This document provides an overview of extra-hepatic portal vein obstruction (EHPVO). It discusses the prevalence, etiology, clinical features, diagnosis, management, and prognosis of EHPVO. Key points include that EHPVO is characterized by obstruction of the portal vein outside the liver, it is more common in India than Western countries, causes include thrombosis and hypercoagulable states, clinical features include variceal bleeding and splenomegaly, management involves preventing complications through anticoagulation and procedures like TIPS, and prognosis depends on the underlying cause and presence of complications.
By Dr. Usama Ragab, Zagazig Faculty of Medicine
PSC incidence ranges from 0.5 to 1.25 cases/100 000.
The prevalence of the disease ranges between six and 20 cases/100 000.
Men are more likely to be affected (70%).
Prevalence of PSC may be increased in first degree relatives of PSC patients
Thrombotic Microangiopathies are diverse group of disorders wherein thrombocytopenia, hemolytic anemia and organ dysfunction such as Kidney and brain occur . Major recent advances in this field have occurred which opens up oppurtunities to effectively manage its clinical challenges .
Presentation by DR. MISHAL on the topic of NON CIRRHOTIC PORTAL HYPERTENSION. Its a grey area but very important topic particularly for FCPS residents .
By Dr. Usama Ragab, Zagazig Faculty of Medicine
PSC incidence ranges from 0.5 to 1.25 cases/100 000.
The prevalence of the disease ranges between six and 20 cases/100 000.
Men are more likely to be affected (70%).
Prevalence of PSC may be increased in first degree relatives of PSC patients
Thrombotic Microangiopathies are diverse group of disorders wherein thrombocytopenia, hemolytic anemia and organ dysfunction such as Kidney and brain occur . Major recent advances in this field have occurred which opens up oppurtunities to effectively manage its clinical challenges .
Presentation by DR. MISHAL on the topic of NON CIRRHOTIC PORTAL HYPERTENSION. Its a grey area but very important topic particularly for FCPS residents .
Portal Hypertension in pediatric populationPrabinPaudyal3
PORTAL HYPERTENSION
OUTLINE:
Definition
Causes
Pathogenesis
Clinical features
Investigations
Management
Complications
Prognosis
Approach
Definition:
Defined as:
Portal Pressure > 10-12 mm Hg, with diameter >10mm Or
Hepatic Venous Pressure Gradient > 4 mm Hg
increased portal resistance or increased portal venous blood flow
major cause of morbidity and mortality in chronic liver diseases
Portal Vein:
Causes of Portal HTN:
Extrahepatic/Pre-hepatic
Hepatic
Pre-Sinusoidal
Sinusoidal
Post-Sinusoidal
Post-hepatic
A. Extra-hepatic:
Portal Vein Thrombosis- Most common
Neonates: Omphalitis, Umbilical Vein Catheterization, Dehydration, Sepsis
Older Children: Intra-abdominal infections e.g., Appendicitis, IBD, PSC
Hypercoagulable states: Deficiencies of factor V Leiden, protein C, S
Blunt Abdominal Trauma
Portal vein agenesis, atresia, stenosis
Splenic vein thrombosis
Biliary tract disease
Extrahepatic biliary atresia
Choledochal cyst
B. Intra-hepatic:
C. Post-hepatic:
Budd-Chiari Syndrome
IVC Webs
Chronic Constrictive Pericarditis
Pathogenesis And Consequence of Portal HTN
Portosystemic collaterals:
Sites:
Lower part of esophagus
Lower part of rectum
Around Umbilicus
Clinical Features:
Bleeding:
Most common presentation
risk of first bleed in cirrhosis is 22%
rises to 38% in with known varices >5-yr period
Pattern of bleeding
Hematemesis/Malena: Most common
worsened by Stress / Intercurrent illness
Size of varices → Bleeding
Splenomegaly:
2nd Most common presentation
asymptomatic or associated with cytopenia
Ascites:
Seen in 7-21% patients
Less common but important manifestations
Portal Hypertensive Biliopathy
Growth Failure
Hepatopulmonary Syndrome
Porto-pulmonary HTN
Caput Medusae:
Abnormal, dilated venous network on anterior abdominal wall, radiating from the umbilicus
Not seen in extra-hepatic portal HTN
Seen in intra-hepatic portal HTN
Continuous murmur between umbilicus and lower sternum
Cruveilhier-Baumgarten Murmur
Investigations
USG with Doppler
portal vein diameter > 10 mm
hepatic diseases, masses, presence of varices and ascites
