Pthn2 Last 50 Flashcards
What is the clinical presentation of portal hypertension as described in IMG_1962.jpeg?
Clinical presentation includes dilated anterior abdominal wall veins (caput medusae), ascites, and esophageal varices which may lead to hematemesis.
What are the causes of splenomegaly mentioned in IMG_1962.jpeg?
Causes include prehepatic causes (e.g., portal vein obstruction), hepatic causes (e.g., liver disease), and posthepatic causes (e.g., congestive liver).
What investigations are recommended for diagnosing portal hypertension in IMG_1962.jpeg?
Investigations include abdominal examination for dilated veins, ultrasound for liver and spleen size, and endoscopy for esophageal varices.
What is the treatment for esophageal varices as mentioned in IMG_1962.jpeg?
Treatment includes endoscopic band ligation, beta-blockers to reduce portal pressure, and in severe cases, transjugular intrahepatic portosystemic shunt (TIPS).
What are the causes of ascites in liver disease, as mentioned in IMG_1962.jpeg?
Causes include portal hypertension, hypoalbuminemia, and sodium retention due to liver dysfunction.
What is the clinical presentation of hematomas in prolonged cases of portal hypertension, as mentioned in IMG_1962.jpeg?
In prolonged cases, hematomas from esophageal varices may occur, which can be mild or life-threatening.
What are the causes of prehepatic splenomegaly mentioned in IMG_1962.jpeg?
Prehepatic causes include portal vein obstruction and splenic vein thrombosis.
What is the treatment for ascites in liver disease, as mentioned in IMG_1962.jpeg?
Treatment includes sodium restriction, diuretics (e.g., spironolactone), and paracentesis for symptomatic relief.
What are the investigations for splenomegaly mentioned in IMG_1962.jpeg?
Investigations include ultrasound to assess spleen size and blood tests to evaluate for underlying causes like liver disease or infections.
What is the clinical presentation of caput medusae in portal hypertension, as mentioned in IMG_1962.jpeg?
Caput medusae refers to dilated veins around the umbilical region and is a sign of severe portal hypertension.
What are the causes of hepatic splenomegaly mentioned in IMG_1962.jpeg?
Hepatic causes include hepatomegaly, mild to moderate splenomegaly, and shrunken liver in advanced hepatic diseases.
What is the treatment for hematemesis due to esophageal varices, as mentioned in IMG_1962.jpeg?
Treatment includes resuscitation, vasoactive drugs (e.g., octreotide), endoscopic therapy, and antibiotics to prevent infection.
What are the investigations for esophageal varices mentioned in IMG_1962.jpeg?
Investigations include endoscopy to visualize varices and imaging studies like ultrasound to assess portal hypertension.
What is the clinical presentation of ascites in advanced liver disease, as mentioned in IMG_1962.jpeg?
Clinical presentation includes abdominal distension, fluid wave on examination, and hypoalbuminemia.
What are the causes of posthepatic splenomegaly mentioned in IMG_1962.jpeg?
Posthepatic causes include congested liver and mild splenomegaly due to obstruction.
What is the treatment for portal hypertension, as mentioned in IMG_1962.jpeg?
Treatment includes beta-blockers to reduce portal pressure, endoscopic therapy for varices, and TIPS in severe cases.
What are the investigations for caput medusae mentioned in IMG_1962.jpeg?
Investigations include abdominal ultrasound to assess portal vein flow and CT/MRI to evaluate liver and spleen.
What is the clinical presentation of hematemesis in portal hypertension, as mentioned in IMG_1962.jpeg?
Hematemesis presents as vomiting of blood and is a life-threatening complication of esophageal varices.
What are the causes of congestive gastropathy mentioned in IMG_1962.jpeg?
Causes include portal hypertension leading to gastric mucosal changes and gastric bleeding.
What is the treatment for congestive gastropathy, as mentioned in IMG_1962.jpeg?
Treatment includes proton pump inhibitors (PPIs) and management of portal hypertension.
What are the investigations for hematomas in portal hypertension, as mentioned in IMG_1962.jpeg?
Investigations include endoscopy to identify the source of bleeding and imaging studies to assess liver and spleen.
What is the clinical presentation of shrunken liver in advanced hepatic diseases, as mentioned in IMG_1962.jpeg?
A shrunken liver is a sign of advanced hepatic disease and is often associated with cirrhosis.
What are the causes of rectal hemorrhoids in portal hypertension, as mentioned in IMG_1962.jpeg?
Causes include increased portal pressure leading to venous dilation in the rectal area.
What is the treatment for rectal hemorrhoids, as mentioned in IMG_1962.jpeg?
Treatment includes sclerotherapy, banding, and management of portal hypertension.
What are the investigations for hypoalbuminemia mentioned in IMG_1962.jpeg?
Investigations include serum albumin levels and liver function tests to assess liver synthetic function.
What is the main topic discussed in IMG_1962.jpeg?
The main topic is Hematology, focusing on splenomegaly, portal hypertension, and related clinical features.
What is splenomegaly, and what are its causes as mentioned in IMG_1962.jpeg?
Splenomegaly is the enlargement of the spleen. Causes mentioned include prehepatic causes (e.g., portal vein obstruction), hepatic causes (e.g., liver disease), and posthepatic causes (e.g., congestive liver).
What are the clinical features of portal hypertension as described in IMG_1962.jpeg?
Clinical features include dilated anterior abdominal wall veins (caput medusae), ascites, and esophageal varices which may lead to hematemesis.
What are the prehepatic causes of splenomegaly mentioned in IMG_1962.jpeg?
Prehepatic causes include portal vein obstruction and splenic vein thrombosis.
What are the hepatic causes of splenomegaly mentioned in IMG_1962.jpeg?
Hepatic causes include hepatomegaly, mild to moderate splenomegaly, and shrunken liver in advanced hepatic diseases.
What are the posthepatic causes of splenomegaly mentioned in IMG_1962.jpeg?
Posthepatic causes include congested liver and mild splenomegaly due to obstruction.
What is the significance of caput medusae in portal hypertension, as mentioned in IMG_1962.jpeg?
Caput medusae refers to dilated veins around the umbilical region and is a sign of severe portal hypertension.
What are the complications of esophageal varices mentioned in IMG_1962.jpeg?
Complications include hematemesis (vomiting of blood), which can be mild or life-threatening.
What is the clinical significance of ascites in advanced liver disease, as mentioned in IMG_1962.jpeg?
Ascites is a sign of advanced liver disease and is associated with hypoalbuminemia and sodium retention.
What are the investigations mentioned for diagnosing portal hypertension in IMG_1962.jpeg?
Investigations include abdominal examination for dilated veins, ultrasound for liver and spleen size, and endoscopy for esophageal varices.
What is the significance of hematemesis in portal hypertension, as mentioned in IMG_1962.jpeg?
Hematemesis is a life-threatening complication of esophageal varices and indicates severe portal hypertension.
What is the role of hypoalbuminemia in the development of ascites, as mentioned in IMG_1962.jpeg?
Hypoalbuminemia reduces oncotic pressure, leading to fluid accumulation in the abdominal cavity (ascites).
What are the early signs of portal hypertension mentioned in IMG_1962.jpeg?
Early signs include splenomegaly and dilated abdominal wall veins.
What is the significance of organomegaly in portal hypertension, as mentioned in IMG_1962.jpeg?
Organomegaly, particularly splenomegaly, is a key feature of portal hypertension and can indicate the underlying cause (prehepatic, hepatic, or posthepatic).
What is the clinical picture of hematomas in prolonged cases of portal hypertension, as mentioned in IMG_1962.jpeg?
In prolonged cases, hematomas from esophageal varices may occur, which can be mild or life-threatening.
What is the significance of dilated veins around the umbilical region in portal hypertension, as mentioned in IMG_1962.jpeg?
Dilated veins around the umbilical region, known as caput medusae, are a sign of severe portal hypertension.
What is the role of sodium retention in the development of ascites, as mentioned in IMG_1962.jpeg?
Sodium retention contributes to fluid accumulation in the abdominal cavity, leading to ascites.
What are the advanced signs of portal hypertension mentioned in IMG_1962.jpeg?
Advanced signs include ascites, hematemesis, and hepatic encephalopathy.
What is the significance of shrunken liver in advanced hepatic diseases, as mentioned in IMG_1962.jpeg?
A shrunken liver is a sign of advanced hepatic disease and is often associated with cirrhosis.
What is the clinical significance of hyperglycemia in prehepatic causes of splenomegaly, as mentioned in IMG_1962.jpeg?
Hyperglycemia may occur in prehepatic causes of splenomegaly and can lead to pancytopenia.
