- Portal hypertension
] However, in less industrialized parts of the world, climate permitting, the major cause is
schistosomiasis . One of the best known cases in recent years is Katie MacLennanSigns and symptoms
Consequences of portal hypertension are caused by blood being forced down alternate channels by the increased resistance to flow through the portal system. They include:
*Ascites (free fluid in theperitoneal cavity )cite web |url=http://www.clevelandclinic.org/health/health-info/docs/0200/0252.asp?index=4912 |title=Portal Hypertension |accessdate=2007-12-07 |format= |work=]
*Hepatic encephalopathy
* Increased risk ofspontaneous bacterial peritonitis
* Increased risk ofhepatorenal syndrome
*Splenomegaly (enlargement of the spleen) with consequentsequestration therein ofred blood cells ,white blood cells , andplatelets , together leading to mildpancytopenia
*Portacaval anastomoses (esophageal varices ,hemorrhoid s,caput medusae ), withesophageal varices posing an ongoing risk of life-threatening hemorrhage.Treatment
Medical management
Treatment with a non-selective
beta blocker is often commenced once portal hypertension has been diagnosed, and almost always if there has already been bleeding from esophageal varices. Typically, this is done with eitherpropranolol ornadolol . The addition of anitrate , such asisosorbide mononitrate , to the beta blocker is more effective than using beta blockers alone and may be the preferred regimen in those people with portal hypertension who have already experienced variceal bleeding. In acute or severe complications of the hypertension, such as bleeding varices, intravenousoctreotide (asomatostatin analogue) or intravenousterlipressin (anantidiuretic hormone analogue) is commenced to decrease the portal pressure.Percutaneous interventions
Transjugular intrahepatic portosystemic shunt ing is the creation of a connection between the portal and the venous system. As the pressure over the venous system is lower than over a hypertensive portal system, this would decrease the pressure over the portal system and a decreased risk of complications.urgical interventions
*
Distal splenorenal shunt
*Liver transplant The most definitive treatment of portal hypertension is a
liver transplant .References
External links
* [http://videos.med.wisc.edu/videoInfo.php?videoid=249 VIDEO - Portal Hypertension: Shunt Surgery in the Era of Transplant and TIPS] , Alysandra Lal, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)
*
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* [http://www.clevelandclinic.org/health/health-info/docs/0200/0252.asp?index=4912 Overview] atCleveland Clinic
* [http://www.childliverdisease.org Children's Liver Disease Foundation]
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