ascertain pattern of flow
Reversal of portal blood flow (Hepatofugal flow) - Associated with bleeding varices
Cavernous transformation of the portal vein in EHPVO
Increased thickness of lesser omentum
CECT and MRA: Needed in selective cases
Selective Arteriography: When surgical decompression is being planned
GIT Endoscopy: Most reliable to detect varices
Other investigations:
CBC
LFT
Barium swallow
Portal angiogram
Percutaneous intrasplenic measurement of portal pressure
Venography
A. Emergency Management of Bleeding Varices
1st Step (Initial resuscitation):
airway protection
Obtain I/V Access
Restoration of IV volume: fluid and BT
PRBC: Target Hb: 7-9 g/dL
Correction of coagulopathy: vitamin K, FFP/PC
NG
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
EHPVO ( Extra Hepatic Portal Vein Obstruction)
1. Extra-Hepatic Portal
Vein Obstruction
Dr Manoj Kumar Kurmana
Resident MU5
Under guidance of
Dr Maniram Kumhar (Head of Dept ,Unit & Sr Prof)
Dr Munesh Kumar ( Associate Prof)
Dr Ravindra Tiwari ( Asst. Prof)
Dr Harsh Tak (Asst. Prof)
5. Introduction
◤ Most Common Cause of Portal Hypertension :
Cirrhosis (>60% of cases), portal vein
obstruction, and coagulation disorders.
◤ Complications: Gastroesophageal varices,
ascites, hypersplenism.
◤ Diagnosis : Thrombocytopenia, enlarged
spleen, ascites, and esophageal varices.
USG, contrast-enhanced imaging &
endoscopy for varices.
6. Introduction
◤ EHPVO(Extra-Hepatic Portal Vein Obstruction) is a medical condition characterized by the
blockage of the portal vein, typically outside the liver. This condition significantly impacts
portal blood flow and can lead to a range of clinical issues
◤ EHPVO is defined as "a vascular disorder of liver, characterized by obstruction of the
extra-hepatic PV with or without involvement of intra-hepatic PV radicles or splenic or
Superior Mesentric Vein"
◤ Types of EHPVO:-
Primary EHPVO: This is the most common form. It can lead to acute portal vein
thrombosis and portal cavernoma.
Secondary EHPVO: Caused by factors like malignant invasion, compression(bland),
or encasement of the portal vein.
7. Prevalence
◤ How common is EHPVO?
Data Estimates from Sweden Studies show varying prevalence estimates,
indicating that EHPVO often develops at a late stage of underlying diseases. An
autopsy study in Sweden estimated the prevalence of EHPVO to be as high as 1.0%.
In another Swedish study based on hospital discharge diagnoses, however, the
prevalence was much lower (3.7 per 100,000 population).The difference between
these 2 estimates suggests that EHPVO commonly develops at a late stage of
many diseases.
Chronic liver disease and abdominal malignancy are each found in about one third
of patients.
Regional Variations: The occurrence of EHPVO can differ in various regions.
8. Prevalence
◤ EHPVO is common in India and is responsible for 6% to 40% of all patients with
portal hypertension in various series
This proportion is <10% in the West.
Males are predominantly affected
In children, EHPVO accounts for up to 70% of cases of portal
hypertension.
9. Aetiopathogenesis of EHPVO
◤ Etiology in Different Age Groups:
Children: Commonly associated with thrombosis of the portal vein.
Contributing factors include infections like neonatal umbilical sepsis,
sepsis, severe dehydration, and abdominal surgery.
Hypercoagulable states may also play a role, though rarely.
10. Aetiopathogenesis of EHPVO
◤ Adults: Acute portal vein thrombosis is the most frequent presentation
Other causes include liver diseases (cirrhosis, hepatocellular carcinoma)
and pancreatic diseases (chronic pancreatitis, trauma, tumors).
Hypercoagulable states, Myeloproliferative disorders, inflammatory
bowel, disease, dehydration, OCP use, pregnancy although less
common, are often associated with EHPVO.
11. Aetiopathogenesis of EHPVO
◤ Portal Biliopathy:
An uncommon but notable complication characterized by bile duct
abnormalities due to collaterals compressing the bile duct.
Can lead to symptoms like biliary colic, obstructive jaundice, or
cholangitis.
Diagnosable by cholangiography but rarely symptomatic.
Role of Prothrombotic Conditions:
Occult prothrombotic disorders are frequently detected in adults with
EHPVO.
