Portal Hypertension Varices And Bleeding

Question 1

What is the pathogenesis of portal hypertension

Answer 1

Intrahepatic resistance due to fibrosis - this causes blood to slow down
Increases vasoconstrictors

Question 2

What happens to the blood flow to the liver as portal hypertension occurs

Answer 2

Splanchnic blood flow increases so you have massive vasodilation to overcome it

Question 3

What is the main treatment for decreasing splanchnic blood flow

Answer 3

Carvedilol- alpha blocker

Propanolol- beta blocker

Question 4

What can cirhsosis lead to

Answer 4

Small varices which can develop into medium/large varices

Both types of varices can bleed

Question 5

What are the risk factors for variceal bleeding

Answer 5

Endoscopic appearance: size, red signs, active bleeding
Wall tension 
Portal pressure
Alcohol
Liver cancer

Question 6

Which type of varices have a higher chance of bleeding

Answer 6

Large varices

Question 7

What is the management of acute variceal bleeding

Answer 7

1. ABCDE approach- resuscitation and correction of hypovolaemia and tissue oxygenation
2. Blood production: restrictive blood transfusion
3. Anti prophylaxis to reduce risk of infection
4. Terlipressin to cause vasoconstriction
5. Aim to endoscope within 24 hours
6. Variceal band ligation (1st line therapy)
7. Baloon tampoonde if endoscopic therapy fails
8. TIPSS

Question 8

What is the secondary prevention of variceal bleeds

Answer 8

Beta blockers e.g pronanolol

TIPSS (transjugulr intrahepatic portosytemic shunts)

Question 9

What scorring system can be used to assess wether the patient needs admission

Answer 9

Glasgow Blatchford score

Question 10

What does the glasgow blatchfors score consider

Answer 10

Urea: in bleeding urea increases
Haemoglobin: decrease in bleeding
Systolic pressure: decrease in bleeding
Other markers: pullse more than 100/min, melaena (upper gi bleed), syncope, hepatic disease, cardiac failure