Clinical Portal Hyoer Tension

Name: Jahanzaib Malik
Zohaib khan
Daniyal umar
Roll:40,41,42
Assignment:Portal hypertension
Submitted to:Mr.Amir Mushtaq

PORTAL HYPERTENSION
INTRODUCTION
“Portal hypertension is an increase in the blood pressure within a system
of
veins called portal venous system”
Veins coming from stomach, intestine, spleen and pancreas merge into
portal vein which takes it to liver.
If vessels in the liver are blocked due to liver damage, blood cannot flow
properly through liver.
As a result, high pressure in the portal system develops.
Portal hypertension is a pressure in the portal venous system that is at least 5
mm Hg higher than the pressure in the inferior vena cava.
This increase in pressure is harmful as it may lead to development of large
swollen veins (varices) within esophagus, stomach, rectum or umbilical
area.
CAUSES
Liver cirrhosis.
Parasitic infection.
Blood clots in portal vein.
Blockage of vein that carry blood from liver to heart.
LIVER ANATOMY
Upper right quadrant
4 lobes / 8 segments
1800g in men / 1400g in women
Largest vein → Portal vein (splenic + mesenteric)
Portal vein supplies 70% of blood flow to liver.
PATHOPHYSIOLOGY
There are many causes of portal hypertension including etiologies
 above the liver, within the liver, and below the liver.
1. SUPRAHEPATIC CAUSES
 Suprahepatic abnormalities leading to portal hypertension include cardiac
disease, hepatic vein etiology, and inferior vena cava thrombosis or webs.
 Liver fibrosis can result from suprahepatic disease, and cirrhosis can also
develop late in the disease course.
2. HEPATIC CAUSES
 Cirrhosis is the most common cause of portal hypertension.
 Cirrhosis is caused due to:
• Hepatitis B or C.
• Hemochromatosis.
• Alcohol consumption.
• Drug induced liver diseases.
3. INFRAHEPATIC CAUSES
 Alterations of portal venous blood flow can also lead to portal
hypertension.
 Splenomegaly and portal vein thrombosis are examples of infrahepatic
causes of portal hypertension.
CLINICAL PRESENTATION
CLINICAL FEATURES
 Splenomegaly
 Gynecomastia
 Caput medusae
 Edema of the legs
SYMPTOMS
 Gastrointestinal hemorrhage
 More advanced liver disease:
• Ascites
• Jaundice
• Coagulopathy
• Spider angioma
• Hepatic encephalopathy
 Splenomegaly
 Hepatomegaly
 Portal vein thrombosis
 Dilated abdominal wall veins
DIAGNOSIS
Portal hypertension can be diagnosed in several ways.
1. CLINICAL DIAGNOSIS
 Clinical diagnosis can be made in the setting of end-stage liver disease
and in the presence of ascites and/or varices.
2. SUBCLINICAL DIAGNOSIS
 Subclinical portal hypertension is much more difficult to diagnose, but
low platelet levels, a large portal vein, and splenic enlargement on
imaging studies are suggestive.
3. WEDGED HEPATIC VEIN PRESSURE
 Direct or indirect measurements of the portal vein may be accomplished
using wedged hepatic vein pressure or splenic pulp pressure, but these
methods are relatively invasive. Wedged hepatic venous pressure
(WHVP) is measured by inflating a balloon at the catheter tip, thus
occluding a hepatic vein branch.
 Measurement of the WHVP provides a close approximation of portal
pressure. Splenic pulse pressure is measured using laparoscopy.
4. IMAGING STUDIES
 Duplex doppler ultrasonography is a noninvasive, low-cost method of
diagnosis that provides specifics regarding the direction and velocity of
portal flow.
 CT (Computed tomography)
 MRI (Magnetic resonance imaging)
5. ENDOSCOPIC DIAGNOSIS
 Gastrointestinal endoscopy allows the physician to visualize and biopsy
the mucosa of the upper gastrointestinal tract including the esophagus,
stomach, and duodenum.
 Portal pressure gradient (PPG) value is measured using invasive
methods.
TREATMENT
 Treatment of portal hypertension is aimed at prevention of complications.
TREARMENT GOAL
 The main goal of therapy is to decrease portal pressures. This is
generally difficult to achieve and adequately maintain.
1. ASCITES
 The most important aspect in treating ascites is to restrict sodium to less
than 2 g per day.
 Diuretic therapy: Loop diuretics + Spironolactones.
2. VARICES
 Acute bleeding from varices or nonvariceal sites in patients with portal
hypertension requires prompt and appropriate measures to control
bleeding and prevent recurrent episodes.
MEDICAL THERAPY
 β-blockers: (Propranolol)
 Vasopressin (to reduce blood flow)
 Somatostatin 50 micro-organisms IV (to sop variceal bleeding)
 Antibiotics (to target gram negative bacteria)
ENDOSCOPIC THERAPY
 Treatment options include Sclerotherapy, banding of esophageal varices
and balloon tamponade to control bleeding.
SCLEROTHERAPY
 The use of sclerotherapy, or injection of a sclerosing agent directly into
and around the varices. The technique consists of injecting 1–10 mL of
sclerosing agent into the varix beginning at the gastroesophageal
junction and circumferentially into all columns.
 After the initial sclerotherapy session, subsequent sessions are scheduled
with the intent to completely obliterate the varices.
 Common side effects include tachycardia, chest pain, fever, and
ulceration at the injection site.
BANDING
 Acute variceal hemorrhage is ideally managed by variceal ligation with
elastic rings, commonly called banding.
 This method is performed endoscopically and is safe and effective. This
technique employs insertion of rubber band ligation into esophagus with
suction device which sucks the varices.
BALLOON TAMPONADE
 Balloon tamponade is useful to control variceal bleeding through
compression.
 Use of one of three commercially available balloons to tamponade
bleeding esophageal or gastric varices can be employed when medical
management has not been successful, and endoscopic management has
failed or is unavailable.
SHUNTING PROCEDURES
 Nonsurgical Trans jugular Intrahepatic Portal-Systemic Shunt (TIPSS)
 Trans jugular intrahepatic portal-systemic shunting is a radiologic
procedure that has become very popular as an alternative method of
controlling acute bleeding, especially if gastric varices are present.
 The procedure is done for dilation of tract. First, access to the hepatic vein
is obtained through the right internal jugular vein. A needle is passed
through the liver parenchyma into the portal vein, followed by dilation of
the tract and subsequent placement of a metal stent. The stent is then
dilated to achieve a portal to hepatic vein gradient of less than 10 mmHg.
SURGICAL SHUNTS
 The aim of surgical shunting in portal hypertension is threefold:
1) To reduce portal venous pressure.
2) To maintain hepatic and portal blood flow.
3) To try to reduce or not complicate hepatic encephalopathy.
LIVER TRANSPLANTATION
 Liver transplantation is the only effective treatment for end-stage liver
disease. This option offers excellent patient survival and rehabilitation.

Clinical Portal Hyoer Tension

Uploaded by

Copyright:

Available Formats

Clinical Portal Hyoer Tension

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Clinical Portal Hyoer Tension

Uploaded by

Copyright:

Available Formats

Name: Jahanzaib Malik

Submitted to:Mr.Amir Mushtaq

You might also like