Portal hypertension

Portal hypertension

1. Portal Hypertension By, Ms. Ekta S Patel Assistant Professor.

2. Portal venous pressure is the blood pressure in the hepatic portal vein, and is normally between 5-10 mmHg .

3. Portal circulation

4. Portal circulation collateralization

5. Meaning Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system.

6. Definition It is defined as the elevation of the hepatic venous pressure gradient to > 10mm Hg

7. Types:

8. Causes: Depending on the site of vascular obstruction;

9. Pre- hepatic Portal vein Thrombosis Pancreatitis Trauma Hypercoaguable states

10. Intra-hepatic Schistosomiasis Congenital hepatic fibrosis Sarcoidosis Myeloproliferative diseases Drugs Toxins Cirrhosis Fatty liver Metastatic malignant disease

11. Postheaptic : Hepatic vein thrombosis ( budd - chiari syndrome) Constrictive pericarditis Rt sided heart failure

12. Clinical manifestation: Ascites Hypersplenism

13. Increased portosysystemic shunting : Oesophageal varices Haemorrhoids Caput medusae

14. Caput medusae : is the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen.

15. Hepatic encephalopathy hepatorenal failure Gastrointestinal bleeding Reduced levels of platelets, blood cells that help form blood clots, or white blood cells

16. Abdominal pain Black, tarry color stool Melena Hematemesis Jaundice Pruritus Gynecomastia

17. Fatigue Increased irritability Altered sleep pattern Weight loss Spider angiomata

18. Diagnostic evaluation: Blood Count Liver Function Tests Oesophagogastroduodenoscopy Usg Mri Liver Angiography Coeliac -mesenteric Arteriography Splenic Portogram

19. Treatment : Endoscopic therapy : Banding Sclerotherapy

20. Medications: Beta blockers Lactulose : to treat mental confusion.

21. Life style changes:

22. Transjugular Intrahepatic Portosystemic Shunt (TIPS)

23. Distal Splenorenal Shunt

24. Devascularization

25. Paracentesis

26. Liver transplant