portal hypertension Flashcards

1
Q

define portal hypertension?

A

abnormally high pressure within the hepatic portal vein.

venous pressure gradient > 10 mmHg

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2
Q

pathophysiology of portal hypertension?

A

Portal venous system consists of portal, splenic and mesenteric vein
These veins contain toxins and nutrients and goes through the liver.
When blood cannot flow from portal vein to IVC = portal hypertension
1. Build-up of toxins -> hepatic encephalopathy
2. Build-up of pressure at portosystemic shunts-> varices and haemorrhoids
3. Round ligament re-channels -> dilation of veins -> caput medusae
4. Blood backs up to splenic vein -> splenomegaly
5. Endothelial cells release more NO -> BP drops -> more aldosterone -> accumulation of fluid

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3
Q

ABCDE of portal hypertension?

A
A  – ascites
B  – bleeding
C – caput medusae 
D – diminished liver function
E – enlarged spleen
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4
Q

most common cause of portal hypertension?

A

• CIRRHOSIS

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5
Q

what are the three catagories of causes of portal hypertension?

A

o Pre-Hepatic - blockage of the portal vein before the liver
• Congenital stenosis
o Hepatic
• CIRRHOSIS
o Post-Hepatic - blockage of hepatic veins or venules
• Budd-Chiari syndrome
• Right heart failure

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6
Q

what are the main presenting complaints of the complications of portal hypertension?

A

o Varices, haematemesis or melaena
o Lethargy, irritability, changes in sleep (hepatic encephalopathy)
o Abdominal distension (ascites)
o Abdominal pain and fever (spontaneous bacterial peritonitis)
o Pulmonary involvement

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7
Q

what are the presenting symptoms of liver disease?

A

o Jaundice
o History of alcohol abuse
o Risk factors for viral hepatitis (e.g. tattoos, unprotected sex, IV drug use, travel abroad and blood transfusion)
o Family history (e.g. haemochromatosis)

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8
Q

major signs og portal hypertension?

A

o Caput medusae
o Splenomegaly
o Ascites

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9
Q

major signs of liver failure?

A
o	Jaundice  
o	Spider naevi 
o	Palmar erythema 
o	Confusion  
o	Asterixis  
o	Fetor hepaticus  
o	Enlarged or small liver  
o	Gynaecomastia  
o	Testicular atrophy
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10
Q

best blood investigation for liver failure?

A
  • prolongation of PT
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11
Q

what specific tests might be done for portal hypertension?

A
o	Ferritin - haemochromatosis  
o	Hepatitis serology  
o	Autoantibodies (e.g. anti-smooth muscle antibodies in autoimmune hepatitis)   
o	1-antitrypsin levels  
o	Caeruloplasmin - Wilson's disease
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12
Q

what imaging might be done for portal hypertension?

A

o Abdominal ultrasound - check liver and spleen size and assess portal blood flow
o Doppler ultrasound - assess direction of blood flow in vessels
o CT/MRI - if other imaging methods are inconclusive
o Endoscopy - to check for oesophageal varices

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13
Q

what other investigations could be done for portal hypertension?

A
  • Measure hepatic venous pressure gradient (HVPG)

* Liver Biopsy - if indicated

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14
Q

how to treat the high blood pressure of portal hypertension?

A

o Beta-blocker eg. propranolol

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15
Q

how to treat ascites of portal hypertension?

A

o Sodium restriction

o Diuretics

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16
Q

how to treat bleeding oesophageal varices of portal hypertension?

A

o Octreotide
o Balloon tamponade
o Sclerotherapy
o Variceal ligation

17
Q

what is TIPS?

A

o Procedure to decrease portal pressure

o Tube inserted to allow communication between portal vein and hepatic vein

18
Q

what are complications of portal hypertension?

A
  • Bleeding from oesophageal varices
  • Ascites + complications of ascites
  • Pulmonary complications
  • Liver failure
  • Hepatic encephalopathy
  • Cirrhotic cardiomyopathy
19
Q

what are complications of ascites?

A

o Spontaneous bacterial peritonitis
o Hepatorenal syndrome
o Hepatic hydrothorax

20
Q

what pulmonary complications might occur?

A
o	Portopulmonary hypertension 
o	Hepatopulmonary syndrome - triad of: 
•	Hepatic dysfunction 
•	Hypoxaemia 
•	Extreme vasodilation
21
Q

what reduces prognosis in portal hypertension patients?

A

• Variceal haemorrhages have a 1-year mortality of 40%