Portal Hypertension Follow-up

  • Author: Jesus Carale, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Sep 24, 2010
 

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).[12] 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.[12] 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.

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Transfer

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

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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.

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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: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

Alex J Mechaber, MD, FACP  Senior 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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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Portal vein and associated anatomy.
 
 
 
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