eMedicine Specialties > Gastroenterology > Liver

Portal Hypertension: Follow-up

Author: Jesus Carale, MD, Consulting Gastroenterologist, Arkansas Valley Regional Medical Center, La Junta, Colorado
Coauthor(s): Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Contributor Information and Disclosures

Updated: Aug 24, 2009

Follow-up

Further Outpatient Care

  • To prevent recurrent variceal hemorrhage, these patients should have EVL sessions scheduled until complete obliteration of varices is achieved. EVL sessions are repeated at 7- to 14-day intervals. These usually require 2-4 sessions for complete obliteration of varices.
  • Ferreira et al analyzed data on portal vein Doppler ultrasonography for postoperative follow-up in 146 patients with schistosomal portal hypertension and a previous history of upper digestive bleeding from esophagogastric varices rupture who underwent an esophagogastric devascularization procedure with splenectomy (EGDS).10  At each of 4 postoperative time points—1, 2, and 5 years and up to 10 years—patients were separated into 2 groups according to esophagogastric varices progression and diameter and mean blood flow velocity were measured.

    Findings included significantly higher values of portal blood flow velocity in patient with variceal progression. hose with portal flow velocity >15.5 cm/sec at the first postoperative year not only had progression of esophagogastric varices but also were at higher risk of rebleeding.10 Ferreira et al concluded that such patients should be included in an on-demand endoscopic program of varices eradication for postoperative follow-up as opposed a prophylactic program.

Transfer

Transfer to a tertiary center with a liver transplantation service, if possible, for patients with uncontrollable bleeding from portal hypertension.

Complications

  • Variceal hemorrhage is the most common complication associated with portal hypertension.
  • Other complications include hepatic encephalopathy, bronchial aspiration, renal failure, systemic infections, SBP, ascites, gastric varices, and hepatorenal syndrome.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform EVL sessions until complete obliteration of varices is achieved
 


More on Portal Hypertension

Overview: Portal Hypertension
Differential Diagnoses & Workup: Portal Hypertension
Treatment & Medication: Portal Hypertension
Follow-up: Portal Hypertension
Multimedia: Portal Hypertension
References
Further Reading
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References

  1. Theodorakis NG, Wang YN, Wu JM, Maluccio MA, Sitzmann JV, Skill NJ. Role of endothelial nitric oxide synthase in the development of portal hypertension in the carbon tetrachloride induced liver fibrosis model. Am J Physiol Gastrointest Liver Physiol. Jul 23 2009;[Medline].

  2. Sanyal AJ, Bosch J, Blei A, Arroyo V. Portal hypertension and its complications. Gastroenterology. May 2008;134(6):1715-28. [Medline].

  3. W. Ray KimRobert S. Brown Jr.Norah A. TerraultHashem El-Serag. Burden of liver disease in the United States: Summary of a workshop conducted by the AASLD. May 2001.

  4. Hou W, Sanyal AJ. Ascites: diagnosis and management. Med Clin North Am. Jul 2009;93(4):801-17, vii. [Medline].

  5. Chawla Y, Duseja A, Dhiman RK. Review article: Modern management of portal vein thrombosis. Aliment Pharmacol Ther. Aug 12 2009;[Medline].

  6. Singal AK, Ahmad M, Soloway RD. Duplex Doppler Ultrasound Examination of the Portal Venous System: An Emerging Novel Technique for the Estimation of Portal Vein Pressure. Dig Dis Sci. Jul 23 2009;[Medline].

  7. Sass DA, Chopra KB. Portal hypertension and variceal hemorrhage. Med Clin North Am. Jul 2009;93(4):837-53, vii-viii. [Medline].

  8. Rimola A, Garcia-Tsao G, Navasa M. Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. International Ascites Club. J Hepatol. Jan 2000;32(1):142-53. [Medline].

  9. Garcia-Tsao G, Sanyal AJ, Grace ND, Carey W. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. Sep 2007;46(3):922-38. [Medline].

  10. Ferreira FG, Ribeiro MA, de Fátima Santos M, Assef JC, Szutan LA. Doppler Ultrasound Could Predict Varices Progression and Rebleeding After Portal Hypertension Surgery: Lessons from 146 EGDS and 10 Years of Follow-Up. World J Surg. Aug 13 2009;[Medline].

  11. Bonnet S, Sauvanet A, Bruno O, Sommacale D, Francoz C, Dondero F, et al. Long-term survival after portal vein arterialization for portal vein thrombosis in orthotopic liver transplantation. Gastroenterol Clin Biol. Jul 28 2009;[Medline].

