This document discusses portal hypertension, its causes, signs, symptoms, diagnosis, and management. It provides an overview of normal portal circulation and defines portal hypertension as a portal pressure greater than 12 mmHg. It describes various etiologies of portal hypertension including presinusoidal, sinusoidal, postsinusoidal, and posthepatic causes. Complications of portal hypertension like variceal bleeding, ascites, and hepatic encephalopathy are discussed. The management of portal hypertension and its complications is also summarized.
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
Approach to Management of Upper Gastrointestinal (GI) BleedingArun Vasireddy
Upper gastrointestinal bleeding is gastrointestinal bleeding in the upper gastrointestinal tract, commonly defined as bleeding arising from the esophagus, stomach, or duodenum. Blood may be observed in vomit (hematemesis) or in altered form in the stool (melena). Depending on the severity of the blood loss, there may be symptoms of insufficient circulating blood volume and shock. As a result, upper gastrointestinal bleeding is considered a medical emergency and typically requires hospital care for urgent diagnosis and treatment. Upper gastrointestinal bleeding can be caused by peptic ulcers, gastric erosions, esophageal varices, and some rarer causes such as gastric cancer.
The initial assessment includes measurement of the blood pressure and heart rate, as well as blood tests to determine hemoglobin concentration. In significant bleeding, fluid replacement is often required, as well as blood transfusion, before the source of bleeding can be determined by endoscopy of the upper digestive tract with an esophagogastroduodenoscopy. Depending on the source, endoscopic therapy can be applied to reduce rebleeding risk. Specific medical treatments (such as proton pump inhibitors for peptic ulcer disease) or procedures (such as TIPS for variceal hemorrhage) may be used. Recurrent or refractory bleeding may lead to need for surgery, although this has become uncommon as a result of improved endoscopic and medical treatment.
Dr. Zahid Iqbal Mir, MBBS, MS (General Surgery), DNB (General Surgery) has done his bachelors and masters in General Surgery from the prestigious Govt Medical College Jammu and DNB in General Surgery from NBEMS New Delhi. He is a passionate surgeon, earlier practising at Government Medical College, Jammu as Registrar in Department of General Surgery. Nowadays working as Senior Resident in Department of General Surgery, Government Medical College & Hospital, Sector 32, Chandigarh and a rising name in field of surgery.
He is an enthusiastic, enigmatic and dedicated teacher as well. He is not just a resolute learner, but also an awe inspiring guiding light for his juniors, which makes him the most loveable and respected senior.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. The hepatic portal
circulation carries blood
from GI tract (i.e. from the
distil esophagus to
anorectal junction) to the
liver.
Porto–systemic
anastomosis occurs in
junctional areas of venous
drainage.
Portal venous blood drain
into venous sinusoids of
liver and hence in to the
hepatic veins.
3. NORMAL PORTAL HYPERTENSION
Pressure = Flow X
Resistance
Portal pressure : 5-10
mm Hg
Normal elevation:
Eating
Exercise
Valsalva
10 mmHg (prolonged) →
Shunting
Lt Gastric → esophageal
Short Gastric → Gastric
Submucosal
Lt portal → epigastric
Retroperetoneal and
anorectal collateral
12 mm Hg → Bleeding
4. Portal hypertension develop
when there is elevation of
portal pressure is greater
than 12 mmHg, while normal
portal pressure is 5 –
10mmHg.
As portal hypertension
produce no symptoms it is
usually diagnosed following
presentation with
decompensated chronic liver
disease encephalopathy,
ascites or variceal bleeding.
7. Cirrhosis results in scarring (perisinusoidal
deposition of collagen)
Scarring narrows and compresses hepatic
sinusoids (fibrosis)
Progressive increase in resistance to portal
venous blood flow results in PH
Portal vein thrombosis, or hepatic venous
obstruction also cause PH by increasing the
resistance to portal blood flow
As pressure increases, blood flow decreases
and the pressure in the portal system is
transmitted to its branches
Results in dilation of venous tributaries
Increased blood flow through collaterals and
subsequently increased venous return cause an
increase in cardiac output and total blood
volume and a decrease in systemic vascular
resistance
With progression of disease, blood pressure
usually falls
8. Oesophageal and gastric varices(lt
gastric vein+short gastric vein(P)-
intercostal,diaphragmatic,esophageal
,azygos vein(VC) )
Haemorrhoids (superior hemohhoidal
vein(P)-middle and inferior
hemorrhoidal veins(VC) )
Caput medusae (remnant of umbilical
circulation-large paraumbilical vein-
epigastric venous system around the
umbilicus )
Retroperitoneal veins-
gastrointestinal veins through the
bare areas of the liver
Omental and lumbar veins
11. Specific treatment in some pre cirrhotic lesions:
Wilson disease—D penicillamine,
Hemochromatosis---phlebotomy,
Antiviral drugs for chronic viral hepatitis
In established cirrhosis-treatment of complications
Screening for hepatocellular carcinoma
Liver transplantation
Maintenance of nutrition
12. Caused by hepatic venous obstruction at the level of the inferior
vena cava, the hepatic veins, or the central veins within the liver itself
Result of congenital webs (in Africa and Asia), acute or chronic
thrombosis (in the West), and malignancy
Acute symptoms include hepatomegaly, RUQ abdominal pain,
nausea, vomiting, ascites
Chronic form present with the sequelae of cirrhosis and portal
hypertension, including variceal bleeding, ascites, spontaneous
bacterial peritonitis, fatigue, and encephalopathy
Diagnosis is most often made by US evaluation of the liver and its
vasculature. Cross-sectional imaging using contrast-enhanced CT or
MRI . Gold standard for the diagnosis has been angiography
Management has traditionally been surgical intervention (surgical
decompression with a side-to-side portosystemic shunt)