What is the significance of congestive gastropathy in portal hypertension, as mentioned in IMG_1962.jpeg?
Congestive gastropathy refers to gastric mucosal changes due to portal hypertension and can lead to gastric bleeding.
What is the role of rectal hemorrhoids in portal hypertension, as mentioned in IMG_1962.jpeg?
Rectal hemorrhoids are a complication of portal hypertension and can cause bleeding.
What is the procedure for inflating balloons in the treatment of internal hemorrhoids?
Balloons inflated through catheter in the nose
What is the primary function of sclerotherapy in the context of esophageal varices?
Sclerotherapy (ethanolamine oleate) or Ligation for esophageal varices
What is the significance of endoscopy in the treatment of esophageal varices?
Diagnostic & Therapeutic
Name one emergency surgical measure for treating pre hepatic thrombosis.
Surgical Porto-systemic shunt
What does TIPSS stand for?
Trans-jugular Intrahepatic Porto-systemic Shunt
What is a potential treatment option for end-stage liver disease?
Liver transplantation
What is a recommended strategy to prevent re-bleeding after the first attack?
Prophylactic Band ligation or sclerotherapy
Which medications are suggested for the prevention of re-bleeding after the first attack?
Propranolol (Beta blocker)
What are the treatment options after a second attack of esophageal varices?
- Beta adrenergic blockers (propranolol)
- Endoscopic sclerotherapy or band ligation
- Surgical porto-systemic shunt
- Liver transplantation
Fill in the blank: The balloon catheter is used to _______ the tract.
dilate
True or False: Avoiding aspirin and NSAIDs is recommended after the first attack of varices.
True
What is the role of the inferior vena cava in the context of balloon catheter procedures?
Shunts blood from varices
What should be avoided during the treatment of varices to prevent complications?
Aspirin and NSAID
What is the purpose of using a guidewire during the procedure?
To assist in catheter placement
Fill in the blank: The portal vein is associated with _______ and varices.
decompressed
What are the laboratory findings for liver function tests in pre-hepatic causes?
Normal functions
Pre-hepatic causes typically do not impair liver function tests.
What are the laboratory findings for liver function tests in hepatic causes?
Impaired functions
Hepatic causes indicate a dysfunction of the liver.
What hematological findings might indicate bleeding or hypersplenism?
Anemia or pancytopenia
Anemia suggests bleeding, while pancytopenia indicates hypersplenism.
What imaging technique assesses the patency and direction of flow in the portal vein?
Doppler flow
Doppler flow studies are crucial for evaluating portal vein status.
What does ultrasonography evaluate in liver pathology?
Liver size, spleen, ascites
Ultrasonography provides a non-invasive assessment of liver and spleen morphology.
What imaging methods are used to assess vessel patency?
CT angiography and MR Venography
Both CT angiography and MR venography are advanced imaging techniques for vascular evaluation.
What is the role of a liver biopsy in the context of hepatic fibrosis?
Should be done after correction of coagulopathy
Liver biopsy is invasive and requires careful management of coagulopathy.
What is the purpose of upper GIT endoscopy in liver disease?
Detection of esophageal varices or ulcers
Endoscopy allows direct visualization and assessment of esophageal conditions.
What is the first step in the emergency treatment of bleeding varices?
ICU Hospitalization and first aid measures (ABC)
Initial management focuses on stabilizing the patient.
What IV fluid is recommended for a shocked patient?
Saline 20 ml/kg
IV fluids are critical for volume resuscitation in shock.
What is the recommended blood transfusion volume for managing bleeding?
10 - 20 ml/kg
Blood transfusions help restore blood volume and improve oxygen carrying capacity.
What treatments are used to correct coagulopathy in bleeding varices?
Fresh frozen plasma, IV Vitamin K, and platelets
These treatments are essential for managing coagulopathy during bleeding episodes.
What types of drugs are used to manage bleeding varices?
H2 receptor blockers or Proton Pump Inhibitors (PPI)
These medications reduce gastric acid secretion, helping to prevent further erosion.
What is the function of vasopressin infusion in bleeding varices?
Decreases portal flow
Vasopressin helps control bleeding by constricting splanchnic vessels.
What is the purpose of a naso-gastric tube in the context of bleeding varices?
For gastric wash and to monitor ongoing losses
Naso-gastric tubes are crucial for managing gastrointestinal bleeding.
What is a compression tube used for in treating bleeding varices?
