Portal Hypertension

Portal Hypertension is a topic covered in the Pocket ICU Management.

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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).

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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).

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Last updated: April 29, 2010