Portal Hypertension Flashcards

1
Q

HVPG typically present in ascites

A

at least 8 mm HG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

HVPG typically seen in Variceal bleeding

A

> 10-12 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Classifications of Portal Hypertension

A
  1. Pre-hepatic - tumors, thrombosis, atresia, etc
  2. hepatic - cirrhosis, fibrosis (Wilson, hemochromatosis)
  3. Post-hepatic (Budd-Chiari, CHF, Constrictive pericarditis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Characteristics of refractory ascites

A
  1. does not respond to diuretics
  2. oliguria
  3. reduction in Na excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

1 year mortality rate of refractory ascites

A

50% die in 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

MELD Score a/w good prognosis in TIPS
MELD Score a/w poor prognosis in TIPS
MELD score that would contraindicate TIPS

A

<18
>18 but <24
>24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

amount of protein lost in 10 liters of ascites

A

200 g (20 g/L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Purpose of Child-Pugh Score

A
  1. assess the prognosis of chronic liver disease and cirrhosis.
  2. Originally developed in 1973 to predict surgical outcomes in patients presenting with bleeding esophageal varices
  3. The score is used with the Model for End-Stage Liver Disease (MELD) to determine priority for liver transplantation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

normal Portal Vein Pressure

A

5-10 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. two main types of cirrhosis
  2. two main complications of decompensated cirrhosis
A
  1. compensated and decompensated
  2. portal hypertension and liver insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. HVPG for portal htn
  2. clinically significant HVPG
  3. HVPG for risk of variceal bleeding and ascites
  4. HVPG for variceal bleeding unlikely to respond to conventional medical therapy
A
  1. HPVG >6
  2. HVPG> 10
  3. HVPG> 12
  4. HVPG> 20
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

2 components causing the pathophysiology of portal htn

A
  1. Fixed component: sinusoidal fibrosis and compression by regenerative nodules
  2. reversible component: vasoconstriction (deficiency in intrahepatic NO and enhanced activity of vasoconstriction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how are liver sinusoidal endothelial cells affected in portal htn

A
  • liver sinusoidal endothelial cells lose their fenestrae in cirrhosis and a fibrous basement membrane develops “capillarization”
  • VEGF is necessary for maintaining fenestrae
  • VEGF function is dependent on NO production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

in portal htn, how does deficient NO activity in the liver affected the mesenteric vasculature

A

it causes mesenteric arteriolar vasodilation and therefore increased portal venous inflow

  • you’ll have splanchnic and systemic vasodilation (your body wants to counteract the intrahepatic vasoconstriction and creates vasodilators outside the liver)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

contraindications to beta blockers

A
  1. symptomatic bradycardia
  2. av block
  3. decompensated heart failure
  4. asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are target hemoglobin levels for variceal hemorrhage

A

7-8 g/dL; 9-11 g/dL have been shown to hvae increase mortality

17
Q

treatment summary of esophageal variceal bleeding

A
  1. antibiotics
  2. octreotide
  3. Transfuse Hb 7-8
  4. EGD
  5. blakemore/TIPS when non-responsive
18
Q

Potential causes of a low SAAG

A
  1. peritoneal dialysis
  2. nephrotic syndrome
  3. Malignant ascites
  4. Tuberculous peritonitis
  5. pancreatitis
  6. ovarian hyperstimulation syndrome
  7. Congenital portosystemic shunts