Minimally invasive treatment using TIPS may be first-line therapy now
Response rates to medical therapy are poor
13. Most common cause in children (fewer than 10% of adult pts.)
Normal liver function and not as susceptible to the development of
complications, such as encephalopathy
Diagnosis by sonography, CT and MRI
Often, the initial manifestation of portal vein thrombosis is variceal
bleeding in a noncirrhotic patient with normal liver function
Causes:
Umbilical vein infection (the most common cause in children)
Coagulopathies (protein C and antithrombin III deficiency),
Hepatic malignancy, myeloproliferative disorders
Inflammatory bowel disease
pancreatitis
trauma
Most cases in adults are idiopathic
Therapeutic options are esophageal variceal ligation and sclerotherapy
Distal splenorenal shunt
Rex shunt in patients whose intrahepatic portal vein is patent (most
commonly children)
14. Most often caused by disorders of the
pancreas (acute and chronic pancreatitis,
trauma, pancreatic malignancy, and pseudocysts)
Related to the location of the splenic vein
Gastric varices are present in 80% of patients
Occurs in the setting of normal liver function
Readily cured with splenectomy (variceal
hemorrhage), although observation for
asymptomatic patients is acceptable.
15. Decrease or reverse portal blood flow to the liver
promote the development of the portosystemic
anastomosis between the portal system and
systemic circulation-dilated veins around umbilicus.
Liver cell dysfunction/liver failure occurs in
hepatic and post – hepatic causes
Ascites
Splenomegaly (hypersplenism may be result)
The CHILD – PUGH classification is used to asses the
severity.
Jaundice
Anemia
Signs of encephalopathy-asterexsis
16. Conditions 1 2 3
Bilirubin (md/dl) <2 2-3 >3
Albumin (g/L) >3.5 2.8 – 3.4 <2.8
Prothrombin
index(%)
>70 40-70 <40
Ascites None Slight-
Moderate
Moderate –
severe
Encephalopathy None Slight-
Moderate
Moderate –
severe
5-7 =A
7-10 =B
>10 =C
Child A – mild
B → non-
transplant
surgery
Child C –
advanced B →
transplant
17. GI bleeding due to gastric and esophageal varices
Ascites
Hepatic encephalopathy
portal hypertensive gastropathy and colopathy.
congestive splenomegaly,hypersplenism
Hepatorenal syndrome
Hepato pulmonary syndrome
18. 1- FBC, Urea & electrolytes ,LFT and clotting fn.tests
2- Screening tests for the causes of the cirrhosis
3- CT & ultrasound scan to assess liver morphology,
diagnose portal hypertension and assess cause.
4- Transabdominal Doppler ultrasound to assess blood
flow in the portal vein and hepatic artery.
5-Gastroscopy in acute variceal bleeding
6-portal venogram
7-measurement of portal venous pressure through
transjugular cannulation of hepatic veins(high in
sinusoidal and postsinusoidal PH)
19. General resuscitation
Anti – coagulation for Budd – Chiari syndrome
Treatment of hepatic cause
Treatment Of Chronic Complication such as Esophageal gastric
varices:
1- Beta – blocker (propranolol or nadolol), reduce portal venous
pressure due to vasodilatory effects on both splanchnic arterial bed and
portal venous system and reduced cardiac output.
2- Repeated injection sclerotherapy or variceal ligation
3- Elective porto – systemic shunt (spleno – renal anastomosis)
4- Liver transplant may be considered for treatment if associated with
severe liver diseases.
Rectal Varices: Injection sclerotherapy
Symptomatic splenomegaly: laparoscopic or open splenectomy.
Ascites: Oral spironolactone, in cases of ascites, paracentesis may be
required with IV albumin replacement.
20. Hemorrhage from the varices is acute complication of the portal
hypertension.
Mortality rate of first variceal bleed established portal hypertension is
30%.
Bleeding arises from oesophageal varices mostly or from gastric varices
Causes & Features:
Typical variceal bleeding is rapid in onset, copious dark blood with little
mixing with food.
