Portal Hypertension Flashcards
state the typical presentation of portal hypertension?
Butt (haemorrhoids), gut (oesophageal varices, splenomegaly and ascites) and caput (caput medusa)
Define portal hypertension?
abnormally high pressure within hepatic portal vein
clinically significant portal hypertension is defined as a hepatic venous pressure gradient > 10 mm Hg (NORMAL is < 5mmHg)
outline the aetiology of portal hypertension?
CIRRHOSIS is most common cause
Collagen deposition and fibrosis
sodium retention and vasoactive substances such as NO ( due to accumulation of toxic metabolites) will increase plasma voluem and splanchnic vasodilation => maintains portal hypertension
how can the causes of portal hypertension be divided?
pre- hepatic- blockage of portal vein before liver
hepatic
post hepatic- blockage of hepatic veins or venules
what are the pre-hepatic caues of portal hypertension?
blockage of portal vein before liver
- congenital stenosis
- portal vein thrombosis
- splenic vein thrombosis
- extrinsic compression
what are the hepatic causes of portal hypertension?
CIRRHOSIS
Chronic hepatitis
Schistosomiasis
Granulomata
Myeloproliferative disease
what are the post hepatic causes of portal hypertension?
Budd-Chiari syndrome (hepatic vein obstruction):Sudden-onset ascites with tender hepatomegaly in the absence of jaundice
Constrictive pericarditis
Right heart failure
what is Budd-chiari syndrome?
hepatic vein obstruction
sudden onset ascites with tender hepatomegaly in the absence of jaundice
summarise the epidemiology of potal hypertension?
common consequence of cirrhosis
what are the presenting symptoms of portal hypertension?
Features of Liver Disease (likely to coexist with portal hypertension)
- Jaundice
- History of alcohol abuse
- Risk factors for viral hepatitis (e.g. tattoos, unprotected sex, IV drug use, travel abroad and blood transfusion)
- Family history (e.g. haemochromatosis)
Complications of Portal Hypertension
- Haematemesis or melaena
- Lethargy, irritability, changes in sleep (hepatic encephalopathy)
- Abdominal distension (ascites)
- Abdominal pain and fever (spontaneous bacterial peritonitis)
- Pulmonary involvement
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what are the symptoms caused by the complications of portal hypertension?
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?
Signs of Portal Hypertension
- Caput medusae
- Splenomegaly
- Ascites
Signs of Liver Failure
- Jaundice
- Spider naevi
- Palmar erythema
- Confusion
- Asterixis
- Fetor hepaticus
- Enlarged or small liver
- Gynaecomastia
- Testicular atrophy
what blood are required to investigate portal hypertension?
LFTs
U&Es
Blood glucose
FBC
Clotting screen (prolongation of PT is one of the earliest signs of liver failure)
what are the specific tests needed to investigate portal hypertension?
- Ferritin - haemochromatosis
- Hepatitis serology
- Autoantibodies (e.g. anti-smooth muscle antibodies in autoimmune hepatitis)
- alpha1-antitrypsin levels
- Caeruloplasmin - Wilson’s disease