MCQ Hepatobiliary Portal Hypertension I

SchistosomiasisQ

CirrhosisQ

• • Splenic vein thrombosisQ
• • SplenomegalyQ
• • Splenic arteriovenous fistulaQ

• • SchistosomiasisQ
• • Myeloproliferative disorderQ

• Veno-occlusive diseaseQ

• • Budd-Chiari syndromeQ
• • Congestive heart failure
• • IVC webQ
• • Constrictive pericarditisQ

• • Pressure in portal vein and SMV are normalQ
• • There is gastrosplenic venous hypertension leading to formation of gastric varicesQ

Pancreatitis

Splenectomy

• 5-10 mm HgQ or 10-15 cm salineQ
• Variceal formation occurs when portal pressure is >10 mm HgQ.
• Variceal bleeding occurs when portal pressure is >12 mm HgQ.

CirrhosisQ.

Audible venous hum in caput medusa

• Hepatic failureQ
• 2nd MC causes of death in cirrhosis patients: variceal hemorrhageQ

Hyponatremia, hypokalemia and metabolic alkalosisQ

Hypoalbuminemia and a prolonged INR, ALT/AST >2 is highly suggestive of alcohol as the cause of liver diseaseQ.

• Triad of signs:
• Liver diseaseQ
• Increased alveolar-arterial gradients (hypoxemiaQ)
• Evidence of intrapulmonary vascular resistance (intra-pulmonary vascular dilatation)Q.

Liver transplant

EVL

It gives a measure of the portal vein pressure; it can be measured by inserting a needle percutaneouslyQ

• It is the scoring system used to assess prognosis in cirrhosisQ and many liverr diseases
• Serum albumin (g/dL) / >3.5 / 2.8-3.5Q/ <2.8
• Bilirubin (mg/dL) // <2 // 2-3Q // >3
• Prothrombin time (sec above normal) or INR // <4, <1.7 //
• 4-6Q, 1.7-2.3Q // >6, >2.3
• Ascites // None // ControlledQ // Uncontrolled
• Encephalopathy // None // ControlledQ // Uncontrolled

• Class A 5-6 pointsQ
• Class B 7-9 pointsQ
• Class C 10-15 pointsQ

• • Major surgeries can be done only in Class AQ
• • Only minor surgical procedures can be performed in Class BQ
• • No surgical intervention should be done in Class C (Best treatment is liver transplantation)Q

• TIPS is used in patients with decompensated liver disease (CTP class B or C)Q.

• Sengstaken and Blakemore tube - triple-lumenQ
• Minnesota tube - Addition of a fourth port above the esophageal balloon for aspiration of oral and esophageal secretions
• Development of a single balloon Linton-Nachlas tube (for gastric varices)Q.

Protected by placement of an endotracheal tubeQ.

• Gastric balloon is inflated with with 300 ml of airQ
• If bleeding does not stop promptly, esophageal balloon may be inflated to a pressure of 40 mm HgQ.

• • Excess vitamin A is stored in stellate cellsQ in the liver and accumulation can lead to their activation and hypertrophy, excess collagen production, fibrosisQ and liver injury.
• Liver biopsy is diagnosticQ

Left gastric veinQ - Azygous veinQ and accessory hemiazygous vein

Superior rectal veinQ - Middle and inferior rectal veinQ

Left branch of portal vein (paraumblical branches) - Superficial (superior and inferior) epigastric veinsQ

Colic and omental veinsQ - Retroperitoneal veinsQ of abdominal wall, renal capsule, splenic and hepatic flexure

Hepatic venulesQ , Right branch of portal vein - Phrenic and intercostal veins, Retroperitoneal veins draining into lumbar, azygous and hemiazygous veins

• Non-variceal – 80%, Peptic ulcer disease (MC)Q
• Variceal – 20%, Gastroesophageal varices most common Q

• • MELD score is used to assess the severity of chronic liver diseaseQ
• • It was initially developed to predict death within 3 months of surgery in patients that had undergone TIPS.Q
• • It is calculated by using 3 variables (CBI): S. Creatinine, S. Bilirubin, INRQ [@ CBI]

• PELD score utilizes following variables (NABIA)Q:
• 1. Nutritional statusQ
• 2. AgeQ
• 3. BilirubinQ
• 4. INRQ
• 5. AlbuminQ

• Thickened sinus, interrupted mucosal folds (earliest sign)Q
• The “worm-eaten” smooth lobulated filling defectsQ

• GE varicesQ.
• Each episode of bleeding is associated with a 20-30% risk of mortalityQ, Seventy percent of patients who survive the initial bleed will experience recurrent variceal hemorrhage within 1 year, if left untreatedQ

• • Cirrhotic patients with variceal bleeding have a high risk of developing bacterial infectionsQ
• • Bacterial infections are associated with rebleeding and a higher mortality rateQ.
• • Use of short-term prophylactic antibiotics has been shown both to decrease the rate of bacterial infections and to increase survivalQ.
• • Ceftriaxone 1 g/day IV is often givenQ.

Splanchnic vasoconstrictionQ.

Serpiginous filling defectsQ (arrows) in the esophagus below the level of the carinaQ.

When two sessions fail to control hemorrhageQ.