4. Increase in the blood pressure within the portal
venous system.
Veins coming from the stomach, intestine, spleen,
and pancreas merge into the portal vein, which then
branches into smaller vessels and travels through
the liver.
Vessels in the liver are blocked due to liver
damage, blood cannot flow properly through the
liver.
High pressure in the portal system develops.
This increased pressure in the portal vein may
lead to
Development of large, swollen veins (varices).
Varices can rupture and bleed, resulting in
potentially life-threatening complications.
5.
6. CAUSE
Liver cirrhosis
Scarring which
accompanies the
healing of liver injury
Scar tissue blocks the
flow of blood through
the liver
Clot
Blood from the liver
to the heart
A parasitic infection called
schistosomiasis, and focal nodular
hyperplasia, a disease seen in people
infected with HIV
7. SYMPTOMS
No specific symptoms
Chance of developing portal hypertension is high if
had liver disease that lead to liver cirrhosis
Gastrointestinal bleeding (black, tarry stools or blood in the
stools)
Hematemesis
Ascites
Encephalopathy / confusion / forgetfulness caused
by poor liver function
8. TREATMENTS
Treatment focuses on preventing or managing the
complications
Diet
Medications
Lactulose can help treat confusion and other mental changes
associated with encephalopathy.
Nonselective beta-blockers (nadolol or propranolol)
Endoscopic therapy
Banding
Sclerotherapy
Surgery
Transjugular intrahepatic portosystemic shunt (TIPS)
Distal splenorenal shunt (DSRS)
and radiology
11. ESOPHAGEAL VARICES
Abnormal, enlarged veins in the lower part of the
esophagus
Esophageal varices occur most often in people with
serious liver diseases (liver cirrhosis, portal
hypertension)
12. Symptoms
Hematemesis
Bloody stool
Shock
Managements
Medication
A medication that tightens
blood vessels
(vasoconstriction) may be
used. Examples include
octreotide or vasopressin.
Esophageal transection
TIPS , DSRS
Banding
Once the bleeding is stopped,
prevent future bleeding
including:
Drugs called beta blockers,
such as propranolol and
nadolol that reduce the risk of
bleeding.
Transjugular intrahepatic
portosystemic shunt (TIPS).
This is a procedure to create
new connections between
two blood vessels in your
liver. This can decrease
pressure in the veins and
prevent bleeding episodes
from happening again.
15. INTERNAL HEMORRHOIDS
Inside the rectum
Can't see or feel them
Don't usually hurt because there are few pain-
sensing nerves in the rectum.
Bleeding may be the only sign that they are there.
Sometimes internal haemorrhoids prolapse, or
enlarge and protrude outside the anal sphincter.
See or feel them as
moist
pink pads of skin that are pinker than the surrounding
area.
16. Symptoms
Bright red bleeding from the
anus. Blood may streak the
bowel movement or the toilet
paper.
Tenderness or pain during
bowel movements.
Painful swelling or a lump near
the anus.
Anal itching.
A mucus anal discharge.
Managements
Creams, ointments and
suppositories can help relieve
swelling and inflammation
symptoms in the short-term.
Warm (but not hot) sit baths
are a traditional therapy for
piles: sit in about 8 cm of
warm water for 15 minutes,
several times a day, especially
after a bowel movement.
Painkillers, such
as paracetamol
Products with
local anaesthetic
If constipated, recommend
using a laxative.
17. Injection or sclerotherapy
Injected with a solution that creates a scar and closes off the
haemorrhoid.
The injection will only hurt a little.
Banding
Coagulation or cauterisation.
Using either an electric probe, a laser beam, or an infrared light,
a tiny burn painlessly seals the end of the haemorrhoid, causing it
to close off and shrink. This is
most useful for prolapsed
haemorrhoids.
Surgery.
Traditional surgery,
18. CAPUT MEDUSAE
Caput medusae, also known as palm tree sign, is
the appearance of distended and engorged
paraumbilical veins, which are seen radiating from
the umbilicus across the abdomen to join systemic
veins.
19. Symptoms
Portal hypertension
Legs and belly to swell
Enlarged spleen
Umbilicus, or belly button, may stick out.
A very large caput medusae it is possible to
sometimes hear the blood humming as it passes
through the inside of your veins with the sound
becoming louder when you breathe in. This is
known as a Cruveilhier-Baumgarten murmur
20. Treatments
Treating what is causing you to have caput medusae.
Liver transplant.
Sometimes if there is a lot of fluid build-up in your stomach
you may need to have it drained away.