Portal hypertension

Portal hypertension - Acute
Rahul Soman, M. Pharm

 

 

Definition  

An increase in portal system pressure

 

Medical History  

* Cirrhosis of liver [Cirrhosis of liver - Acute]

* Alcoholic hepatitis

* Portal vein thrombosis

* Budd-Chiari syndrome

* Schistosomiasis

* Heart failure

 

Findings  

* Hematemesis

* Melena

* Hematochezia

* Ascites - Acute

* Hemorrhoids - Acute

* Trunk varices

* Jaundice

* Asterixis

* Palmar erythema

* Spider nevus

* Xanthomatosis

* Altered mental status

* Personality change

 

Tests  

 

Suspected or known gastroesophageal varices  

* Gastrointestinal tract endoscopy: Endoscopy is routinely done in cirrhotic patients to screen for the presence of varices .

 

Suspected portal hypertension  

* Abdominal ultrasound: Ultrasound examination can help make the diagnosis of portal hypertension and may clarify the etiology .

 

Treatment  

 

Drug Therapy  

 

 

Primary and secondary prophylaxis of bleeding gastroesophageal varices  

 

PROPRANOLOL HYDROCHLORIDE  

Adults: Initial dose of 20 mg orally twice daily; adjust to maximal tolerated dose

 

NADOLOL  

Adults: Initial dose of 40 mg once a day; adjust to maximal tolerated dose

 

Procedural Therapy  

 

Gastroesophageal varices  

* Ligation of esophageal varices: Endoscopic variceal ligation is used in primary and secondary prophylaxis, as well as treatment during an acute variceal bleed .

* Sclerotherapy of esophageal varices: Sclerotherapy is used to control active variceal bleeding in cirrhotic patients if endoscopic variceal ligation (EVL) is not technically feasible .

 

Bleeding esophageal varices  

* Transjugular intrahepatic portosystemic shunt: A transjugular intrahepatic portosystemic shunt is used to treat refractory variceal bleeding and to prevent recurrent bleeding .