Portal Hypertension

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Portal Hypertension

• Prof. Dr. Faisal Ghani Siddiqui
• faisalghani_at_lumhs.edu.pk

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Preamble

• What is portal hypertension ?
• How does it present ?
• How do we manage it ?

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Splenic vein
Superior mesenteric vein
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Portal veinis not a true vein
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80
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Portal venous pressuregt 10 mm Hg
Increased resistance to portal flow
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Posthepatic
Hepatic
Prehepatic
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Prehapatic(portal vein obstruction)

• Thrombosis of portal vein
• Congenital atresia / stenosis
• Extrinsic compression

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Hepatic

• Cirrhosis
• Schistosomiasis

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Posthepatic

• Budd-Chiari syndrome
• Cardiac disease

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Portal hypertensionhas no symptoms
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Ascites
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Caput Medusae
Variceal Bleeding
Haemorrhoids
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• Investigations in Ascites
• CT with IV contrast
• Aspiration of fluid
• Portal pressure measurement

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Ascites
Shrunken Liver
Portal vein thrombosis
Splenomegaly
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• Investigations in Ascites
• CT with IV contrast
• Aspiration of fluid
• Portal pressure measurement

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• Investigations in Ascites
• CT with IV contrast
• Aspiration of fluid
• Portal pressure measurement

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Portal Pressure Measurement

• Wedged hepatic venous pressure
• Splenic pulp pressure
• Catheterization of umbilical vein

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Treatment

• Medical Treatment
• Peritoneo-venous shunting
• TIPS
• Liver transplantation

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Medical Treatment

• Salt restriction
• Diuretics
• Paracenteses

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• Peritoneo-venous shunt
• (LeVeen shunt, Denver shunt)

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TIPS
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TIPS
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in summary

• Pressure gt 10 mm Hg
• Secondary to ?resistance to flow
• Presents as ascites / variceal bleeding

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in summary

• Ascites can be treated with
• Medical treatment
• PJ shunt
• TIPS
• Liver transplantation