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Portal Hypertension

Dr. HAMID HINDI

Preamble

What is portal hypertension ? How does it present ? How do we manage it ?

Superior mesenteric vein

Splenic vein

Portal vein is not a true vein

20 %
80 %



Portal venous pressure > 10 mm Hg
Increased resistance to portal flow

Prehepatic

Hepatic
Posthepatic

Prehapatic (portal vein obstruction)

Thrombosis of portal vein Congenital atresia / stenosis Extrinsic compression

Hepatic

Cirrhosis Schistosomiasis

Posthepatic

Budd-Chiari syndrome Cardiac disease

Portal hypertension has no symptoms

Ascites

Variceal Bleeding
Caput Medusae
Haemorrhoids


Investigations in Ascites CT with IV contrast Aspiration of fluid Portal pressure measurement

Ascites

Shrunken Liver
Portal vein thrombosis
Splenomegaly


Investigations in Ascites CT with IV contrast Aspiration of fluid Portal pressure measurement

Investigations in Ascites CT with IV contrast Aspiration of fluid Portal pressure measurement


Portal Pressure Measurement
Wedged hepatic venous pressure Splenic pulp pressure Catheterization of umbilical vein

Treatment

Medical Treatment Peritoneo-venous shunting TIPS Liver transplantation

Medical Treatment

Salt restriction Diuretics Paracenteses

Peritoneo-venous shunt (LeVeen shunt, Denver shunt)

TIPS

TIPS

… in summary Pressure > 10 mm HgSecondary to resistance to flowPresents as ascites / variceal bleeding


… in summary Ascites can be treated with Medical treatment PJ shunt TIPS Liver transplantation





رفعت المحاضرة من قبل: ياسر خضير احمد الجبوري
المشاهدات: لقد قام 53 عضواً و 206 زائراً بقراءة هذه المحاضرة








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