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Portal Hypertension

Portal Hypertension. - Definition : - Causes : Liver cirrhosis (Com.). Extra hepatic portal v. occlusion. Intra hepatic veno occlusive Dis. Occlusion of hepatic vein. - Presentation : Decompensated Ch. Liver Di. Ascites. Encephalopathy. Variceal bleeding.

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Portal Hypertension

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  1. Portal Hypertension

  2. - Definition: • - Causes: • Liver cirrhosis (Com.). • Extra hepatic portal v. occlusion. • Intra hepatic veno occlusive Dis. • Occlusion of hepatic vein. • - Presentation: • Decompensated Ch. Liver Di. • Ascites. • Encephalopathy. • Variceal bleeding.

  3. Management of bleeding varices I - General Resuscitation: 1 .Central venous access. 2 . Blood preparation. 3 . Vit. K injection (10 mg I.V.). 4 . Correction of coagulopathy. 5 . Correction of thrombocytopenia. 6 . Endoscopic evaluation. 7 . Avoid bronchial aspiration. 8 . Sengestaken – Blakemore tube.

  4. N.B. • Severity of bleeding. • Liver cirrhosis. • Sengestaken – Blakmore tube. Oesophageal aspiration channel Oesophageal balloon 20-30 mmHg greater than predetermined pressure Gastric balloon at least 300 ml at 300 ml Gastric aspiration channel

  5. II - Drugs for variceal bleeding: 1 .Vasopressin / 20 units in 10ml 5% D/W. over 10 minutes. 2 . Nitroglycerine / 40 g/min. 3 . Octreotide. III - Endoscopic treatment of varices: 1 . Sclerotherapy. 2 . Banding.

  6. IV - Tipss • Indication. • Procedure. • Complications. • Contraindication. • V - Surgical shunts • - Indication. • - Types: • 1 . Selective (splenorenal). • 2 . Non selective (portosystemic). • Perforation of liver. • Occlusion. • Encephalopathy. • Stenosis

  7. Surgical shunts (a-d). Surgical treatments for portal hypertension involve shunting portal blood into the systemic veins. This commonly involves (a) a side-to-side proto-caval anastomosis. (b) end-to-side porto-caval, (c) meso-caval or (d) spleno-renal.

  8. N.B. • Prophylactic shunting. • Emergency shunts. • VI - Oesophageal stapled transection. • VII- Variceal bleeding and liver transplant.

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