Portal Hypertension

First Things First (assess for & address the following)

• Diagnosis of underlying liver disease
  • Portal hypertension is a result of cirrhosis or portal vein thrombosis (PVT)
    • Presinusoidal, sinusoidal, and postsinusoidal cirrhosis
• Estimation of functional hepatic reserve
  • Useful in predicting operative outcomes and prognosis in patients not undergoing operation
    • Child-Pugh classification
    • MELD score
• Definition of portal venous anatomy and hepatic hemodynamics
  • Has pt had any manipulation of the portal venous system?
    • TIPS
    • Surgical porto-systemic shunts
  • How high is the pressure of the portal vein?
• Identify site of upper GI hemorrhage (if present)
  • Esophagogastric variceal bleeding is the most life-threatening complication of portal hypertension (responsible for 1/3 deaths in cirrhotic patients).
  • Variceal bleeding is worse in pts with cirrhosis than those with more normal hepatic function (PCT).