- Definition:

- Causes:

1.Liver cirrhosis (Com.).

2.Extra hepatic portal v. occlusion.

3. Intra hepatic veno occlusive Dis.

4.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 channel

Oesophageal balloon20-30 mmHg greater than predetermined pressure

Gastric balloon at least 300 ml at 300 ml

Gastric 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.