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Portal Hypertension

Portal Hypertension. Prof. Dr. Faisal Ghani Siddiqui faisalghani@lumhs.edu.pk. Preamble. What is portal hypertension ? How does it present ? How do we manage it ?. Splenic vein. Superior mesenteric vein. Portal vein is not a true vein. 20 %. 80 %.

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Portal Hypertension

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  1. Portal Hypertension Prof. Dr. Faisal Ghani Siddiqui faisalghani@lumhs.edu.pk

  2. Preamble • What is portal hypertension ? • How does it present? • How do we manageit ?

  3. Splenic vein Superior mesenteric vein

  4. Portal veinis nota true vein

  5. 20 % 80 %

  6. Portal venous pressure> 10 mm Hg Increased resistance to portal flow

  7. Posthepatic Hepatic Prehepatic

  8. Prehapatic(portal vein obstruction) • Thrombosis of portal vein • Congenital atresia / stenosis • Extrinsic compression

  9. Hepatic • Cirrhosis • Schistosomiasis

  10. Posthepatic • Budd-Chiari syndrome • Cardiac disease

  11. Portal hypertensionhas no symptoms

  12. Ascites

  13. Caput Medusae Variceal Bleeding Haemorrhoids

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

  15. Ascites Shrunken Liver Portal vein thrombosis Splenomegaly

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

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

  18. Portal Pressure Measurement • Wedged hepatic venous pressure • Splenic pulp pressure • Catheterization of umbilical vein

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

  20. Medical Treatment • Salt restriction • Diuretics • Paracenteses

  21. Peritoneo-venous shunt (LeVeen shunt, Denver shunt)

  22. TIPS

  23. TIPS

  24. … in summary • Pressure > 10 mm Hg • Secondary to resistance to flow • Presents as ascites / variceal bleeding

  25. … in summary • Ascites can be treated with • Medical treatment • PJ shunt • TIPS • Liver transplantation

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