Portal Hypertension in Children.. Dr.Malathi Sathiyasekaran

Portal hypertension in children Malathi Sathiyasekaran Pediatric Gastroenterologist. Chennai

Portal Hypertension ,[object Object],[object Object]

Portal Hypertension ,[object Object],[object Object],[object Object],[object Object]

Classification of PHT ,[object Object],[object Object],[object Object],[object Object],[object Object],1 2 3 4 5

Causes of PHT VOD,Classical BCS IVC obstruction ,[object Object],[object Object],[object Object],cirrhosis ,[object Object],Portal,splenic vein thrombosis,cong.malformations CHF,NCPF ,[object Object],[object Object],[object Object]

Clinical Evaluation • Splenomegaly • Abdominal veins • Ascites ,[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],I Evaluation of PHT: type and consequences of PHT

II Evaluate: Physical signs of chronic liver disease

III Evaluate: Presence of PSE ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Splenomegaly

Dilated Abdominal Veins ,[object Object],[object Object],[object Object],[object Object]

Ascites ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Liver Size & Consistency

Age & PHT India Children Adults West - Children Anand A C et al. Yachha et al Goncalves M E

Age & PHT ICH & HC Chennai, 1999 - 2001 Total Number 165

Presentation:GI Bleed ,[object Object],[object Object],[object Object],[object Object]

Porto Systemic Hepatic Encephalopathy ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Hematological changes

Clinical Features ,[object Object],[object Object],[object Object],[object Object]

Clinical Features ,[object Object],[object Object],[object Object]

Evaluation of various forms of portal hypertension Enlarged / firm / nodular Decreased vol / firm / nodular Firm Normal or Small volume Liver + + + ++ + + Spleen + / - + - - Encephalopathy +++ ++ - - Pedal oedema + + + + + 5% - 10% 5% - 10% Ascites + / - + ++ Well tolerated ++ Well tolerated GI Bleed All ages All ages 18-25 Children & occ. adults Mean age (years) HVOO Cirrhosis NCPF EHPVO Parameter

Features EHPVO NCPF CIRRHOSIS HVOO Centrilobular necrosis, fibrosis Reversed lobulation Necrosis, nodules fibrosis Normal / Peri Portal fibrosis Normal Liver biopsy Liver enlarged Hepatic vein thrombosis or IVC obstruction Liver coarse echoes Collaterals dilated PV ascites Splenomegaly Patent dilated PV splenomegaly collaterals PV thrombosis Cavernoma Collaterals Splenomegaly US T P decreased Glob increased (Chronic) T.P decreased Glob increased Normal Normal T. Protein A/G ratio + + + Back vein ++ + / - - / few veins on lumbar region Anterior Abdominal Veins

EHPVO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Causes of EHPVO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Natural history of EHPVO ,[object Object],[object Object],[object Object]

Complications of EHPVO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnosis of PHT ,[object Object],[object Object],[object Object]

ENDOSCOPY ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ultrasound&Doppler

Ultrasound and Doppler ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Other features on US ,[object Object],[object Object],[object Object],[object Object]

Measurement of Variceal Pressure ,[object Object],[object Object],[object Object]

Hepatic Venous Pressure Gradient ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management of variceal bleed ,[object Object],[object Object],[object Object]

Management of EHPVO ,[object Object],[object Object],[object Object],[object Object]

EHPVO :without bleed . ,[object Object],[object Object],[object Object]

EHPVO with bleed ,[object Object],[object Object],[object Object],[object Object],[object Object]

EHPVO following bleed . ,[object Object],[object Object],[object Object]

Indications for surgery in EHPVO ,[object Object],[object Object],[object Object],[object Object],[object Object]

Reasons for not advocating early surgery in EHPVO ,[object Object],[object Object],[object Object]

TIPSS ,[object Object],[object Object],[object Object],[object Object],[object Object]

Portal Hypertension in Children.. Dr.Malathi Sathiyasekaran

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Portal Hypertension in Children.. Dr.Malathi Sathiyasekaran