Portal Hypertension Flashcards
Describe portal venous anatomy
Portal vein drains abdominal part of GI tract –> carries blood to liver –> venous sinusoids of liver
Where do porto-systemic anastomoses exist?
Cardia of stomach
Anus
Retroperitoneal organs
Paraumbilical veins of anterior abdominal wall
Why can portal hypertension occur?
No valves in system - blood from portal territory can flow back through system if liver obstructed
Define portal hypertension
Pressure in portal vein >10mmHg
How can the causes of portal hypertension be classified?
Pre-hepatic
Hepatic
Post-hepatic
What are the pre-hepatic causes of portal hypertension?
Portal vein thrombosis
What are the hepatic causes of portal hypertension?
Cirrhosis Hepatitis Idiopathic non-cirrhotic portal hypertension Schistosomiasis Congenital hepatic fibrosis
What are the post-hepatic causes of portal hypertension?
Budd-Chiari syndrome
What are the clinical manifestations of portal hypertension?
Variceal bleeding Haemorrhoids/caput medusae Ascites Splenomegaly Porto systemic encephalopathy
What is Budd-Chiari Syndrome?
Occlusion of hepatic veins w/ 3 key Sx (v. rare)
- abdominal pain
- ascites
- hepatomegaly
How is acute variceal bleeding managed acutely?
A-E resus
Vit K & FFP to correct clotting
IV terlipressin (or somatostatin analogues)
IV antibiotic prophylaxis (decreases mortality)
Sengsten Blakemore tube if cannot get to theatre immediately and bleeding badly
Endoscopy and ligation
TIPs procedure if all else fails
What is the definitive management for varices resistant to banding?
Transjugular intrahepatic portosystemic shunting (TIPSS)
-can use surgical porto-caval shunts
What prophylaxis for bleeding varices is available?
Endoscopy +/- adrenaline & banding
Sclerotherapy
Non-selective b-blockers
