Portal Hypertension

Portal hypertension is defined as a increase in portal vein pressure above the normal level of 5 to 10 mm Hg. In established cases of portal hypertension, direct portal pressure measurement may be elevated to 15 mm Hg or even more. Portal hypertension is due to obstruction somewhere in the portal veins draining into the inferior venacava (post- hepatic)

 The Manifestation are:  Oesophegeal Varicosity  Haemorrhoids  Splenomegaly & Hypersplenism  Liver Failure

 Pre – hepatic causes:– 20% Congenital atresia or Hypoplasia. Trauma Tumor Isolated spleenic vein thrombosis.

 Hepatic causes:– 80%. Nutritional cirrhosis. Postnecrotic cirrhosis. Billary cirrhosis. Haemochromatosis. Wilson's disease.

 Post Hepatic:– Rare Budal chair syndrome. Right sided heart failure.

 Pre-hepatic causes

 Hepatic Causes

 Post- Hepatic Cause

 Management three stages:  Resuscitation:  Blood volume should be maintained.  Saline should be avoided because of ascites.  Pulse rate, blood pressure should be monitored.  Gastric acid secretion should be decreased.

 Diagnosis:  Endoscopy

Specific Treatment:  Vasopressin.  Endoscopic Variceal Sclerosis.  Balloon Tamponade.

 Shock  Clotting Problems  Ascites  Liver Failure