The most important and the most emergent
of our portal hypertension
sequelae will be
Or what we talked about earlier
when we have issues in engorgement.
Let's go ahead and
talk about the actual blood vessels.
So your esophageal
or gastric type of varices
It can occur due to portal hypertension
due to any cause.
Mortality much lower in cases
of non-cirrhotic portal hypertension.
If it’s cirrhotic portal hypertension
then you're pretty much
increasing risk of mortality.
Surgical shunt maybe perhaps necessary.
your Esophageal varices will be
An area or region of
So a shunt to therefore decrease
the pressure in this area
provides a durable control of bleeding
and is indicated in child
class A cirrhosis
or non-cirrhotic portal hypertension
And in that case, I mean to say
That you can shunt
and decrease the pressure immediately
Gastric varices are treated
with either glue
We call this something like
or what is TIPPS?
Your transjugular intrahepatic
you completely bypass the liver
Because this will be an example of
cirrhotic porto hypertension
causing esophageal varices
your focus should be on
and your focus should be on
proper management of your patient.
Because that is where
the questions will come from
Either cirrhotic or non-cirrhotic.
The topic of pulmonary manifestations
of portal hypertension is the following:
and in this case
A relative contra-indication
is what you want to keep in mind.
So, what do you want to do:
is when you think about cirrhosis,
As to take a look at
all of our pressures.
Can have portal hypertension
You can have hypo-tension globally
And you can have
And you can have
What is this?
This is when your patient is suffering
hypoxemia and platypnea
an orthodoxia due to
You want to think of this as being
atelectases that is taking place.
of your ovuli.
and so therefore there is
inter-pulmonary shunting taking place
Of the two,
either porto pulmonary hypertension
Or hepato-pulmonary syndrome
You pay attention
to hepato-pulmonary syndrome
in which liver
transplantation is curative.
Liver damage causing,
hypoxemia and death too.
resulting to interpulmonary
Remember, patient with portal hypertension,
also suffering from ascites.
In addition to accumulating fluid
into the Peritoneal cavity
there is also a possibility
that a patient is also developing
fluid in the pleural cavity.
We've talked about this earlier,
this is hepatic hydrothorax.
Really important for you to pay attention
to the origin of the pleural effusion
Does it respond well to diuretics?
Look for that
as being a common description.
And because the problem
took place and originated in the liver,
with Portal hypertension and ascites
Than If, you're able
to bypass the liver,
using once again, TIPSS
Then you'll find,
Not only would ascites start dropping,
but as would be the hepatic hydrothorax.