Feature of established portal hypertension e.g. capute medusae
Feature of developing hepatic encephalopathy
Factors like NSAIDS intake,high portal pressure,large varices,endoscopic
variceal stigma(red spots,red stripes),tense ascites precipitate bleeding
Symptoms and signs of shock(tachycardia,systolic Bp <90mmHg,urine
output <30ml/hr)
21. Established large caliber IV access, give crystalloid fluid up to 1000
mL, if tachycardic or hypotensive.
Only use O - ve blood if the patient is in extreme shock, otherwise
wait for cross – match blood.
Catheterize and place on fluid balance chart if hypotensive.
Send blood for FBC, HB conc. WCC, U&E, Na, K, LFT, albumin and
clotting.
Monitor pulse rate, BP and urinary output.
Insertion Of Sengstaken Blackemore gastro-esophageal tube may
be a life saving. To be deflated after 24 hrs.If bleeding stops remove
in another 24 hrs.
22. Decreases the rate of bleeding
Enhances the endoscopic ability to visualize the site of bleeding
1.Vasopressin - potent splanchnic vasoconstrictor; decreases portal
venous blood flow and pressure.0.1-0.5 units/min for 4-12 hrs then
reduce dose upto 48 hrs. Terlipressin is better in hepatorenal syndrome
Somatostatin: direct splanchnic vasoconstrictor.250 microgm bolus
followed by 250 microgm/hr infusion
Octreotide:Synthetic somatostatin analogue.50 microgm bolus IV foll by
50 microgm/hr
Short acting nitrates(NTG)-lower portal pressure by direct vasodilation of
porto systemic collaterals
23. Endoscopic Sclerotherapy with sodum morrhuate,absolute
alcohol,ethanolamine oleate: complications occur in 10-30%
and include retrosternal chest pain, perforation,ARDS,sepsis
Endoscopic band variceal ligation: becoming the initial
intervention of choice; success rates range from 80-100%
Surgery
Porto systemic shunt-selective,nonselective
Totally diverting (end-side portacaval)
Partially diverting (side-side portacaval)
Selective (distal splenorenal shunt)
Splenectomy –splenic vein thrombosis
Liver transplantation
24. Primary prophylaxis: prevent 1st episode of bleeding
Secondary prophylaxis: prevent recurrent episodes of
bleeding
Include control of underlying cause of cirrhosis and
pharmacological, surgical interventions to lower portal
pressure
Beta blockade: Beta blockade (Nadolol, Propranolol)
Sclerotherapy
Endoscopy band variceal ligation
TIPSS
Portosystemic Shunt Surgery
Prevent encephalopathy by giving lactulose
25. Neuropsychiatric complication of cirrhosis
Results from spontaneous or surgical / radiological
portal-systemic shunt + chronic liver failure
Failure to metabolize neurotoxic substances
Alterations of astrocyte morphology and function
(Alzheimer type II astrocytosis)
Types:
1.acute or subacute-reversible
2.chronic-progressive leading to coma and death
26.
27. Increased nitrogen load(GI
Bleed,uremia,constipation,in
creased protein intake)
Electrolyte
imbalance(hypokalemia,hyp
ovolemia,hypoxia,alkalosis)
Drugs(narcotics,diuretics,se
datives)
Large binge of alcohol
Large volume paracentesis
TIPSS
Infection,surgery ,acute liver
disease
28. Identify and treat
precipitating factor
Infection
GI hemorrhage
Prerenal azotemia
Sedatives
Constipation
Lactulose (adjust to 2-3
bowel movements/day)
Protein restriction, short-
term (if at all)
29.
30. Hepatorenal Syndrome Hepatopulmonary syndrome
6 criterias
1.Cirrhosis with ascites
2.Creatinine>1.5 mg%
3.Absence of other cause of renal
failure
4.No treatment with nephrotoxic
drugs
5.Absence of shock
6.Kidney is anatomically, histologically
functionally normal
Type 1:acute,rapid,poor prognosis
Type 2:chronic,stable,better prognosis
Decreased blood volume and
increased sympathetic tone
Treat precipitating factors,
saline/albumin,midodrine,octreotide
Liver transplant
4 criterias
1.Advanced chronic liver disease
2.Arterial hypoxemia
3.Intra pulmonary vasodilation
(defective clearance of vasodilatory
substance by liver)
4.No primary cardiopulmonary disorder
Clinical
Platypnoea(dyspnoea in upright)
Orthodeoxia(desaturation in upright)
Inv
Contrast enhanced ECHO
Technetium-99m macroaggregated
albumin lung perfusion scan
Treat
Oxygen,drugs like almitrine,methylene
blue, garlic-increase pulmonary vasc
resistance+pulm art pressure
TIPS,liver transplant
31. CAUSES
Prehepatic, hepatic ,posthepatic
COMPLICATIONS
GI bleeding due to gastric and esophageal varices
Ascites
Hepatic encephalopathy
portal hypertensive gastropathy and colopathy.
congestive splenomegaly
Hepato renal,hepato pulmonary syndrome
TREATMENT
Treat the cause, reduce portal pressure, liver
transplant