Portal hypertension

Question 1

What is the normal hepatic venous pressure gradient [HVPG] (portal venous pressure)?

Answer 1

5-10 mmHg

Question 2

What are varices?

Answer 2

Engorged veins

Question 3

What is the portosystemic anastomosis at the oesophageal junction? (2)

Clinical sign in portal hypertension? (1)

Answer 3

Portal: Left gastric (coronary) vein
Systemic: azygos vein

Esophageal varices

Question 4

What is the portosystemic anastomosis at the umbilicus? (2)

Clinical sign in portal hypertension? (1)

Answer 4

Portal: Paraumbilical vein
Systemic: small epigastric veins

Caput medusae

Question 5

What is the portosystemic anastomosis at the rectum? (2)

Clinical sign in portal hypertension? (1)

Answer 5

Portal: superior rectal vein
Systemic: middle and inferior rectal vein

Anorectal varices

Question 6

What does TIPS stand for?

How does TIPS work?

TIPS complication? (1)

Answer 6

TIPS = transhepatic intrajugular portosystemic shunt

Places a shunt between portal vein and hepatic vein
relives portal hypertension by shunting blood to the
systemic circulation bypassing the liver

Hepatic encephalopathy

Question 7

Investigations and findings that can be done in portal hypertension?

Most accurate imaging to diagnose portal hypertension?

Answer 7

Abdominal US –> Large portal vein
Doppler US –> TRO venous thrombosis
Abdominal CT –> portal vein patency
Magnetic resonance angiography –> portal vein patency

Hepatic venography

Question 8

Portal hypertension results in splenomegaly with enlarged, tortuous and aneurysmal splenic vessels.

Splenomegaly –> Functional hypersplenism

What does functional hypersplenism cause?

Answer 8

• Leukopenia
• Thrombocytopenia
• Anemia

Question 9

Prevention of esophageal varices bleed? (3)

Answer 9

• non-selective Beta- blocker
• OGDS surveillance with
• Band ligation