Portal Hypertension and Oesophageal Varices
Definition
Portal hypertension is a condition characterized by increased pressure in the portal vein and its tributaries, leading to the formation of oesophageal varices.
Types of Portal Hypertension
- Pre-hepatic portal hypertension: obstruction of the portal vein due to thrombosis or other causes
- Post-hepatic portal hypertension: obstruction of the hepatic veins or the inferior vena cava
- Intra-hepatic portal hypertension: due to liver disease, such as cirrhosis or portal vein thrombosis
Clinical Features
- Abdominal distension
- Ascites
- Hematemesis
- Melena
- Jaundice
- Encephalopathy
Pathophysiology
- Increased resistance to blood flow: due to liver disease or obstruction of the portal vein
- Increased blood volume: due to splenic enlargement and increased cardiac output
- Shunting of blood: through collateral vessels, leading to formation of oesophageal varices
Investigations
- Endoscopy: to visualize oesophageal varices and assess bleeding risk
- Doppler ultrasound: to evaluate portal vein and hepatic artery flow
- Imaging studies: such as CT or MRI, to evaluate liver and portal vein anatomy
Complications
- Variceal bleeding: leading to haematemesis and melena
- Ascites: leading to abdominal distension and discomfort
- Encephalopathy: leading to confusion, altered consciousness, and seizures
Management of Variceal Bleeding
- Endoscopic sclerotherapy: to reduce bleeding and prevent re-bleeding
- Endoscopic variceal ligation: to reduce bleeding and prevent re-bleeding
- Surgical shunting: to reduce portal pressure and prevent bleeding
- TIPS (Transjugular Intrahepatic Portosystemic Shunt): to reduce portal pressure and prevent bleeding
Homeopathic Therapeutic Medicines
- Arsenicum album: for haematemesis and melena
- Belladonna: for abdominal distension and ascites
- Nux vomica: for encephalopathy and confusion
- Phosphorus: for variceal bleeding and ascites
Surgical Shunting Procedures
- Portocaval shunt: to reduce portal pressure and prevent bleeding
- Mesocaval shunt: to reduce portal pressure and prevent bleeding
- Splenorenal shunt: to reduce portal pressure and prevent bleeding
TIPS Procedure
- Access the jugular vein: using a transjugular approach
- Insert a catheter: into the hepatic vein
- Dilate the hepatic vein: using a balloon dilator
- Create a shunt: between the hepatic vein and the portal vein
- Measure portal pressure: to assess shunt effectiveness