Portal Hypertension

Question 1

Describe portal venous anatomy

Answer 1

Portal vein drains abdominal part of GI tract –> carries blood to liver –> venous sinusoids of liver

Question 2

Where do porto-systemic anastomoses exist?

Answer 2

Cardia of stomach
Anus
Retroperitoneal organs
Paraumbilical veins of anterior abdominal wall

Question 3

Why can portal hypertension occur?

Answer 3

No valves in system - blood from portal territory can flow back through system if liver obstructed

Question 4

Define portal hypertension

Answer 4

Pressure in portal vein >10mmHg

Question 5

How can the causes of portal hypertension be classified?

Answer 5

Pre-hepatic
Hepatic
Post-hepatic

Question 6

What are the pre-hepatic causes of portal hypertension?

Answer 6

Portal vein thrombosis

Question 7

What are the hepatic causes of portal hypertension?

Answer 7

Cirrhosis
Hepatitis
Idiopathic non-cirrhotic portal hypertension
Schistosomiasis
Congenital hepatic fibrosis

Question 8

What are the post-hepatic causes of portal hypertension?

Answer 8

Budd-Chiari syndrome

Question 9

What are the clinical manifestations of portal hypertension?

Answer 9

Variceal bleeding
Haemorrhoids/caput medusae
Ascites
Splenomegaly
Porto systemic encephalopathy

Question 10

What is Budd-Chiari Syndrome?

Answer 10

Occlusion of hepatic veins w/ 3 key Sx (v. rare)

• abdominal pain
• ascites
• hepatomegaly

Question 11

How is acute variceal bleeding managed acutely?

Answer 11

A-E resus
Vit K & FFP to correct clotting
IV terlipressin (or somatostatin analogues)
IV antibiotic prophylaxis (decreases mortality)
Endoscopic banding & adrenaline
Balloon tamponade

Question 12

What is the definitive management for varices resistant to banding?

Answer 12

Transjugular intrahepatic portosystemic shunting (TIPSS)

-can use surgical porto-caval shunts

Question 13

What prophylaxis for bleeding varices is available?

Answer 13

Endoscopy +/- adrenaline & banding
Sclerotherapy
Non-selective b-blockers