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By ULY CLINIC

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Portal Hypertension

 

Introduction

 

This is high blood pressure in the hepatic portal system which includes the portal veins and its branches which drains from most of the intestines to the liver. It is indicated when the hepatic venous pressure gradient exceeds 7mmHg, while liver cirrhosis remains the most common cause which in our local setting is commonly caused by chronic viral hepatitis followed by heavy alcohol intake.

 

Diagnostic Criteria

 

  • Ascites, Splenomegaly

  • Esophageal varices, and hematemesis

  • Swollen veins of the anterior abdomen(caput medusa) and hemorrhoids PLUS

  • Radiological evidence of shrunken liver, with typical features of cirrhosis. 

 

Pharmacological Treatment

 

Ascites

 

  • Spironolactone 50mg – 400mg (PO) once daily incrementally till ascites resolves 

AND

  • Furosemide 40mg–160 mg (PO) once daily or in divided doses incrementally till ascites resolves 

AND

  • Propranolol 40mg–160mg (PO) once daily incrementally until portal venous pressure is stabilizes to normal values        

OR

  • Carvedilol 6.25mg–12.5mg (PO) once daily, incrementally till portal pressures stabilizes to normal  AND

  • Albumin 25% infusion (IV) – in refractory ascites and large volume parecentecis. Give 25g stat, repeat at 15–30min interval at max dose of 250g/48 hourly  

 

Bleeding Esophageal Varices 

 

  • Octreotide Inj (SC) 50 µg–100 µg 8 hourly for 3 days   

AND

  • Band ligation of beeding esophageal varices (EVL); 3 – 6 shoots per session.   

OR

  • Inj sclerotherapy (Histo Acryl Glue Inj 5%; Ethanolamine oleate 5%); given 2mls -5mls per varix up to 20mls per session.   

AND

  • Blood transfusion (PRBC, PLT concentrates and FFP) as appropriate. 

 

Hepatic Encephalopathy

 

  • L-Ornithine L-Aspartate (Herpemez) granules (PO) 9g/day in divided dose for 4–12 weeks    

AND

  • Lactulose 20mls (PO) 12 hourly for bowel ceasing  

AND

  • Metronidazole (IV) 400mg 8 hourly for 7days 

AND

  • Ceftriaxone (IV) 1g 12 hourly for 7days (if evidence of spontaneous bacterial peritonitis)  Fluid deficit correction and electrolytes replacements as appropriate

 

Hepatorenal Syndrome

 

  • Terlipressin (IV) 0.5–2mg 6 hourly for 14 days 

Plus

  • Albumin 5% albumin infusion (Dose 1g/kg up to 100g/day)

Plus

  • Fluid deficit correction.

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Updated on, 2.11.2020

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References

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1. STG

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