Portal Hypertension - PHT

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Portal Hypertension - PHT

Portal hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver).

The increase in pressure is caused by a blockage in the blood flow through the liver.

06/10/2024

A 57 year old man with alcoholic cirrhosis had a massive upper GI bleed 3 months ago whilst in Scotland (BP 67/45, Hb 5.7 g/dl, platelets 38). An emergency OGD showed bleeding from the cardia and adrenaline was injected blindly + 3 bands were placed on small oesophageal varices. The bleeding continued and a Sengstaken tube was inserted. The patient was ventilated, had Terlipressin, blood transfusion, antibiotics etc. A CT scan showed gastric varices which was confirmed on re-look endoscopy (fundal varices with stigmata). The patient settled and was commenced on Carvedilol.
He returned to England and was referred to me by a colleague in another hospital for elective glue injection of the gastric varices…see video… it’s normally not as scary as this

A 57 year old man with alcoholic cirrhosis had a massive upper GI bleed 3 months ago whilst in Scotland (BP 67/45, Hb 5.7 g/dl, platelets 38). An emergency O...

05/10/2024

Acute variceal bleeding (AVB) is a severe complication of portal hypertension and occurs at a rate of around 10%-15% per year in patients with cirrhosis. Approximately 50% of cirrhotic patients develop varices and at least 2,000 patients are admitted to hospital in England per year with variceal bleeding, which has an inpatient mortality of 15% and 1 year mortality of up to 40% [1].

The 2015 UK guidelines from the BSG recommend endoscopic therapy (variceal band ligation [VBL] for treating acute oesophageal variceal bleeding or glue injection for acute gastric variceal bleeding) in combination with drug therapy (Terlipressin and antibiotics) in acute variceal bleeding.

This is a slightly unusual case of a 50 year old ex-publican who was admitted with a 24 hour history of haematemesis and melaena. He was a heavy user of alco...

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