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44 Cards in this Set
- Front
- Back
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What is Portal Hypertension?
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High pressure in the portal vein or its tributaries
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What is the MC cause of portal hypertension?
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Liver cirrhosis
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What are 6 other causes of Portal Hypertension? one more?
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-Hepatitis
-Budd-Chiari -Wilsons/Hemochromatosis -Schistosomiasis -Splenic vein thrombosis, Tumors |
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What causes 50% of portal HTN in children?
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Portal vein thrombosis
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What are 5 clinical manifestations of Portal hypertension?
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-Caput medusa
-Asterixis -Esophageal varices -Spider angiomas -Palmar erythema |
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What are 4 major complications of Portal Hypertension?
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Bleeding from Esophageal Varices
Ascites Hemorrhoids Hepatic encephalopathy |
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What are 3 signs/sx of bleeding from esophageal varices?
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-Hematemesis
-Melena -Hematochezia |
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How is Esophageal varices diagnosed?
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EGD
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What is Obtunded?
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Dulled sense to pain
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What is the initial treatment for variceal bleeding in patients with portal HTN?
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Volume resuscitation via large bore IVs
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What should be infused in pts with esophageal variceal bleeds?
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Blood products
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What is the best clinical indicator of circulatory perfusion?
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Urine output - so place a urinary catheter asap to monitor!
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What 2 meds can be used to cause splanchnic vasoconstriction and decrease variceal bleeding?
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IV Somatostatin
Vasopressin + nitroglycerin |
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What treatment is effective in 80% of patients with variceal bleeds?
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Endoscopic therapy
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What are the 2 forms of endoscopic therapy for variceal bleeds?
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-Sclerotherapy
-Banding |
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What treatment is effective in 90% of variceal bleeds?
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Luminal tamponade
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What is the most effective treatment for variceal bleeds?
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TIPS
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What is TIPS?
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Transjugular
Intrahepatic Portacaval Shunt |
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What does the TIPS procedure do?
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Allows blood to flow thru the liver more easily so it's not backing up the esophageal veins
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What are 2 adverse outcomes that can develop as a result of doing TIPS?
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-Hepatic encephalopathy
-Shunt occlusion Due to intimal hyperplasia |
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What are Porto-Systemic shunts?
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Large bore connections between the portal circulation and systemic
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What is a Total Portosystemic shunt?
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An End (portal vein) to Side (IVC) anastomosis that completely bypasses the liver
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What is a Partial portosystemic shunt?
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Side-to-Side anastomosis that only shunts PART of the portal blood to the IVC around the liver
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What is a Synthetic Portosystemic H-Shunt?
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Using a tube to connect the portal vein and IVC
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How does a synthetic H-shunt compare to the TIPS procedure?
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It goes AROUND the liver, not thru it; thus less encephalopathy associated with the H-shunt
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What is the adverse feature of the synthetic H-shunt?
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High rate of thrombosis
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What type of portosystemic shunt sidesteps the liver even earlier than the portal vein?
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Synthetic MesoCAVAL H-graft
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What does a synthetic Mesocaval H-graft connect?
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The Superior mesenteric vein SMV to the IVC
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What type of portosystemic shunt has the LOWEST rates of encephalopathy? Why?
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Distal splenorenal shunt - does not use a synthetic prosthetic material
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What is another name for a distal splenorenal shunt?
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Warren shunt
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What is as effective as a splenorenal shunt but much easier to place?
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Coronary-caval shunt
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What type of graft is used in a Coronary-Caval shunt?
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PTFE
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What is ascites exactly?
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Accumulation of SEROUS fluid in the peritoneal cavity
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Why does ascites form in portal hypertension?
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-Increased hydrostatic pressure
-Decreased oncotic pressure |
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What are the 2 basic medical ways to manage ascites?
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-Restrict fluids
-Give diuretics |
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What should fluid intake be limited to in ascitic patients?
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<40 mEq/day
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What does diuresis start with, and how is it progressed?
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Spironolactone - to get rid of sodium; increase dose until Na excretion exceeds that of K
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What should be added to spironolactone if more diuresis is needed?
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Thiazides or loops, but with caution!
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What is the next step in treating ascites if diureses is not sufficient?
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Pericentesis
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What should be infused at the time of paracentesis to replace the good contents of ascites?
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Salt-poor albumin IV - to replace the protein!
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How is ascites treated when medications and paracentesis fail to be effective?
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With Shunts
-Peritoneal-Venous (IJV) -Porto-Systemic shunts (TIPS) |
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What fraction of patients with cirrhosis will develop portal hypertension?
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2/3
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What fraction of patients with cirrhosis develop esophageal varices?
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40%
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What fraction of patients with variceal bleeding will survive 5 yrs?
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Only 50%
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