Mechanical compression for bleeding varices (not more than 48H)
Compression tubes can help control bleeding but should be used with caution.
True or False: Compression tubes can be used indefinitely for bleeding varices.
False
Compression tubes should not be used for more than 48 hours to avoid complications.
What is the primary cause of splenomegaly in hepatology?
Congestion of abdominal viscera drained by portal vein
This occurs due to increased pressure in the portal venous system.
What are the consequences of portal hypertension related to blood flow?
Development of collaterals carrying blood from portal venous system to systemic circulation
This can lead to various complications, including varices.
List three high-risk conditions associated with gastrointestinal bleeding due to portal hypertension.
- Esophageal varices
- Gastric varices
- Rectal hemorrhoids (Piles)
These conditions arise from increased pressure in the portal system.
What is Caput Medusae?
Dilated veins around the umbilicus
This is a visible sign of portal hypertension.
Which vein is associated with the development of collateral circulation in portal hypertension?
Azygos vein
This vein can provide alternative pathways for blood flow.
What is hematemesis?
Vomiting blood
This can occur as a result of bleeding from esophageal varices.
What does ascites indicate in advanced liver disease?
Hypoalbuminemia & sodium retention
It is a common manifestation in patients with liver dysfunction.
What is a key prehepatic cause of splenomegaly?
Significant & early splenomegaly with normal liver function
This can occur due to portal vein obstruction.
What condition may lead to pancytopenia in the context of splenomegaly?
Hypersplenism
This condition results from an enlarged spleen sequestering blood cells.
What are the hepatic causes of splenomegaly?
- Hepatomegaly
- Mild to Moderate Splenomegaly
- Shrunken liver in advanced hepatic diseases
These conditions reflect liver dysfunction and its effects on the spleen.
What is the clinical picture of hematemesis from esophageal varices?
May be the first manifestation; may be mild or massive life-threatening
This can indicate severe portal hypertension and warrants immediate medical attention.
What examination findings are associated with advanced liver disease?
- Ascites
- Organomegaly
These findings are common in patients with significant liver dysfunction.
True or False: Markedly congested liver with no splenomegaly indicates supra-hepatic obstruction.
True
This condition can occur early in the obstruction process.
What is the definition of portal hypertension?
Portal venous pressure more than 10-12 mm Hg (Normal: 5-10 mm Hg)
Portal hypertension can lead to various complications and is often associated with liver disease.
What are pre-hepatic causes of portal hypertension?
• Portal vein thrombosis
• Splenic vein thrombosis
• Mesenteric vein thrombosis
Pre-hepatic causes often involve blockages before blood reaches the liver.
What is the commonest cause of umbilical vein thrombosis?
Umbilical thrombophlebitis
This condition can occur due to umbilical catheterization or infections such as omphalitis.
List some intra-hepatic causes of portal hypertension.
• Fibrosis
• Hepatocellular disease
• Congenital hepatic fibrosis
• Chronic hepatitis
• Cirrhosis
• Veno-occlusive disease
Intra-hepatic causes are related to conditions affecting the liver tissues directly.
What are examples of biliary tract diseases associated with portal hypertension?
• Biliary atresia (EHBA)
• Cystic fibrosis
• Sclerosing cholangitis
These diseases affect the bile ducts and can lead to increased pressure in the portal system.
What symptoms are associated with hepatic vein thrombosis in Budd-Chiari syndrome?
Pain and ascites
Budd-Chiari syndrome is characterized by obstruction of hepatic veins, leading to hepatic venous outflow obstruction.
True or False: High IVC obstruction can lead to portal hypertension.
True
High inferior vena cava obstruction can result in increased pressure in the portal system.
Fill in the blank: Portal vein thrombosis can be caused by _______.
umbilical catheter, omphalitis, or sepsis
These factors can increase the risk of thrombus formation in the portal vein.
What is the significance of a hepatic vein thrombosis?
It can lead to Budd-Chiari syndrome and associated symptoms like pain and ascites
This condition can severely affect liver function and overall health.
What are some post-sinusoidal causes of portal hypertension?
• Central vein thrombosis
• Veno-occlusive disease
These conditions occur after blood has passed through the liver.
What is the role of polycythemia in portal vein thrombosis?
It can lead to dehydration and increased blood viscosity, contributing to thrombosis
Polycythemia is a condition where there is an increased number of red blood cells.
