Portal Hypertension.pptx

For 2nd year B.Sc Nursing students

1. PORTAL HYPERTENSION Presented By: Mr . Nandish. S Asso. Professor Mandya Institute of Nursing Sciences

2. DEFINITION : It is an increased pressure within the portal venous system. It is characterized by an increased venous pressure through out the portal circulation along with large collateral veins. It is an abnormally increased pressure in the portal vein and its branches from most of intestine to Liver. It is hepatic venous pressure gradient greater than 5mm Hg.

3. ETIOLOGY : They are classified under : Pre - Hepatic Intra - Hepatic Post – Hepatic The most common cause is Cirrhosis of Liver (Chronic Liver Failure).

4. PRE – HEPATIC CAUSES Portal vein thrombosis Splenic vein thrombosis Hypercoagulate states Arterio -venous Fistula Splenomegaly / Hypersplenism (Increased blood flow)

5. INTRA HEPATIC CAUSES : Chronic viral Hepatitis Primary sclerosing cholangitis Chronic pancreatitis Congenital Hepatic Fibrosis Nodular Regenerative hyperplasia Hereditary Haemorrhagic Telangiectasia Infiltrative Liver Disease Toxicity (Arsenic, Copper, Vitamin A) Fatty Liver Disease Hepato toxic drugs / medications.

6. POST – HEPATIC CAUSES : Inferior vena cava obstruction Right side heart failure Constrictive pericarditis Budd – Chiari syndrome is also known as Hepatic vein thrombosis.

7. Pathophysiology : Increased vascular resistance Hepatic stellate cells get activated Increased endogenous vasodilation More blood flow in the portal veins Clinical features

8. CLINICAL MANIFESTATIONS : Ascites Abdominal pain Splenomegaly Thrombocytopenia Anorectal varices Caput Medusae (swollen veins on the anterior abdominal wall)

9. DIAGNOSTIC STUDIES : History collection & Physical examination Ultrasonography Doppler ultrasound Hepatic venous pressure gradient measurement (> or = to 5mm Hg)

10. TREATMENT : 1) Portosystemic shunt - Splenorenal (splenic vein to left renal vein) Portal vein to inferior vena cava Superior mesenteric vein & the inferior vena cava Transjugular Intrahepatic portosystemic shunting (TIPS) : easy to perform & doesn’t disrupt liver’s vascularity.

11. 2) Prevention of Bleeding : It includes both pharmacological & endoscopic treatment. Medical : Non specific β – blockers Nitrate Isosorbide mononitrate Vasopressin Vasoactive drugs like Somatostatin & Octreotide . Endoscopy : Endoscopic banding ligation Balloon tamponade

12. Management of Ascites : Salt restriction Abdominal paracentesis Diuretics (spironolactone) TIPS

13. General management : Administration of Lactulose Enema Restriction of dietary protein Antibiotics ( Rifaximin , Neomycin, Vancomycin ) Quinolne

14. NURSING MANAGEMENT : ?

15. THANK YOU