Portal Hypertension Flashcards
Describe the portal venous anatomy?
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.
What is portal hypertension and what are the causes?
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
In portal hypertension where are the collateral circulations formed?
Gastro-oesophageal junction Rectum Left Renal Vein Diaphragm Retroperitoneum
What are the signs of portal hypertension?
Varices: Oesophageal Caput Medusae Umbilical Haemorrhoids
Splenomegaly
Describe the management of bleeding oesophageal varices?
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.
Sengstaken-Blackmore tube