Examples include JAK2 mutation, antithrombin III, protein C, and protein
S deficiencies, prothrombin gene mutation, factor V Leiden mutation, and
more.
12. Clinical Features of EHPVO
◤ Clinical Features in Children:
Most Common Presentation: Recurrent upper gastrointestinal (GI)
bleeding from esophageal varices (hematemesis and melena).
Tolerated Bleeding: Bleeding episodes are usually well-tolerated.
Splenomegaly: Almost universal in pediatric EHPVO patients.
Asymptomatic Hypersplenism: Often asymptomatic, although some may
present with symptomatic anemia or thrombocytopenia.
Growth Retardation: Approximately 50% of children with EHPVO
experience growth retardation
Transient Ascites: Occurs in some children following upper GI bleeding.
13. ◤ Clinical Features in Adults:
Acute EHPVO: Presents as acute abdominal pain, fever, ascites, and intestinal
ischemia.
Chronic EHPVO: Characterized by recurrent upper GI bleeding from
esophageal or gastric varices.
Uncommon Presentations: Some patients may experience transient
transudative ascites after upper GI bleeding, symptomatic hypersplenism, or
portal biliopathy (rarely symptomatic).
Clinical Features of EHPVO
14. Variceal Bleeding: May occur from ectopic varices in the duodenum or
anorectal region.
Liver Dysfunction: Some patients may develop liver dysfunction during long-
term follow-up.
Hepatitis Risk: Patients at risk of acquiring hepatitis B and hepatitis C through
blood transfusions for recurrent GI bleeding.
Clinical Features of EHPVO
15. Acute Portal Vein Thrombosis in EHPVO
◤ Acute PVT is characterized by the presence of a thrombus, shown on imaging as solid
material in the lumen of the portal vein, in the absence of a cavernoma. The
subsequent transformation of an acutely thrombosed portal vein into a portal
cavernoma has frequently been referred to as chronic PVT.
16. Acute Portal Vein Thrombosis in EHPVO
◤ Risk Factors for PVT
Hyper-coagulable States: These include various conditions like antiphospholipid
syndrome, factor V Leiden mutation, and more
Infections: Conditions like appendicitis, cholangitis, and liver abscess can lead to
PVT.
Inflammatory Diseases: Inflammatory conditions like IBD or pancreatitis may also
contribute.
17. Acute Portal Vein Thrombosis in EHPVO
Impaired Portal Vein Flow: Conditions like cirrhosis, cholangiocarcinoma, and
nodular regenerative hyperplasia can obstruct blood flow in the portal vein.
Miscellaneous Factors: Central obesity, bladder cancer, and living at high
altitudes are among other possible risk factors.
Pathogenesis of Acute PVT
Acute PVT can be caused by inflammatory foci, injuries to the portal veins, or
stasis of blood in the portal venous bed.
18. Acute Portal Vein Thrombosis in EHPVO
◤ Clinical Features
Patients with acute PVT often experience severe abdominal pain,
sometimes with a fever.
Symptoms and physical examination may vary based on the stage and
complications of PVT.
19. Acute Portal Vein Thrombosis in EHPVO
◤ Diagnosis and Natural History
Imaging, like Doppler US or contrast-enhanced CT, helps in diagnosing
acute PVT.
Its difficult to Dx on USG as the thrombus may be hypoechoic & With time,
it becomes more echogenic and easier to identify but where as Colour
Doppler will be able to demonstrate absent flow & Enhancement of walls
on CT & Complete or Partial non opacification of vein indicate PVT.
Early anticoagulation treatment is associated with better outcomes in
many cases.
20. Portal Cavernoma in EHPVO
◤ Portal cavernoma is a condition characterized by the disappearance of the
normal portal vein, replaced by a network of portoportal collaterals.
◤ The distinction between chronic portal vein thrombosis (PVT) and portal
cavernoma is based on the presence of documented acute PVT in the former.
21. Portal Cavernoma in EHPVO
◤ Causes of Portal Cavernoma
The causes of portal cavernoma are similar to those of acute PVT,
although there is a lower proportion of recognized local factors at the
stage of portal cavernoma.
◤ Liver Structure and Function
In the presence of a portal cavernoma, liver structure and function
typically remain normal, even though atrophy of peripheral segments and
hypertrophy of central segments may occur.
22. Portal Cavernoma in EHPVO
◤ Symptoms and Clinical Findings
Patients with portal cavernoma often remain asymptomatic until
complications related to portal hypertension arise.
GI bleeding related to portal hypertension is the most common
complication.
23. Portal Cavernoma in EHPVO
Diagnosis
Imaging modalities, such as ultrasound (US), CT, and MRI, are useful in diagnosing
portal cavernoma where Cavernous transformation appears as numerous tortuous
vessels occupying the portal vein bed is seen on USG & numerous vascular
structures in the region of the portal vein, which enhance during the portal venous
phase, and not during the arterial phase on MULTIPHASE CT.
GI bleeding is a common complication.
Recurrent venous thrombosis and biliary complications may also occur.
24. Portal Cavernoma in EHPVO
◤ Therapeutic Approaches
Anticoagulation therapy is sometimes recommended to prevent
recurrent thrombosis.
Management of portal hypertension complications is crucial.
Nonselective β-adrenergic blockers and endoscopic variceal ligation can
be used to prevent bleeding.
In selected cases, surgical or radiological interventions like TIPS or meso-
Rex shunt (mesenterico-left portal vein shunt)can be considered.
25. Portal Cavernoma in EHPVO
◤ Prognosis
Mortality in patients with a portal cavernoma is often related to the
underlying condition, and not typically due to the complications of portal
hypertension
26. Complications
◤ Complications of EHPVO
Portal Hypertension: The most common complication, leading to the
development of varices and related issues.
Gastrointestinal Bleeding: Varices, particularly esophageal varices, can
rupture and result in life-threatening bleeding.
Portal Vein Thrombosis: Thrombosis within the portal venous system can
further exacerbate portal hypertension and affect liver function.
Ascites: Accumulation of fluid in the abdominal cavity is often associated
with advanced portal hypertension and liver disease.
Splenomegaly: Enlargement of the spleen is common and can lead to
hypersplenism with reduced platelet counts.
27. Management
◤ Management of EHPVO
Effective management of EHPVO is crucial to improve the patient’s quality of life and
address the underlying cause.
◤ Treatment Goals
The primary goals of EHPVO management are to prevent and manage
complications, improve the patient’s quality of life, and address the underlying
cause
28. Management
Anticoagulation Therapy
In cases of acute EHPVO, anticoagulation therapy may be initiated to prevent
further thrombus extension and reduce the risk of complications.
Anticoagulation helps to prevent clot formation and allows for the recanalization
of the portal vein.
Endoscopic Interventions
Endoscopic procedures are used to manage varices, particularly esophageal
varices.
Techniques like variceal band ligation and sclerotherapy can reduce the risk of
variceal bleeding.
29. ◤ TIPS Procedure
In patients with severe portal hypertension and recurrent bleeding
despite other measures, a Transjugular Intrahepatic Portosystemic Shunt
(TIPS) procedure may be considered.
TIPS involves creating a shunt to redirect blood flow and reduce portal
pressure.
Surgical Shunts
In some cases, surgical shunts such as the meso-Rex bypass may be an
option to manage portal hypertension when other interventions are not
suitable.
These procedures aim to redirect blood flow within the portal system.
30. Liver Transplantation
Liver transplantation is considered in severe cases with liver failure or
intractable complications that do not respond to other treatments.
It serves as a definitive treatment, providing a new, functioning liver
31. ◤ Long-Term Follow-Up
Patients with EHPVO require long-term follow-up to monitor their
condition, assess the effectiveness of treatments, and make necessary
adjustments.
The goal is to prevent complications and optimize quality of
life.Collaborative Care
EHPVO management often involves a multidisciplinary approach,
requiring collaboration between hepatologists, gastroenterologists,
interventional radiologists, and surgeons.
Individualized treatment plans are developed based on the patient’s
specific condition and needs.
32. Prognosis
◤ Prognosis of EHPVO
The prognosis of extrahepatic portal vein obstruction (EHPVO) can vary
depending on several factors.
Factors influencing prognosis include the underlying cause, age at
diagnosis, the extent of portal vein involvement, and the presence of
complications.
Patients diagnosed at a younger age may have better long-term outcomes.
33. NCPF
◤ Non Cirrhotic Portal Fibrosis (NCPF) is a distinct condition characterized by
'obliterative portovenopathy' leading to Portal hypertension,
massive splenomegaly and well-tolerated episodes of variceal bleeding, one of
the important causes of noncirrhotic portal hypertension which is also Known as
Idiopathic Portal Hypertension (IPH) in some Asian region where as Different terms
are used worldwide, including hepatoportal sclerosis and noncirrhotic
intrahepatic portal hypertension.
◤ NCPF/IPH is a disease of uncertain etiology characterized by periportal fibrosis
and involvement of small and medium branches of the portal vein, resulting in the
development of portal hypertension where liver functions and structure primarily
remain normal (APASL)
34. NCPF
◤ Uncertain Etiology : Noncirrhotic Portal Fibrosis (NCPF) lacks a clear cause,
making its pathogenesis intricate.
◤ Portal Venous Injury:
○ NCPF is linked to portal venous injury, especially in the presinusoidal region.
○ Intestinal infections can trigger intramural thrombi and stellate cell
activation, leading to perisinusoidal fibrosis.
◤ Xenobiotic Exposure:Suspected factors like arsenic exposure, often from
contaminated water, play a role where Arsenic may induce hepatic oxidative
stress and proinflammatory cytokines, but its involvement is debated.
◤ Immunologic Abnormalities: NCPF frequently involves immunologic irregularities,
including T-lymphocyte and adhesion molecule issues.
◤ Other Factors : Potential associations include infections, autoimmune disorders,
prothrombotic states, and exposure to various chemicals or medications.
◤ The majority of NCPF cases have an unknown cause.
36. References
◤ Filipe Gaio Nery, Dominique Charles Valla.,Vascular Diseases of the Liver In M. Feldman, L. S. Friedman, &
L. J. Brandt (Eds.), Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology,
Diagnosis, Management (12th ed.,pg 1324-1326)
◤ Y P Munjal, Surendra K Sharm et.al API Textbook of Medicine, Ninth Edition
◤ Ghai OP,Piyush Gupta, Paul VK et.al.,Ghai Essential Pediatrics 8th Ed.
◤ Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L., & Loscalzo, J. (2018).
Harrison’s Principles of Internal Medicine (21st ed.). McGraw-Hill Education.
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Editor's Notes
Compensated Cirrhosis: HVPG 5-10 mmHg, often asymptomatic, lasting ≥10 years
“Welcome to our presentation on Extra-Hepatic Portal Venous Obstruction, often referred to as EHPVO.” • “EHPVO is a medical condition characterized by the blockage of the portal vein, typically outside the liver. This condition significantly impacts portal blood flow and can lead to a range of clinical issues.” • “In this session, we will delve into the intricacies of EHPVO, including its causes, clinical features, diagnosis, treatment, and prognosis.” • “By the end of this presentation, you will have a comprehensive understanding of this condition, its management, and its impact on patients.”
“Welcome to our presentation on Extra-Hepatic Portal Venous Obstruction, often referred to as EHPVO.” • “EHPVO is a medical condition characterized by the blockage of the portal vein, typically outside the liver. This condition significantly impacts portal blood flow and can lead to a range of clinical issues.” • “In this session, we will delve into the intricacies of EHPVO, including its causes, clinical features, diagnosis, treatment, and prognosis.” • “By the end of this presentation, you will have a comprehensive understanding of this condition, its management, and its impact on patients.”
“Welcome to our presentation on Extra-Hepatic Portal Venous Obstruction, often referred to as EHPVO.” • “EHPVO is a medical condition characterized by the blockage of the portal vein, typically outside the liver. This condition significantly impacts portal blood flow and can lead to a range of clinical issues.” • “In this session, we will delve into the intricacies of EHPVO, including its causes, clinical features, diagnosis, treatment, and prognosis.” • “By the end of this presentation, you will have a comprehensive understanding of this condition, its management, and its impact on patients.”
“Welcome to our presentation on Extra-Hepatic Portal Venous Obstruction, often referred to as EHPVO.” • “EHPVO is a medical condition characterized by the blockage of the portal vein, typically outside the liver. This condition significantly impacts portal blood flow and can lead to a range of clinical issues.” • “In this session, we will delve into the intricacies of EHPVO, including its causes, clinical features, diagnosis, treatment, and prognosis.” • “By the end of this presentation, you will have a comprehensive understanding of this condition, its management, and its impact on patients.”
“Welcome to our presentation on Extra-Hepatic Portal Venous Obstruction, often referred to as EHPVO.” • “EHPVO is a medical condition characterized by the blockage of the portal vein, typically outside the liver. This condition significantly impacts portal blood flow and can lead to a range of clinical issues.” • “In this session, we will delve into the intricacies of EHPVO, including its causes, clinical features, diagnosis, treatment, and prognosis.” • “By the end of this presentation, you will have a comprehensive understanding of this condition, its management, and its impact on patients.”
Asian Pacific association for study of liver
Geographical variation exists, with a higher incidence in developing countries.
Frequently observed among young adults, with no gender predilection.