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SURGICAL DISEASES > TH4 PORTAL HYPERTENSION > Flashcards

TH4 PORTAL HYPERTENSION Flashcards

1
Q

DEFINE PORTAL HYPERTENSION?

A

INCREASED PRESSURE IN PORTAL VENOUS SYSTEM / INCREASED RESISTANCE

WHERE THE PORTAL PRESSURE IS HIGHER THAN 5mmHg

most common cause is CIRRHOSIS

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2
Q

WHEN DOES PORTAL HYPERTENSION USUALLY OCCUR?

A

DUE TO INCREASED PORTAL VENOUS RESISTANCE THAT IS:
> PREHEPATIC
> INTRAHEPATIC
> POST HEPATIC

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3
Q

MOST COMMON CAUSE FOR PREHEPATIC PORTAL HYPERTENSION?

A

PORTAL VEIN THROMBOSIS

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4
Q

CAVERNOUS TRANSFORMATION OF PORTAL VEIN? WHAT IS THAT?

A
  • occurs when native portal vein = thrombosed in absence of liver disease

> HEPATOPETAL (to liver) PORTAL COLLATERAL VESSELS DEVELOP TO RESTORE PORTAL PERFUSION

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5
Q

WHAT IS THE TERM GIVEN TO WHEN PORTAL VEIN IS THROMBOSED AND HEPATOPETAL PORTAL COLLATERAL VESSELS ARE FORMED TO RESTORE PORTAL PERFUSION?

A

CAVERNOUS TRANSFORMATION OF THE PORTAL VEIN

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6
Q

WHAT ID BUSS CHIARI SYNDROME?

A

> HEPATIC VENOUS THROMBOSIS
which is one of the post hepatic cause of portal hypertension

hepatic veins are blocked/ narrowed by clot
blockage cause blood to back up to liver
liver grows larger > hepatomegaly

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7
Q

MOST COMMON CAUSE OF PORTAL HYPERTENSION?

A

LIVER CIRRHOSIS (inter hepatic obstruction)

> INCREASED INTRA HEPATIC VASCULAR RESISTANCE BY FIBROSIS, THROMBOSIS + NODULAR REGENERATION

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8
Q

PORTAL HYPERTENSION STIMUALTED PORTOSYSTEMIC COLLATERALISATION.

WHICH IS THE MOST IMPORTANT COLLATERAL NETWORK AND WHY?

A

MOST IMPORTANT COLLATERAL NETWORK?
> CORONARY ARTERY
> SHORT GASTRIC VEINS TO AZYGOUS VEINS

> > RESULTS IN FORMATION OF ESOPHAGEAL VARICES

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9
Q

DEFINE CAPUT MEDUSA?

A

RECANALISED UMBILICAL VEINS FROM LEFT PORTAL VEIN TO EPIGASTRIC VENOUS SYSTEM DUE TO PORTAL HYPERTENSION

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10
Q

WHICH INSTRUMENTAL METHOD IS USED TO DX ESOPHAGEAL VARICES IN CASE OF PORTAL HYPERTENSION?

A

ESOPHAGO-GASTRO ENDOSCOPY

  • size
  • distribution
  • colour of varices
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11
Q

MAIN METHOD OF FIRST CHOICE IN DX PORTAL HYPERTENSION?

A

ABDOMINAL ULTRASOUND

  • cheap
  • easy to perform
  • well tolerated by px
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12
Q

MOST IMPORTANT COMPLICATION OF PORTAL HYPERTENSION?

A

> GASTRO INTESTINAL BLEEDING (secondary to oesophageal + gastric varices)

> ASCITES

> HEPATIC ENCEPHALOPATHY

  • nervous system disorder brought on by liver
  • dyfuntioning liver > toxic build up in blood > cross blood brain barrier
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13
Q

WHICH ARE THE TYPES OF SURGICAL DECOMPRESSION FOR THE TX OF BLEEDING ESOPHAGEAL VARCIES?

A

3 MAIN TYPES

> SHUNT PROCEDURE
DEVASCULARISATION PROCEDURES
LIVER TRANSPLANTATION

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14
Q

DEFINE ASCITES?

A

ACCUMULATION OF FREE FLUID WICHIN ABDOMINAL CAVITY

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15
Q

HERNIA OF ANTERIOR ABDOMINLA WALL OCCUR IN 20% OF PX WITH PORTAL HYPERTENSION DUE TO LIVER CIRRHOSIS

WHICH ARE CAUSE OF HERNIA?

A

> INCREASED INTRA ABDOMINAL PRESSURE

> NUTRITIONAL DEFICIT WITH MUSCULAR WASTING + THINNING OF FASCIA

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16
Q

COMPLICATION OF HERNIA IN PX THAT IS LEFT UNTREATED?

A

RISK OF INCARCERATION
RUPTURE
STRANGULATION
LEAKAGE

17
Q

WHICH ARE THE 4 OPTIONS FOR EMERGENCY TREATMENT OF BLEEDING ESOPHAGEAL VARICES?

A

PHARMACOTHERAPY
ENDOSCOPIC THERAPY
BALLOON TAMPONADE
SURGICAL DECOMPRESSION

18
Q

WHAT IS ENDOSCOPIC SCLEROTHERAPY IN BLEEDING ESOPHAGEAL VARICES?

A

INJECTION OF SCLORSING AGENT INTO LUMEN OF VARIX (intravariceal) OR INTO SUB MUCOSAL TISSUE SURROUNDING VARIX (paravariceal)

> IN ORDER TO CLOT/ TAMPONADE THE VARIX

19
Q

WHAT IS THE STRUCTURE OF SENGSTAKEN BLAKEMORE TUBE?

A

3 LUMEN TUBE
> GASTRIC BALLOON
> ESOPHAGEAL BALLOON
> DISTAL GASTRIC PORT FOR ASPIRATION OF GASTRIC CONTENT

> AIM:
- control acute esophageal gastric bleeding

20
Q

WHY IS BALLOON TAMPONADE IN ESOPHAGEAL VARICEAL BLEEDING IS A DANGEROUS PROCESURE

A

RISK OF ULCERATION + ESOPHAGEAL RUPTURE

> PREVENT RISK :
PX WITH ESOPHAGEAL BLOON SHOULD NOT BE LEFT INFLATED FOR MORE THAN 48h

21
Q

WHICH CONDITION ACCOUNTS FOR APPROX 50% OF CASES OF PORTAL HYPERTENSION IN CHILDREN?

A

PORTAL VEIN THROMBOSIS

22
Q

ALCOHOLIC CIRRHOSIS IS THE MOST COMMON CAUSE FOR PORTAL HYPERTENSION
IT USUALLY CAUSES INCREASED RESISTANCE TO PORTAL FLOW AT WHICH POINT?

A

SINUSOIDAL +

POST SINUSOIDAL LEVELS

23
Q

WHICH CONDITION CAN CAUSE POST HEPATIC PORTAL HYPERTENSION?

A

HEART FAILURE

24
Q

MOST SERIOUS + LIFE THREATENING COMPLICATION OF PORTAL HYPERTENSION?

A

GASTR INTESTINAL BLEEDING

25
Q

WHICH PHARMACOTHERAPY CAN BE USED IN BLEEDING ESOPHAGEAL VARICES IN ADDITIONAL TO ENDOSCOPIC TREATMENT?

A

SOMATOSTATIN
VASOPRESSIN
ANTIBIOTIC
BETA BLOCKERS

SURGICAL DISEASES (13 decks)

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