portal hypertension and varices

Question 1

risk factors for portal hypertension

Answer 1

cirrhosis
increased portal blood flow
increased hepatic vascular resistance
intrahepatic arteriovenous shunting

Question 2

pathology of portal hypertension

Answer 2

blockage –> >10mmHg (portal HTN) –> collateral circulation through portosystemic shunt –> dilation of gastro-oesophageal veins

Question 3

complications of portal hypertension

Answer 3

varices

splenomegaly

Question 4

treatment of portal hypertension

Answer 4

prevent bleeding (drugs/surgery)
new portosystemic shunts to relieve pressure (most common is splenorenal)

Question 5

risk factors for oesophagi-gastric varices

Answer 5

portal hypertension

Question 6

pathology of varices

Answer 6

dilated veins at gastro-oesophageal junction due to increased blood flow through the porto-systemic shunt

Question 7

signs of varices

Answer 7

anaemia
signs of liver disease
haematemesis
melaena
abdominal pain 
dysphagia

Question 8

complications of varices

Answer 8

bleeds

Question 9

diagnosis of varices

Answer 9

endoscopy
bloods - FBC, U&E, LFT
CXR - for aspiration of chest infection
check for portal hypertension

Question 10

treatment of varices

Answer 10

blood transfusion if needed
correct clotting abnormalities - vitamin K, fresh frozen plasma, platelet transfusion
IV terlipressin
vatical ligation via endoscopy