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Portal hypertension

  1. Elevation of portal venous pressure to values above 10-12 mm Hg
  2. Two types-Extrahepatic and intrahepatic
  3. Extrahepatic portal hypertension is more common
  4. Bleeding due to gastroesophageal varices formed as a result of portal hypertension is the commonest cause of Upper GI
  5. bleeding*in children. 

Intrahepatic Portal hypertension- Caput medusae, Ascites are more common


Extrahepatic Portal hypertension - Hematemesis / melena typically occurs in a previously healthy thriving child.

Diag - Upper Gl endoscopy is most reliable method for detecting gastroesophageal varices.

  1. By ultrasound patency of portal vein, diameter of vessels, extent of block, presence of collaterals can be ascertained.
  2. Vasopressin , somatostatin , octreotide is indicated in Upper GI bleeding

Management- In extrahepatic PH management of bleeding varices is the definite therapy .in contrast for patients of intrahepatic PH management of recurrent bleeding is usually a stabilizing measures before definitive treatment.

  1. Shunt surgeries
  2. Variceal sclerotherapy
  3. Propranolol, nitrates 

NB: More details about viral hepatitis and portal hypertension, please see our Chapter of Liver and GIT in our Medicine Notes.

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