MCQ Hepatobiliary - NCPF, EHPVO

Internal jugular vein graft (mesenteric-left portal vein bypass)Q used in EHPVOQ

End-to-side portacaval shuntQ.

• It is also called as Peritoneovenous Shunt – used for relief of ascites due to chronic liver diseaseQ.
• Peritoneal cavity - internal jugular vein - SVCQ

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

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.

• NeomycinQ
• LactuloseQ

• 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

Splenomegaly is about 4 times more common in NCPF than EHPVQ

Confluence of splenic vein and SMVQ

Mesenterico-left portal shunt Q

Chronic ingestion of Arsenic (As), Copper (Cu) and Vinyl chlorideQ

• Fibrous intimal thickening of the portal vein or its branchesQ.
• Portal and periportal fibrosis of varying extent (No bridging fibrosis
• Megasinusoids or periportal angiomatosisQ.

Smaller branches (3rd or 4th order branches)Q

• Obstruction of hepatic venous outflowQ producing intense congestion of the liver
• Clinical manifestations of ascites, hepatomegaly and abdominal painQ

caudate lobe mainly

• • 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.

• • 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

Hepatic venous outflow obstruction is due to subendothelial sclerosis of the sublobular hepatic veins and terminal hepatic venulesQ within