All about Portal Hypertension (P-HTN)

All about Portal Hypertension (P-HTN) ➡️

💊 Normal Portal venous pressure — 5-6 mmHg.

💊 Clinically significant when pressure excceds — 10 mmHg.

💊 Patient is in risk of variceal bleeding when pressure excceds — 12 mmHg.

💊 Most Common cause of P-HTN is — Cirrhosis of liver(90%).(Developed countries).

💊 Worldwide most common cause — Schistosomiasis.

💊 Cardinal feature of P-HTN is — Splenomegaly.

A diagnosis of P-HTN is very unusual when splenomegaly is not detected clinically or by USG.

💊 Once Diagnosis is made Upper GI endoscopy should be perform to screen for oesophageal varices.

💊 Most important consequence of P-HTN is — Variceal bleeding.

💊 Prophylactic use of Propanolol significantly reduced the risk of variceal bleeding.

non-bleeding varices are identified at endoscopy, β-adrenoceptor antagonist (β-blocker) therapy with propranolol (80–160 mg/ day) or nadolol (40–240 mg/day) is effective in reducing portal venous pressure.Administration of these drugs at doses that

reduce the heart rate by 25% has been shown to be effective in the primary prevention of variceal bleeding. In patients with cirrhosis, treatment with propranolol reduces variceal bleeding by 47% ), death from bleeding by 45% and overall mortality by 22%

💊 Terlipressin use in case of Acute variceal bleeding, it reduce portal pressure by reducing the portal blood flow.

💉 Complication of P-HTN ➡️


💊 A… Ascitis.

💊 R… Renal Failure.

💊 C… Congestive gastropathy.

💊 H… Hypersplenism.

💊 I… Iron deficiency Anaemia.

💊 V… Variceal bleeding.

💊 E… Encephalopathy

💊💉Regarding management of acute variceal bleeding

Acute hemorrhage from esophageal varices should be managed with

1-fluid and/or blood resuscitation, To replace extracellular volume

2-prophylactic antibiotics such as oral ciprofloxacin or iv cephalosporin OR Prpiracillin\tazobactem To reduce incidence of spontaneous bacterial peritonitis

3- pharmacotherapy. Pharmacotherapy is directed at reducing portal pressure with vasoconstrictors or reducing intrahepatic vascular resistance with vasodilators that includes the following

💊💉 Iv terlipressin The dose of terlipressin is 2 mg IV 4 times daily until bleeding stops, and then 1 mg 4 times daily for up to 72 hours. Caution is needed in patients with severe ischaemic heart disease or peripheral vascular disease because of the drug’s vasoconstrictor properties

💊💉Octreotide is the synthetic analogue of somatostatin. It selectively reduces splanchnic blood flow without producing the systemic cardiac effects of vasopressin dosage is 50mcg iv boulus and 50mcg/hour maintinince for 2-5 days it can be used when terlipressin is not available

4- endoscopic identification followed by one of Emergency endoscopic therapy that includes

💊💉Endoscopic banding ligation : Banding is best suited to the treatment of oesophageal varices. It is associated with a lower risk of oesophageal perforation or stricturing than sclerotherapy

💊💉 Injection sclerotherapy

😍😌 If haemostasis is achieved then Continue terlipressin to 72 hrs Introduce β-blocker as secondary prophylaxis ,Enter patient into endoscopic banding programme to obliterate varices

💔😓 If bleeding is continues Further endoscopic therapy or Balloon tamponade or Emergency TIPSS

5- Proton pump inhibitor To prevent peptic ulcers because Prophylactic acid suppression with proton pump inhibitors reduces the risk of secondary bleeding from bandinginduced ulceration.

6- Phosphate enema and/or lactulose To prevent hepatic encephalopathy