  12. Abraczinskas DR, Ookubo R, Grace ND. Propranolol for the prevention of first esophageal variceal hemorrhage: a lifetime commitment?. Hepatology. Dec 2001;34(6):1096-102. [Medline].

  13. Baik SK, Jeong PH, Ji SW. Acute hemodynamic effects of octreotide and terlipressin in patients with cirrhosis: a randomized comparison. Am J Gastroenterol. Mar 2005;100(3):631-5. [Medline].

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  16. Conn HO. Portal hypertension, varices, and transjugular intrahepatic portosystemic shunts. Clin Liver Dis. Feb 2000;4(1):133-50, vii. [Medline].

  17. de Franchis R. Updating consensus in portal hypertension: report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol. Nov 2000;33(5):846-52. [Medline].

  18. Feldman M, Scharschmidt B, Zorab R, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. Philadelphia, Pa:. WB Saunders;1998.

  19. Garcia-Pagan JC, Bosch J. Medical treatment of portal hypertension. Baillieres Best Pract Res Clin Gastroenterol. Dec 2000;14(6):895-909. [Medline].

  20. Garcia-Tsao G. Current management of the complications of cirrhosis and portal hypertension: variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology. Feb 2001;120(3):726-48. [Medline].

  21. Goh SH, Tan WP, Lee SW. Clinical predictors of bleeding esophageal varices in the ED. Am J Emerg Med. Jul 2005;23(4):531-5. [Medline].

  22. Henderson JM. Surgical treatment of portal hypertension. Baillieres Best Pract Res Clin Gastroenterol. Dec 2000;14(6):911-25. [Medline].

  23. Krige JE, Beckingham IJ. ABC of diseases of liver, pancreas, and biliary system. Portal hypertension-1: varices. BMJ. Feb 10 2001;322(7282):348-51. [Medline].

  24. Krige JE, Shaw JM, Bornman PC. The evolving role of endoscopic treatment for bleeding esophageal varices. World J Surg. 2005;29:966-73. [Medline].

  25. Lowe RC, Grace ND. Pharmacologic therapy for portal hypertension. Curr Gastroenterol Rep. Feb 2001;3(1):24-9. [Medline].

  26. Merkel C, Zoli M, Siringo S. Prognostic indicators of risk for first variceal bleeding in cirrhosis: a multicenter study in 711 patients to validate and improve the North Italian Endoscopic Club (NIEC) index. Am J Gastroenterol. Oct 2000;95(10):2915-20. [Medline].

  27. Pruvot FR, Quandalle P, Paris JC. [What's left for surgical treatment of portal hypertension in cirrhosis patients?]. Gastroenterol Clin Biol. Nov 2003;27(11):1013-20. [Medline].

  28. Russo MW, Brown RS Jr. Endoscopic treatment of patients with portal hypertension. Gastrointest Endosc Clin N Am. Jan 2001;11(1):1-14. [Medline].

  29. Samonakis DN, Triantos CK, Thalheimer U. Management of portal hypertension. Postgrad Med J. Nov 2004;80(949):634-41. [Medline].

  30. Schiff ER, Sorrell MF, Maddrey WC, eds. Schiff's Diseases of the Liver. Philadelphia, Pa:. Lippincott-Raven;1999.

  31. Sherlock S, Dooley J, eds. Diseases of the Liver and Biliary System. Oxford, UK:. Blackwell Science;1997.

  32. Soares-Weiser K, Brezis M, Tur-Kaspa R. Antibiotic prophylaxis of bacterial infections in cirrhotic inpatients: a meta-analysis of randomized controlled trials. Scand J Gastroenterol. Feb 2003;38(2):193-200. [Medline].

  33. Sterling RK, Sanyal AJ. Are TIPS tops in the treatment of portal hypertension? A review on the use and misuse of transjugular intrahepatic portosystemic shunts. Can J Gastroenterol. Nov 2000;14 Suppl D:122D-128D. [Medline].

  34. Wongcharatrawee S, Groszmann RJ. Diagnosing portal hypertension. Baillieres Best Pract Res Clin Gastroenterol. Dec 2000;14(6):881-94. [Medline].

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Keywords

portal hypertension, hypertension, liver transplant, ascites, esophageal varices, liver diseases, cirrhosis, portal vein, variceal hemorrhage

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Contributor Information and Disclosures

Author

Jesus Carale, MD, Consulting Gastroenterologist, Arkansas Valley Regional Medical Center, La Junta, Colorado
Jesus Carale, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

Coauthor(s)

Sandeep Mukherjee, MB, BCh, MPH, FRCPC, Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center
Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

Ann Ouyang, MBBS, Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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