Portal hypertension

Question 1

Define portal hypertension

Answer 1

Hypertension within the portal veins that Bring blood back to the liver

Question 2

Aetiology and risk factors of portal hypertension

Answer 2

Mainly due to chronic liver disease progressing to cirrhosis
main causes of cirrhosis are alcohol, NASH, and viral Hep
but also include PSC
And thrombosis-budd-chiari syndrome

risk factors:
Alcohol
Obesity/insulin resistance
Using drugs
Smoking
UC
Age
Men

Question 3

Epidiemology of portal hypertension

Answer 3

quite a big problem and seen with a lot of patient due to cirrhosis being very common
Budd
PSC is rare but linked with UC
buddchiari is also rare (1/100000)

Question 4

Signs and Sx of portal Hypertension

Answer 4

Proper to HTN:
Caput medusae
Ascites
Bleeding varices-hematemasis or Malena (big killer)
Encelopathy
Splenomegaly

ANY signs or Sx of cirrhosis would be associated -

Sx of buddchiari-RUQ pain, hepatomegaly, short onset, ascites

Question 5

Investigations of portal hypertension

Answer 5

Clinical diagnosis per say
But OGD for vatical bleeds
Xrays

can show thrombocytopenia

Question 6

Management of portal hypertension

Answer 6

treat the underlying cause

NON selective B-blockers are also good, and can act as prophylaxis for the bleeds

after bleed-terlipressin and gastric band ligation
Fluid rescus

surgery-can create a shunt from portal to

Question 7

Complications of portal hypertension

Answer 7

its the vaticeal bleeds lol

ascites-can have spontaneous bacterial peritonitis-sepsis

Buddchiari-acuteliver failure and death

Question 8

Prognosis of portal hypertension

Answer 8

bad signs if appearing with cirrhosis
if no variceal veins+no ascites-1% death /y
if veins but no bleed or no ascites-4%
if ascites + veins-25%/y
if bleeds-57%/year