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22 Cards in this Set
- Front
- Back
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location of resistance for portal vein thrombosis or splenic vein thrombosis |
pre-hepatic |
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location of resistance for schistosomiasis |
pre-sinusoidal (also PBC) |
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location of resistance for cirrhosis |
sinusoidal |
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location of resistance for veno-occlusive disease |
post-sinusoidal |
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location of resistance for budd-chiari syndrome |
post-hepatic (also right heart failure) |
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what happens if portal pressure rises above 12 mmHg? |
Varices 12 is the magic number |
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when calculating the Hepatic Venous Pressure Gradient (HVPG), what is measured in the Wedged position (WHVP)? |
balloon inflated sinusoidal pressure (a reflection of portal pressure) Inthe normal liver, extensive intersinusoidal anastomoses can dissipate the pressure |
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when calculating the Hepatic Venous Pressure Gradient (HVPG), what is measured in the Free position (FHVP)? |
balloon deflated systemic venous pressure (equivalent tomeasuring pressure in the inferior vena cava) The FHVP is used as an internal zero reference point. |
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when will you see an elevatedHepatic Venous Pressure Gradient (HVPG)? |
only in sinusoidal portal hypertension and post-sinusoidal hypertension the location of the resistance is between the balloon and the sinusoidal anastamoses so pressure can't be dissipated |
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why don't you see anelevated Hepatic Venous Pressure Gradient (HVPG) in post-hepatic portal hypertension (heart failure and budd chiari)? |
WHVP and FHVP are both elevated so HVPG appears normal. the resistance is after the balloon |
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why don't you see an elevated Hepatic Venous Pressure Gradient (HVPG) in pre-hepatic portal hypertension and pre-sinusoidal hypertension? |
WHVP and FHVP are both normal so HVPG appears normal the resistance is before the sinusoidal anastamoses so pressure can dissipate |
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treatment to prevent first hemorrhage in medium/large varices |
non-selective B-blockers (propranolol, nadolol) (Endoscopicband ligation can be considered in patients intolerant to beta-blockers or whohave contraindications to beta-blockers) |
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treatment to prevent first hemorrhage in small varices |
repeat endoscopy in 1-2 years in compensated cirrhosis repeat endoscopy annually in decompensated cirrhosis |
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prophylaxis of variceal hemorrhage in a cirrhotic pt without varices |
repeat endoscopy in 2-3 years |
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management of acute variceal hemorrhage |
GENERAL: IV access and fluid resuscitation (do not over transfuse [hemoglobin > 7-8?g/dL] because this could precipitate bleeding) antibiotic prophylaxis! (any time you have a GI hemorrhage in a cirrhotic pt) SPECIFIC: - prophylactic pharmacotherapy - endoscopic therapy |
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treatment for first rebleed of gastric varices |
Transjugular Intrahepatic Portosystemic Shunt (TIPS) |
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complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS) |
complicationsrelated to diversion of blood flow away from the liver: - portal-systemicencephalopathy - liver failure |
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pharmacoligical therapy in the treatment of acute variceal hemorrhage |
vasoactivedrugs: - vasopressin +/- nitroglycerin - terlipressin (not available in US) - somatostatin (not available in US) - octreotide *figure out where B-blockers fit in here* |
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endoscopic therapy in the treatment of acute variceal hemorrhage |
1. band ligation 2. sclerotherapy (not as good as band ligation) (COMBINATION DRUG/ENDOSCOPIC THERAPY ISMORE EFFECTIVE THAN ENDOSCOPIC THERAPY ALONE) |
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prevention of recurrent variceal hemorrhage |
band ligation + non-selective B-blockers if they rebleed after this combination therapy: - TIPS |
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in portal hypertension, in increase in 1._____________ and a decrease in 2._____________ both lead to vasoconstriction |
1. vasoconstrictors (endothelin 1) 2. NO |
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in portal hypertension, splanchnic vasodilation results from an increase in _______________ |
NO |
