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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 Prof. Dr. Faisal Ghani Siddiqui faisalghani@lumhs.edu.pk
Preamble • What is portal hypertension ? • How does it present? • How do we manageit ?
Splenic vein Superior mesenteric vein
20 % 80 %
Portal venous pressure> 10 mm Hg Increased resistance to portal flow
Posthepatic Hepatic Prehepatic
Prehapatic(portal vein obstruction) • Thrombosis of portal vein • Congenital atresia / stenosis • Extrinsic compression
Hepatic • Cirrhosis • Schistosomiasis
Posthepatic • Budd-Chiari syndrome • Cardiac disease
Caput Medusae Variceal Bleeding Haemorrhoids
Investigations in Ascites • CT with IV contrast • Aspiration of fluid • Portal pressure measurement
Ascites Shrunken Liver Portal vein thrombosis Splenomegaly
Investigations in Ascites • CT with IV contrast • Aspiration of fluid • Portal pressure measurement
Investigations in Ascites • CT with IV contrast • Aspiration of fluid • Portal pressure measurement
Portal Pressure Measurement • Wedged hepatic venous pressure • Splenic pulp pressure • Catheterization of umbilical vein
Treatment • Medical Treatment • Peritoneo-venous shunting • TIPS • Liver transplantation
Medical Treatment • Salt restriction • Diuretics • Paracenteses
Peritoneo-venous shunt (LeVeen shunt, Denver shunt)
… in summary • Pressure > 10 mm Hg • Secondary to resistance to flow • Presents as ascites / variceal bleeding
… in summary • Ascites can be treated with • Medical treatment • PJ shunt • TIPS • Liver transplantation