portal hypertension Flashcards

1
Q

What is portal hypertension

A

when the pressure in the portal vein is >10 clinically significant.
extrahepatic portal vein obstruction is the commenest cause in childhood and adult. while cirrhosis is 90% in the developed world.

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2
Q

what is the cardinal finding in liver portal hypertension

A

splenomegaly is the cardinal finding in portal hypertension

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3
Q

how to diagnose portal hypertension

A

clinically or by USS

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4
Q

why caput medusae forms

A

because of portal hypertension collateral circulation forms and in the abdomen it is express as caput medusae

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5
Q

where can varices happen

A

oesophagus
stomach
above 2 are most important and cause upper GI bleed
rectum

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6
Q

how to investigate portal hypertension

A

endoscopy
USS - can show splenomegaly and collateral and may indicate cause

CT/MRI portal vein clot or hepatic vein patency

Clotting - thrombocytopenia common leucopenia not so common
FBC - anaemia very common cause of bleeding

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7
Q

tell me about bleeding varices

A

usually bleeding occurs from the gastro oesophageal junction or in the stomach

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8
Q

how to reduce risk of bleeding varices pharmacologically

A

propanalol or nadolol are effective in reducing portal hypertension
if not tolerated prophylactic banding is indicated
Terlipres­sin a vasopressor which lowers portal pressure

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9
Q

other approaches to reduce risk of bleeding varices

A

sclerotherapy or banding
banding have greatly replaced sclerotherapy becuase of reduced risk of perf.
balloon tamponade - stop variceal bleed to await definitive tx

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