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Portal Hypertension

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Title: Portal Hypertension


1
Portal Hypertension
  • Tiffany Young

2
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

3
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4
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

5
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6
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)

7
Symptoms of Portal Hypertension
  • Esophageal Varices
  • Ascites
  • Hepatic encephalopathy
  • Palmar erythema
  • Clubbing
  • Caput Medusae

8
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

9
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

10
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

11
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

12
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

13
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

14
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15
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

16
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!

17
References
  • Familypracticenotebook.com http//www.fpnotebook.c
    om
  • Wikipedia
  • http//en.wikipedia.org
  • EMedicine
  • http//www.emedicine.com
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