Portal hypertesion
Presented by:
Mrs.Sumathigopinath
Principal
DAIMS
INTRODUCTION
Portal hypertension is an increase in
the blood pressure within a system of veins
called the portal venous system.
Veins coming from the stomach,
intestine, spleen, and pancreas merge into
the portal vein, which then branches into
smaller vessels and travels through the liver.
If the vessels in the liver are blocked due to
liver damage, blood cannot flow properly
through the liver. As a result, high pressure in
the portal system develops.
Normal portal pressure is 5-10 mmHg.
Portal pressure > 12mm Hg with
concomitantly increased wedged hepatic
vein pressure (WHVP) gradient between
the pressure in the portal vein and
inferior jejunal vein > 2-6mm Hg diagnose
portal hypertension
DEFINITION
Portal hypertension is an increase in
the blood pressure within a system of
veins called the portal venous system.
It is defined as a clinical syndrome
manifested by hemodynamic changes due
to difficult blood outflow from the portal
bed
Causes
injury caused by hepatitis,
alcohol,
blood clots in the portal vein,
blockages of the veins that carry the
blood from the liver to the heart,
a parasitic infection called schistosomiasis,
focal nodular hyperplasia,
a disease seen in people infected with HIV,
the virus that may lead to AIDS.
PATHOPHYSIOLOGY
SIGNS/SYMPTOMS
Gastrointestinal bleeding marked by black, tarry
stools or blood in the stools,
vomiting of blood due to the spontaneous rupture
and hemorrhage from varices
Ascites (an accumulation of fluid in the abdomen)
Encephalopathy or confusion and forgetfulness caused
by poor liver function
Reduced levels of platelets, blood cells that help form
blood clots, or white blood cells, the cells that fight
infection.
Classification of portal hypertension
according Petruff
1.Prehepatic
Portal vein thrombosis – independent of
cause, splenic vein thrombosis,
cavernous transformation of the portal
vein, splenic arteriovenous fistula,
idiopathic tropical splenomegaly
2.Intrahepatic
a) presinusoidal
Schistosomiasis, chronic viral hepatitis HBV,
HCV, cirrhosis biliaris primaria,
myeloproliferative diseases, focal nodular
hyperplasia, idiopathic portal
hypertension, sarcoidosis, tuberculosis,
Wilson’s disease, hemochromatosis,
amyloidosis, remaining storing diseases,
polycystic liver disease, infiltration of
liver hilus - independent of cause, benign and
malignant neoplasms .
b) sinusoidal
Liver cirrhosis - independent of etiology,
acute viral and alcoholic hepatitis,
acute fatty liver of pregnancy
c) postsinusoidal
Venous-occlusion disease, alcoholic
hyaline sclerosis of central veins
3.Extrahepatic
Hepatic veins thrombosis (Budd- Chiari
disease), inflammatory/neoplastic
infiltration cavering hepatic veins, caval
inferior occlusion (thrombosis,
neoplasms), cardiac diseases: chronic right
ventricular failure, chronic
constrictive pericarditis, tricuspid
insufficiency
DIAGNOSIS
Evaluation of medical history
A physical exam
Blood tests
Angiogram (an X-ray test that takes
pictures of the blood flow within a
particular artery)
Ultrasound
Endoscopy
MEDICATIONS
electrocardiogram (EKG) (a test that
records the electrical activity of your
heart), chest X-ray, or additional blood
tests. If your doctor thinks you will need
additional blood products (such as
plasma), they will be ordered at this time.
MANAGEMENT
endoscopic therapy,
surgery, and
radiology procedures
a role in treating or preventing the
complications.
Endoscopic therapy
This is usually the first line of treatment for
variceal bleeding and consists of either
banding or sclerotherapy.
Banding is a procedure in which a
gastroenterologist uses rubber bands to
block off the blood vessel to stop bleeding.
Sclerotherapy is occasionally used when
banding cannot be used and is a procedure
in which a blood-clotting solution is injected
into the bleeding varices to stop bleeding.
Transjugular intrahepatic
portosystemic shunt (TIPS):
This procedure involves placing a stent (a
tubular device) in the middle of the liver.
The stent connects the hepatic vein with
the portal vein, which reroutes blood flow
in the liver and helps relieve pressure in
abnormal veins.
Distal splenorenal shunt
(DSRS)
This procedure connects the vein from
your spleen to the vein from the
left kidney in order to reduce pressure in
the varices and control bleeding.
Other Treatments for Portal
Hypertension
Liver transplant . This is done in cases of
end-stage liver disease.
Devascularization. A surgical procedure
that removes the bleeding varices; this
procedure is done when a TIPS or a surgical
shunt is not possible or is unsuccessful in
controlling the bleeding.
Paracentesis. This is a procedure in which
the accumulation of fluid in the abdomen
(ascites) is directly removed. The results are
usually temporary and the procedure will
need to be repeated as needed.
LIFE STYLE CHANGES
Do not use alcohol or street drugs.
Do not take any over-the-counter or prescription
drugs or herbal medicines without first consulting
your doctor or nurse. (Some medications may
make liver disease worse.)
Follow the dietary guidelines given by your health
care provider, including eating a low-sodium (salt)
diet.You will probably be required to consume no
more than 2 grams of sodium per day. Reduced
protein intake may be required if confusion is a
symptom. A dietitian can create a meal plan for
you.
FOLLOW UP CARE
to evaluate your progress afterv10 days .
ultrasound is often done so your doctor
can check that the shunt is functioning
properly,
US after 12 months - angiogram so that
your doctor can check the pressure
within the veins across the shunt.
