Portal Hypertension and Oesophageal varices Flashcards
Portal hypertension is a complication of…
cirrhosis
Portal hypertension is increased pressure in the…
portal vein
What are pre-hepatic causes of portal hypertension?
Portal vein thrombosis
What are intra-hepatic causes of portal hypertension?
Cirrhosis (most common in UK)
Schistosomiasis (worms from freshwater causing inflammation)
What are post-hepatic causes of portal hypertension?
Budd-Chiari (hepatic vein obstruction)
RHS heart failure
Constrictive pericarditis
How does constrictive pericarditis cause portal hypertension?
Fibrosis/calcification/thickening of pericardium means the pericardium loses its elasticity and impairs filling ability of heart. Leads to elevated pressures in central veins which is transmitted back to portal vein. Can lead to hepatic congestion
What is the normal pressure within the portal vein?
5-8 mmHg
Cirrhosis of the liver means there is increased resistance to flow therefore s______ d______ and compensatory increased c_____ o_____
splanchnic dilation (arteries to abdominal GI organs)
cardiac output
The splanchnic dilation and compensatory increased cardiac output (due to cirrhosis) result in…
fluid overload in portal vein (pressure 10+ is bad, 12+ is very bad)
What is the response to fluid overload of the portal vein?
Collateral blood shunting to gastroesophageal veins
What complication can be caused by collateral blood shunting in hepatic hypertension?
Oesophageal varices at cardia and lower oesophagus
What are symptoms of portal hypertension?
Mostly asymptomatic
Possible oesophageal varices rupture
What is the presenting symptom oesophageal varices haemorrhage?
Haematemesis
What are 2 conditions causing blood in the oesophagus with haematemesis on presentation?
Oesophageal varices and Mallory Weiss tear
How are oesophageal varices diagnosed?
(OGD) Oesophagogastroduodenoscopy
What is acute treatment for oesophageal varices?
Resus until haemodynamically stable (blood volume, pressure and perfusion eg IV fluids, blood transfusions and meds for anaemia)
Consider blood transfusion if Hb under 70g/L or 80g/l with cardiac comorbidity
What treatment is performed to stop the bleed of a ruptured oesophageal varices?
IV Terlipressin
Variceal band ligation (bands off varices)
TiPPS (Transjugular intrahepatic portosystemic shunt to decrease portal pressure by diverting to other larger veins)
What is a complication of TiPPS procedure?
Hepatic encephalopathy as blood is not filtered properly
What treatment is given to prevent oesophageal haemorrhage?
Non-selective Beta-blocker like propranolol
Nitrates
Repeat variceal banding
Last resort = liver transplant (for decompensated cirrhosis)
How does propranolol (non-selective beta-blocker) help to prevent oesophageal haemorrhage?
Lowers portal pressure by decreasing splanchnic blood flow
Decreases CO by decreasing contractility via adrenergic receptors
