portal hypertension

Question 1

What is portal hypertension

Answer 1

when the pressure in the portal vein is >10 clinically significant.
extrahepatic portal vein obstruction is the commenest cause in childhood and adult. while cirrhosis is 90% in the developed world.

Question 2

what is the cardinal finding in liver portal hypertension

Answer 2

splenomegaly is the cardinal finding in portal hypertension

Question 3

how to diagnose portal hypertension

Answer 3

clinically or by USS

Question 4

why caput medusae forms

Answer 4

because of portal hypertension collateral circulation forms and in the abdomen it is express as caput medusae

Question 5

where can varices happen

Answer 5

oesophagus
stomach
above 2 are most important and cause upper GI bleed
rectum

Question 6

how to investigate portal hypertension

Answer 6

endoscopy
USS - can show splenomegaly and collateral and may indicate cause

CT/MRI portal vein clot or hepatic vein patency

Clotting - thrombocytopenia common leucopenia not so common
FBC - anaemia very common cause of bleeding

Question 7

tell me about bleeding varices

Answer 7

usually bleeding occurs from the gastro oesophageal junction or in the stomach

Question 8

how to reduce risk of bleeding varices pharmacologically

Answer 8

propanalol or nadolol are effective in reducing portal hypertension
if not tolerated prophylactic banding is indicated
Terlipres­sin a vasopressor which lowers portal pressure

Question 9

other approaches to reduce risk of bleeding varices

Answer 9

sclerotherapy or banding
banding have greatly replaced sclerotherapy becuase of reduced risk of perf.
balloon tamponade - stop variceal bleed to await definitive tx