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MC cause of gastric varices?
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What is Rex shunt?
Internal jugular vein graft (mesenteric-left portal vein bypass)Q used in EHPVOQ
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What is Eck’s Fistula?
End-to-side portacaval shuntQ.
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What is Le-Veen Shunt?
- It is also called as Peritoneovenous Shunt – used for relief of ascites due to chronic liver diseaseQ.
- Peritoneal cavity - internal jugular vein - SVCQ
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Mechanism of Action of Le-Veen shunt?
Owing to a one-way valve within the tubing, peritoneal fluid is drawn from the abdomen and drained to the circulation due to the lower pressure in the SVC in comparison with the abdomen during the respiratory cycleQ
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What is Denver Shunt?
To prevent the high occlusion rate in Le-Veen shunt, a chamber placed over the costal margin to allow digital pressure and evacuation of any debris within the peritoneovenous shunt (Denver shunt)Q.
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Drugs effective in encephalopathy?
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Age of presentation of NCPF and EHPVO?
- NCPF - 2nd and 3rd decade
- EHPVO - in two age groups:
- – Children: 1st and 2nd decade due to congenital malformationsQ\
- – Adults: 4th and 5th decade due to thrombotic event
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Spelenomegaly in NCPF and EHPVO?
Splenomegaly is about 4 times more common in NCPF than EHPVQ
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MC site of obstruction in EHPVO?
Confluence of splenic vein and SMVQ
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What is Rex shunt?
Mesenterico-left portal shunt Q
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Etiology of NCPF?
Chronic ingestion of Arsenic (As), Copper (Cu) and Vinyl chlorideQ
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HPE of NCPF?
- Fibrous intimal thickening of the portal vein or its branchesQ.
- Portal and periportal fibrosis of varying extent (No bridging fibrosis
- Megasinusoids or periportal angiomatosisQ.
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Site of block is NCPF?
Smaller branches (3rd or 4th order branches)Q
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What is Budd-Chiari Syndrome?
- Obstruction of hepatic venous outflowQ producing intense congestion of the liver
- Clinical manifestations of ascites, hepatomegaly and abdominal painQ
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Which lobe is enlarged in Budd Chiari syndrome?
caudate lobe mainly
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Treatment of Budd Chiari Syndrome?
- • Thrombolysis of the hepatic vein clot is largely ineffective because the window for effective clot lysis is only 2-3 weeks, and most patients present after months of symptoms;
- • Side to Side Porto-Caval Shunt: most effective therapy for BCS caused by thrombosis of the hepatic veinsQ.
- In cases of BCS caused by thrombosis or occlusion of the IVC, combined SSPCS and CASQ (Cavoatrial Shunt) has replaced mesoatrial shunt as the preferred treatmentQ.
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Indications of OLT in Budd Chiari Syndrome?
- • Cirrhosis with progressive liver failure (MC indication)Q
- • Failure of a portal-systemic shunt, usually because of thrombosisQ
- • Unshuntable portal hypertension due to thrombosis of the portal vein, splenic vein or SMVQ
- • Acute fulminant hepatic failure; rarest indicationQ
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What is Veno-Occlusive Disease?
Hepatic venous outflow obstruction is due to subendothelial sclerosis of the sublobular hepatic veins and terminal hepatic venulesQ within
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