Portal Hypertension - ECAB

Author: Koshy   Abraham  

Publisher: Elsevier Health Sciences APAC‎

Publication year: 2012

E-ISBN: 9788131231814

Subject: R4 Clinical Medicine

Language: ENG

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Chapter

Introduction

Role of Portal Pressure Measurement in the Management of Complications of Cirrhosis

Historical Evolution of the Pressure Measurement Techniques

Criteria for Failure of Secondary Prophylaxis

Therapeutic Options in Patients with Portal Hypertension

HVPG Measuring Technique

Apparent Contradiction in Baveno IV

Distinction Between HVPG Monitoring for Research and Monitoring for Patient Care

New Information Available Since Baveno IV

Local Experience

Alternatives to HVPG Measurement

Algorithm

Explanations

Oral Pharmacotherapy

Conclusions

Case Studies Role of Portal Pressure Measurement in the Management of Complications of Cirrhosis

Case Study I

History

Examination and Management

Comment

Case Study II

History

Examination and Management

Comment

Case Study III

History

Examination and Management

Management

Comment

Case Study IV

History

Examination

Comment

Management of Portal Hypertensive Bleeding

Pathophysiology

Classification of Portal Hypertension

Hemodynamic Measures of Portal Hypertension

Wedged Hepatic Venous Pressure

Hepatic Vein Pressure Gradient

Natural History of Portal Hypertensive Bleeding

Diagnosis of Variceal Bleeding

Prediction of Variceal Hemorrhage

Assessment of Severity

Treatment of Portal Hypertensive Bleeding

Immediate Treatment

Specific Treatment

Pharmacologic Therapy

Vasopressin and its Analog Terlipressin

Somatostatin and its Analogs Octreotide and Vapreotide

Endoscopic Treatment

Transjugular Intrahepatic Portosystemic Shunt

Indications and Contraindications of TIPS in Portal Hypertensive Bleeding

Efficacy of TIPS

Complications of TIPS

Balloon Tamponade

Surgery

Gastric Varices

Classification of Gastric Varices

Risk Factors for Gastric Variceal Hemorrhage

Specific Management of Gastric Varices

Portal Hypertensive Gastropathy

Natural History of PHG

Role of Gastric Mucosal Blood Flow in PHG

Management of PHG

Gastric Antral Vascular Ectasia

Etiopathogenesis of GAVE

GAVE Versus PHG

Management of GAVE

Prevention of Esophagogastric Varices

Screening

Primary Prophylaxis

Modalities for Primary Prophylaxis

Secondary Prophylaxis

Pharmacotherapy

Endoscopy

Combination of Endoscopy and Pharmacotherapy

TIPS and Surgery

Summary

Case Studies Management of Portal Hypertensive Bleeding

Case Study I

Case Study II

Endoscopic Management of Portal Hypertension

Endoscopic Management of Varices

Endoscopic Sclerotherapy

Endoscopic Variceal Ligation

Glue Injection

Approach to Patients With Esophageal Varices

Prevention of First Variceal Hemorrhage

Endoscopic Sclerotherapy

Endoscopic Variceal Ligation for Primary Prevention of Variceal Hemorrhage

Management of Acute Variceal Bleed

Immediate Treatment

Endoscopic Management

Combination Therapy

Prevention of Recurrent Variceal Bleed

Management of Gastric Variceal Bleed

Endoscopic Treatment

Portal Hypertensive Gastropathy

Algorithm

Summary

Case Study I

History

Examination

Management

Discussion

Case Study II

History

Examination

Management

Discussion

Shunt Surgery in Portal Hypertension

Traditional Approach to Surgical Shunts (1970-1990)

Types of Surgical Shunts

Nonselective Shunts

Selective Shunts

Partial Shunts

Temporary Portacaval Shunts

Preoperative Evaluation of Patients for Shunt Surgery

Current Concepts

TIPSS Versus Surgical Shunts

Primary Prophylaxis

Acute Bleeding Episode

Secondary Prophylaxis or Rebleeding

Which Surgical Shunt to be Considered?

EHPVO

Shunt Surgery in the Era of Liver Transplantation

Indian Scenario

Cirrhosis of Liver

EHPVO

NCPF

Future of Shunt Surgery

Conclusion

Summary

Forthcoming Books

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