Portal Hypertension
Dr. HAMID HINDIPreamble
What is portal hypertension ? How does it present ? How do we manage it ?Superior mesenteric vein
Splenic veinPortal veinis not a true vein
20 %80 %
Portal venous pressure> 10 mm Hg
Increased resistance to portal flow
Prehepatic
HepaticPosthepatic
Prehapatic(portal vein obstruction)
Thrombosis of portal vein Congenital atresia / stenosis Extrinsic compressionHepatic
Cirrhosis SchistosomiasisPosthepatic
Budd-Chiari syndrome Cardiac diseasePortal hypertensionhas no symptoms
Ascites
Variceal BleedingCaput Medusae
Haemorrhoids
Investigations in Ascites CT with IV contrast Aspiration of fluid Portal pressure measurement
Ascites
Shrunken LiverPortal 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 transplantationMedical Treatment
Salt restriction Diuretics ParacentesesPeritoneo-venous shunt (LeVeen shunt, Denver shunt)
TIPSTIPS
… 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