varices:
Oesophageal 
Caput Medusae
Umbilical 
Haemorrhoids

Splenomegaly

Question 5

Describe the management of bleeding oesophageal varices?

Answer 5

A to E assessment.

Airway may be compromised due to bleeding.
B: May be infection afterwards due to aspiration
C: Fluid/Blood resuscitation (consider major haemorrhage protocol)

Refer for emergency endoscopy band ligation. If this is not possible a balloon tamponade can be used as a temporary measure.

Prophylactic antibiotics should be used to prevent aspiration pneumonia from occurring.

If a patient is on low dose aspirin or clopidogrel consider stopping initially.