Portal Hypertension
OVERVIEW
- Portal Hypertension = increased resistance to flow through liver -> shunted around the other collateral vascular beds.
- the most common complication of cirrhotic liver disease
COMPLICATIONS
1. bleeding (oesophageal, gastric and colonic varices)
2. ascites -> SBP
3. hypersplenism (thrombocytopaenia, neutropenia)
4. porto-systemic shunting (hepatorenal syndrome, encephalopathy, prolonged action of hepatically metabolised drugs, systemic spread of gut-derived microorganisms and endotoxin)
MANAGEMENT
Acute management
- resuscitation
- lactulose
- endoscopy (ligation or injection)
- vasopressin, terlipressin, octreotide
- Sengstaken-Blakemore tube
- TIPSS: Transjugular Intrahepatic Porto-systemic Shunt Procedure
- surgery
Chronic management
- reverse pathology
- transplantation
Further reading
- Wiesbauer F. Hypertension. Medmastery
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC