portal hypertension Flashcards
define portal hypertension?
abnormally high pressure within the hepatic portal vein.
venous pressure gradient > 10 mmHg
pathophysiology of portal hypertension?
Portal venous system consists of portal, splenic and mesenteric vein
These veins contain toxins and nutrients and goes through the liver.
When blood cannot flow from portal vein to IVC = portal hypertension
1. Build-up of toxins -> hepatic encephalopathy
2. Build-up of pressure at portosystemic shunts-> varices and haemorrhoids
3. Round ligament re-channels -> dilation of veins -> caput medusae
4. Blood backs up to splenic vein -> splenomegaly
5. Endothelial cells release more NO -> BP drops -> more aldosterone -> accumulation of fluid
ABCDE of portal hypertension?
A – ascites B – bleeding C – caput medusae D – diminished liver function E – enlarged spleen
most common cause of portal hypertension?
• CIRRHOSIS
what are the three catagories of causes of portal hypertension?
o Pre-Hepatic - blockage of the portal vein before the liver
• Congenital stenosis
o Hepatic
• CIRRHOSIS
o Post-Hepatic - blockage of hepatic veins or venules
• Budd-Chiari syndrome
• Right heart failure
what are the main presenting complaints of the complications of portal hypertension?
o Varices, haematemesis or melaena
o Lethargy, irritability, changes in sleep (hepatic encephalopathy)
o Abdominal distension (ascites)
o Abdominal pain and fever (spontaneous bacterial peritonitis)
o Pulmonary involvement
what are the presenting symptoms of liver disease?
o Jaundice
o History of alcohol abuse
o Risk factors for viral hepatitis (e.g. tattoos, unprotected sex, IV drug use, travel abroad and blood transfusion)
o Family history (e.g. haemochromatosis)
major signs og portal hypertension?
o Caput medusae
o Splenomegaly
o Ascites
major signs of liver failure?
o Jaundice o Spider naevi o Palmar erythema o Confusion o Asterixis o Fetor hepaticus o Enlarged or small liver o Gynaecomastia o Testicular atrophy
best blood investigation for liver failure?
- prolongation of PT
what specific tests might be done for portal hypertension?
o Ferritin - haemochromatosis o Hepatitis serology o Autoantibodies (e.g. anti-smooth muscle antibodies in autoimmune hepatitis) o 1-antitrypsin levels o Caeruloplasmin - Wilson's disease
what imaging might be done for portal hypertension?
o Abdominal ultrasound - check liver and spleen size and assess portal blood flow
o Doppler ultrasound - assess direction of blood flow in vessels
o CT/MRI - if other imaging methods are inconclusive
o Endoscopy - to check for oesophageal varices
what other investigations could be done for portal hypertension?
- Measure hepatic venous pressure gradient (HVPG)
* Liver Biopsy - if indicated
how to treat the high blood pressure of portal hypertension?
o Beta-blocker eg. propranolol
how to treat ascites of portal hypertension?
o Sodium restriction
o Diuretics
