Portal Hypertension Flashcards
What is portal hypertension?
Increased pressure in the portal vein, due to resistance to blood flow.
How might portal hypertension present?
SPLENOMEGALY!
Stigmata of CLD Coagulopathy Ascites Varices Encephalopathy
Caput Medusae
Why do caput medusae form?
Because of increased pressure in the portal vein, there is increased pressure in the umbilical vein leading to protrusions.
How would you treat ascites?
Spironolactone
Gradually to avoid encephalopathy
What are the main causes of portal hypertension?
Cirrhosis
Thrombus in portal vein
Schistomoniasis
How would you investigate portal hypertension?
Bloods - may show thrombocytopenia, due to splenomegaly
LFTs - deranged
USS abdo - cirrhosis? thrombosis?
+ Doppler - pressure gradient across the vein
Endoscopy - check for varices
How would you treat portal hypertension and complications?
TIPS - transhepatic intrajugular portosystemic shunt
B-Blocker - reduce pressure in portal vein
Ascites - spironolactone - gradual
Variceal bleed - banding during endoscopy
How are beta-blockers effective in reducing pressure in the portal vein?
Cause vasoconstriction of the splanchnic arteries which reduces portal flow
What is TIPS?
Transhepatic Intrajugular Portosystemic Shunt
Insert shunt between the tributaries of the portal vein and hepatic vein
What is a complication of TIPS?
Encephalopathy
Blood is not being detoxified, so toxin blood is flowing to brain
What is the main complication of portal HTN?
Variceal bleed
