Portal Hypertension

Question 1

Portal Hypertension Definition

Answer 1

-Hepatic venous pressure gradient of 10 or more

Question 2

Portal Hypertension Aetiology

Answer 2

• Pre-hepatic, hepatic, post hepatic
• Pre-hepatic (blockage of portal vein before the liver): congenital atresia, portal vein thrombosis, extrinsic compression
• Hepatic: cirrhosis, chronic hepatitis, schistosomiasis, idiopathic
• Post-hepatic: Budd-Chiari, constrictive pericarditis, right heart failure

Question 3

Portal Hypertension Pathophysiology

Answer 3

• Increased vascular resistance in the portal venous system
• Increased blood flow to the portal veins due to excessive release of vasodilators
• Open up venous collaterals (oesophageal varices, caput medusae)
• In Budd-Chiari collaterals open up within the liver, blood drains through caudate lobe

Question 4

Portal Hypertension Presentation

Answer 4

• Hx of jaundice, alcohol, predisposition to HC/BV, FHx (e.g. Wilson’s, haemochromatosis)
• Signs of liver failure (jaundice, spider naevi, liver failure, confusion, liver flap,
• Haematemesis
• Lethargy, irritability, and changes sleep pattern suggest encephalopathy
• Ascites, caput medusae, venous hum, splenomegaly, ascites, spontaneous bacterial peritonitis
• Pulmonary involvement

Question 5

Portal Hypertension Ix

Answer 5

• LFTs, U&Es, glucose, clotting
• USS, doppler
• CT
• Endoscopy for varices
• Portal hypertension measurement by hepatic venous pressure gradient

Question 6

Portal Hypertension Management

Answer 6

• Treat underlying cause
• BBs reduce bleeding rates in oesophageal varices
• Beta blockers (non-selective) and nitrates to reduce portal pressure
• Terlipressin to constrict splanchnic circulation and reduce portal pressure, can control bleeding varices
• Salt restriction and diuretics
• Endoscopy to detect and monitor varices
• Transjugular intrahepatic portal shunt has become treatment option

Question 7

Portal Hypertension Porgnosis

Answer 7

-Child-Pugh classification