Definition: - Causes: 1.Liver cirrhosis (Com.). 2.Extra hepatic portal v. occlusion. 3.Intra hepatic veno occlusive Dis. 4.Occlusion of hepatic vein

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Text of Definition: - Causes: 1.Liver cirrhosis (Com.). 2.Extra hepatic portal v. occlusion. 3.Intra hepatic...

  • - Definition:- Causes:Liver cirrhosis (Com.).Extra hepatic portal v. occlusion.Intra hepatic veno occlusive Dis.Occlusion of hepatic vein.- Presentation:Decompensated Ch. Liver Di.Ascites.Encephalopathy.Variceal bleeding.

  • I - General Resuscitation:

    1 .Central venous access.2 .Blood preparation.3 . Vit. K injection (10 mg I.V.).4 .Correction of coagulopathy.5 .Correction of thrombocytopenia.6 .Endoscopic evaluation.7 .Avoid bronchial aspiration.8 .Sengestaken Blakemore tube.

  • N.B.Severity of bleeding.Liver cirrhosis.Sengestaken Blakmore tube.Oesophageal aspiration channelOesophageal balloon20-30 mmHg greater than predetermined pressureGastric balloon at least 300 ml at 300 mlGastric aspiration channel

  • II - Drugs for variceal bleeding:

    1 .Vasopressin / 20 units in 10ml 5% D/W. over 10 minutes.2 .Nitroglycerine / 40 g/min.3 .Octreotide.

    III - Endoscopic treatment of varices:1 .Sclerotherapy.2 .Banding.

  • IV - Tipss

    Indication.Procedure.Complications.Contraindication.

    V - Surgical shunts

    - Indication.- Types:

    1 . Selective (splenorenal).2 . Non selective (portosystemic). Perforation of liver. Occlusion. Encephalopathy. Stenosis

  • Surgical shunts (a-d). Surgical treatments for portal hypertension involve shunting portal blood into the systemic veins. This commonly involves (a) a side-to-side proto-caval anastomosis. (b) end-to-side porto-caval, (c) meso-caval or (d) spleno-renal.

  • N.B.Prophylactic shunting.Emergency shunts.

    VI - Oesophageal stapled transection.

    VII- Variceal bleeding and liver transplant.