Portal Hypertension Flashcards
Define Portal Hypertension?
Abnormally high pressure within the hepatic portal vein
What is clinically significant Portal Hypertension is defined as?
a hepatic venous pressure gradient > 10 mm Hg
What is the most common cause of Portal Hypertension?
Cirrhosis
How can the other causes of Portal Hypertensionbe divided?
Pre-Hepatic
Hepatic
Post-Hepatic
What do the subdivisions of the causes mean in Portal Hypertension?
Pre-Hepatic : Blockage of the portal vein before the liver
Post-Hepatic- Blockage of hepatic veins or venules
What are the Pre-Hepatic causes of Portal Hypertension?
Congenital stenosis
Portal vein thrombosis
Splenic vein thrombosis
Extrinsic compression
What are the Hepatic causes of Portal Hypertension?
Cirrhosis
Chronic hepatitis
Schistosomiasis
Myeloproliferative disease
What are the Post-Hepatic causes of Portal Hypertension?
Budd-Chiari Syndrome (hepatic vein obstruction)
Constrictive pericarditis
Right heart failure
What is the epidemiology of Portal Hypertension?
A common consequence of cirrhosis
What are the presenting symptoms of Portal Hypertension?
Features of Liver Disease (likely to coexist with portal hypertension)
Complications of Portal Hypertension
What are the features of Liver Disease?
Jaundice
History of Alcohol abuse
Risk factors for viral hepatitis
Family history (e.g. haemochromatosis)
What are the risk factors for Viral Hepatitis?
E.g. tattoos, unprotected sex, IV drug use, travel abroad and blood transfusion
What are the complications of Portal Hypertension that present as symptoms?
Haematemesis or Melaena
Lethargy, irritability, changes in sleep (hepatic encephalopathy)
Abdominal distension (ascites)
Abdominal pain and fever (spontaneous bacterial peritonitis)
Pulmonary involvement
What are the signs of Portal Hypertension on physical examination?
Caput Medusae
Splenomegaly
Ascites
Signs of Liver Failure
What are the Signs of Liver Failure?
Jaundice Spider naevi Palmar Erythema Confusion Asterixis Fetor Hepaticus Enlarged or small liver Gynaecomastia Testicular Atrophy
What investigations do we do for Portal Hypertension?
Bloods Specific Tests Imaging Measure Hepatic Venous Pressure Gradient (HVPG) Liver Biopsy - if indicated
What bloods do we do for Portal Hypertension?
LFTs U&Es Blood Glucose FBC Clotting Screen
Why do we do a Clotting Screen for Portal Hypertension?
Prolongation of PT is one of the earliest signs of liver failure
What specific tests can we do for Portal Hypertension?
Ferritin - haemochromatosis Hepatitis serology Autoantibodies (e.g. anti-smooth muscle antibodies in autoimmune hepatitis) a1-antitrypsin levels Caeruloplasmin - Wilson's Disease
What imaging can we do for Portal Hypertension?
Abdominal US
Doppler US
CT/MRI
Endoscopy
Why would we do an Abdominal US for Portal Hypertension?
Check liver and spleen size and assess portal blood flow
Why would we do a Doppler US for Portal Hypertension?
Assess direction of blood flow in vessels
When do we do a CT/MRI for Portal Hypertension?
If other imaging methods are inconclusive
Why would we do an Endoscopy for Portal Hypertension?
To check for oesophageal varices
What is the problem with a management plan for Portal Hypertension?
Difficult to treat Portal Hypertension specifically
What is the focus of treatment of Portal Hypertension?
Treat the underlying cause
What is the conservative management plan for Portal Hypertension?
Salt restriction
Diuretics
What are some of the few management plans that are used for Portal Hypertension?
Non-selective beta-blockers
Terlipressin
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
Liver transplant
How do Non-Selective beta-blockers help with Portal Hypertension?
Reduce portal pressure and reduces risk of variceal bleeding
How do Terlipressin help treat Portal Hypertension?
Can reduce portal venous pressure
What is involved in a Transjugular Intrahepatic Portosystemic Shunt (TIPS)?
Surgical shunt placed between the hepatic portal vein and the hepatic vein to ease congestion in the portal vein
What are the possible complications of Portal Hypertension?
Bleeding from oesophageal varices Ascites + complications of ascites Pulmonary complications Liver Failure Hepatic Encephalopathy Cirrhotic Cardiomyopathy
What are the complications of Ascites?
Spontaneous Bacterial Peritonitis
Hepatorenal Syndrome
Hepatic Hydrothorax
What is Hepatorenal Syndrome?
A life-theratening condition that consists of a rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure
What is Hepatic Hydrothorax?
A transudative pleural effusion in patients with portal hypertension without any underlying primary cardiopulminary cause
What are some of the Pulmonary complications present in Portal Hypertension?
Portopulmonary hypertension
Hepatopulmonary Syndrome - a triad
What is the triad of complications associated with Hepatopulmonary Syndrome?
Hepatic dysfunction Hypoxaemia Extreme Vasodilation (intrapulmonary vascular dilatation)
What is the prognosis for patients with Portal Hypertension?
Depends on the underlying cause
Variceal haemorrhages have a 1-year mortality of 40%
