Portal Hypertension

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Portal Hypertension

• Tiffany Young

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Portal Hypertension

• Portal hypertension is an increase in pressure in
  the portal vein which is caused by obstructed
  blood flow through the liver
• Normal pressure 5-10mm Hg
• Anything over 10mm Hg is considered high
• Problems
• Blood will find a way to bypass the liver to
  reach the heart or there is too much pressure
  upstream
• Major cause of portal hypertension is cirrhosis
  of the liver
• Alcohol
• Hepatitis B and C

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Cirrhosis of the Liver

• Liver tissue is replaced by connective tissue and
  causes loss of function
• The damage is irreversible but treatment of the
  causative agent can slow or stop further damage
• Early symptoms
• Red Palms
• Spider Angioma (red spots on the upper body)
• Fatigue, nausea and weight loss

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Cirrhosis of the Liver - Causes

• Alcohol induced cirrhosis Alcoholic Liver
  Disease (ALD)
• One of two common causes of cirrhosis in the
  United States
• Occurs in 15 of all alcoholics
• Approx3-4 drinks per day in Men 2-3 drinks per
  day in Women
• Hepatitis B
• Most common cause of cirrhosis world wide
• Passed through blood or bodily secretions
• 100 more infectious than HIV
• United States 1.5m World 300m infected
• Hepatitis C
• Second of two common causes of cirrhosis in the
  United States
• United States 6.5m
• Mostly passed through needle use (not sexually)

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Symptoms of Portal Hypertension

• Esophageal Varices
• Ascites
• Hepatic encephalopathy
• Palmar erythema
• Clubbing
• Caput Medusae

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Esophageal Varices

• Extreme dilation of the sub-mucosal
• veins in the lower mucosa of the
• esophagus and sometimes upper part of
• the stomach
• Life threatening shock
• Diagnose by endoscopy
• Two main inflows for esophageal varices are left
  coronary vein or splenic hilus through the short
  gastric veins
• Responsible for 5-11 of gastrointestinal bleeding

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Esophageal Varices

• Chronic Liver Disease -
• 8 per year for the first two
• years
• 30 by the sixth year
• Risk of bleeding is 30 in
• the first year after ID
• 70 chance of rebleeding and approx 1/3 of the
  episodes are fatal
• Treatment
• Banding tying rubber band around bleeding veins
• Sclerotherapy injection of sclerosing agent
  which causes them to shrink

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Ascites

• Accumulation of fluid in the peritoneal cavity
• Not deadly but can lead to further complications
• Can cause fluid retention by the kidneys
• Diuretics are used in treatment and safer than
  drainage

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Hepatic Encephalopathy

• Hepatic Encephalopathy impairment of brain
  cells because of toxic substances in the blood
• Impaired cognition, tremors, and decreased levels
  of consciousness
• Subtle signs are usually observed in 70 of
  people with cirrhosis

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Palmar Erythema and Clubbing

• Palmar erythema reddening of
• the skin on the hands because of
• capillary congestion
• Therapy treat portal hypertension
• Clubbing deformity of the fingers and
  fingernails
• Thought to cause vasodilation
• in the fingers and therefore
• hypertrophy of the nailbeds

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Caput Medusae

• Appearance of distended or engorged umbilical
  veins radiating from umbilicus
• Blood trying to circumvent the liver because of
  pressure
• Looks similar to an inferior vena cava
  obstruction
• To differentiate look at the blood flow below the
  umbilicus
• Blood flow towards the legs Caput Medusa
• Blood flow towards the head Inferior vena cava
  obstruction

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Treatment of Portal Hypertension

• Nitric Oxide vasodilator that decreases
  intrahepatic resistance
• Something that is normally found in the liver but
  levels decrease in a cirrhotic liver
• Drug therapies are being looked at to provide NO
  to the liver only
• Transjugular intrahepatic portosystemic shunt
  (TIPS) catheter is extend from portal vein
  across liver and connects to the hepatic vein
• Portacaval Shunts pass blood from portal vein
  to inferior vena cava
• High death rate
• 24-53 show debilitating symptoms of hepatic
  encephalopathy

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Preventing Portal Hypertension

• Preventing portal hypertension preventing
  cirrhosis
• No more than 1 drink a day for women and 2 for
  men
• Take vitamin supplements only if your diet is
  restricted
• Vitamins A, D, E and K are dependent on the
  liveer to metabolize
• Many commonly used chemicals and solvents are
  liver toxins
• Eat a balanced diet!

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References

• Familypracticenotebook.com http//www.fpnotebook.c
  om
• Wikipedia
• http//en.wikipedia.org
• EMedicine
• http//www.emedicine.com