portal hypertension Flashcards
What is portal hypertension
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.
what is the cardinal finding in liver portal hypertension
splenomegaly is the cardinal finding in portal hypertension
how to diagnose portal hypertension
clinically or by USS
why caput medusae forms
because of portal hypertension collateral circulation forms and in the abdomen it is express as caput medusae
where can varices happen
oesophagus
stomach
above 2 are most important and cause upper GI bleed
rectum
how to investigate portal hypertension
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
tell me about bleeding varices
usually bleeding occurs from the gastro oesophageal junction or in the stomach
how to reduce risk of bleeding varices pharmacologically
propanalol or nadolol are effective in reducing portal hypertension
if not tolerated prophylactic banding is indicated
Terlipressin a vasopressor which lowers portal pressure
other approaches to reduce risk of bleeding varices
sclerotherapy or banding
banding have greatly replaced sclerotherapy becuase of reduced risk of perf.
balloon tamponade - stop variceal bleed to await definitive tx