Liver & GIT
Upper GI Bleeding:
Normally 80% blood to liver is from portal vein and 20% by hepatic artery But in cirrhosis major blood supply to liver is by hepatic A
The major sites of collateral involve:
1. Esophagogastricvarices Q– Left gastric vein and short gastric vein join Qwith esophageal vein of caval system.
2. Hemorrhoids – superior hemorrhoidal vein of portal system to middle and inferior hemorrhoidal vein of the caval system.
3. Caput medusae– remnants of the umbilical circulation of fetus present in the falciform ligament.
4. Retroperitoneal space.
5. Bare area of liver
Extra Edge: Common Causes of hematemesis
1. Acute gastritis 2. Peptic ulcer 3. Portal hypertension
4. Mallory’s Weiss syndrome 5. Stomach cancer.
1) Fibro-optic esophagoscopy– shows the presence of esophageal varices.
2) Measurement of portal venous pressure by either percutaneous transhepatic skinny needle catheterization or through transjugularcannulation of the hepatic veins. Wedged hepatic venous pressure is high in sinusoidal and post sinusoidal portal hypertension.
3) USG abdomen Q– features of portal hypertension such as splenomegaly, collaterals, or portal vein thrombosis can be detected. The size of portal vein can be measured. Normal size is 10 mm.
4) Portal venogramQ – site and cause of portal venous obstruction can be detected.
Rockall score system :
Rockall risk scoring system is to identify patients at risk of adverse outcome following acute upper gastrointestinal bleeding.
Rockall score in based on 1. Age 2.Presence or absence of shock 3. Comorbidity