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1. INTRODUCTION As early as the 17th century, it was realized that structural changes in the portal cinculation could cause gastrointestinal bleeding. > In 1902, Gilbeni and Carnot introduced the term 'portal hypertension' to describe this condition.

2. DEFINITION Portal hypertension is also a vascular disease. Hypertension or high blood pressure is a disease in which pressure of increases in blood. When blood pressure increases in portal vein and its branches then the condition known as Portal hypertension. ∆ Portal hypertension is defined as portal pressure gradient of 12 mm Hg or greater.

3. EPIDEMIOLOGY Age: The incidence of portal hypertension increase in early 4th decade in females and early 3rd decade in males. ∆ Idiopathic portal hypertension affects -- between 43-56 years old. ∆ Non- cinnhotic portal hypertension affects-- between 25-35 years old. Risk factors: Liver Cirrhosis. Chronic viral hepatitis. Blood clots. Various congenital disorders. Primary biliary cirrhosis, an autoimmune disease.

4. Related to Anatomy Physiology

5. CLASSIFICATION

6. CAUSES

7. PATHOPHYSIOLOGY

8. Portal Hypertension Features

9. Clinical Manifestation: Abdominal pain Gastrointestinal bleeding Varicose veins of the esophagus ( varices ) Black, tarry stools or blood in the stools ( melena ) Blood in vomiting ( hematemesis ) Development of fluid in the abdomen ( ascites ) Percentage of platelets is reduced Jaundice Hepatic encephalopathy Spider Angiomata Caput medusae Gynecomastia Pruritus (widespread itching) Fatigue and weakness Increased irritability Altered sleep patterns Weight loss (malnutrition)

10. Diagnostic Evaluations: History collection Physical examination Blood count Livers function test Esophagogastroduodenoscopy USG MRI Liver angiography Coeliac - Mesenteric anteriography Splenic portogram .

11. Medical Management ►Pharmacological management: Somatostatin -Decreases portal flow, splanchnic vasoconstriction. Octreotide -- to reduce complications of bleeding afters selenotherapy . Vasopressin-Reduce blood flow to all splanchnic organs, deeneases porotal pressure, Antibiotics-to prevent infection.

12. ► Non-Pharmacological management : Avoiding alcohol consumption Exercise regularly Quitting smoking if patient smoke. Reduce weight and avoid obesity. Check blood pressure regularly. Focus on nutrition.

13. Surgical Management: Endoscopy TIPS( Transjugular Intrahepatic Portosystemic Shunt) DSRS(Distal Splenorenal Shunt) Devascularization Paracentesis Liver transplant

14. Nursing Management: Acute abdominal pain related to disease condition as evidence by patient's verbalization and facial expression. 2. Imbalance nutritional status less than body requirement related to anorexia as evidence by loss of appetite. 3. Impaired bowel movement related to less food intake as evidence by ausculting bowel sound and patient verbalization. 4. Altered sleep pattern related to disease condition and hospital environment as evidence by frequent yawning, facial expression. 5. Anxiety related to disease condition and hospital environment as evidence by non cooperative behavior. 6. Knowledge deficit related to disease condition as evidence by frequent questioning

15. COMPLICATION ► If Untreated : Hepatic encephalopathy Gastroesophageal varices and GEV Hemorrhage Liver failure Hepatocellular carcinoma Ascites and SBP Hepato - renal syndrome. Chronic bleeding. Abdominal swelling

16. ► After Surgery : Recurrence of the gastrointestinal hemorrhage. Recurrence of ascites because these patients more often develop dehiscence of the abdominal wall. The degree of decompensation of the hepatopathy immediately before the operation.During the postoperative. course of emergency surgery all types of complication may occur.

17. HEALTH EDUCATION: Stay away from drugs and limit alcohol intake. Switch to a low-sodium diet. Do not consume over the counter medications without a doctor's recommendation. Get a customized portal hypertension diet chart prepare by a dietician.

18. CONCLUSION: Portal hypertension is a major complication of cirrhosis, and its consequences, including ascites , esophageal vanices , hepatic encephalopathy and hepotorenal syndrome, lead to substantial mobidity and mortality.

19. Thank You…