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Portal Hypertension

Portal Hypertension

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Published by: drnareshkumar3281 on Oct 27, 2008
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05/15/2012

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PORTAL HYPERTENSION
1.CHIEF COMPLAINT
Portal hypertension
2.HPI3.ROS4.SYMPTOMS
Ascites
Hepatic encephalopathy
Splenomegaly
Mild pancytopenia
Esophageal varices
Hemorrhoids
Caput medusae
5.HISTORY
FAMILY HISTORY
o
Hemochromatosis
o
Wilson disease
SOCIAL HISTORY
o
Alcohol abuse
PAST MEDICAL HISTORY
o
Jaundice
o
Blood transfusions
o
Intravenous drug use
o
Pruritus
o
Portal vein thrombosis
o
Splenic vein thrombosis
o
Right heart failure
SURGICAL HISTORY
CHRONIC CONDITIONS
o
Congenital atresia
o
Stenosis of portal vein
o
Splanchnic arteriovenous fistula
o
Schistosomiasis
o
Primary biliary cirrhosis
 
o
Idiopathic portal hypertension
o
Nodular regenerative hyperplasia
o
Polycystic disease
o
Sarcoidosis
o
Tuberculosis
o
Hepatic cirrhosis
o
Acute alcoholic hepatitis
o
Schistosomiasis
o
Primary biliary cirrhosis
o
Idiopathic portal hypertension
o
Acute and fulminant hepatitis
o
Congenital hepatic fibrosis
o
Vitamin A toxicity
o
Peliosis hepatitis
o
Venoocclusive disease
o
Budd-Chiari syndrome
o
Inferior vena cava (IVC) obstruction
o
Constrictive pericarditis
o
Tricuspid regurgitation
o
Budd-Chiari syndrome
o
Arterial-portal venous fistula
6.ALLERGIES7.PHYSICAL EXAMINATION
Dilated veins in the anterior abdominal wall
Venous pattern on the flanks
Caput medusa
Rectal hemorrhoids
Ascites - Shifting dullness and fluid wave
Paraumbilical hernia
Ascites
Jaundice
Spider angiomas
Palmar erythema
Asterixis
Testicular atrophy
Gynecomastia
Dupuytren contracture
Muscle wasting
Splenomegaly
 
Bounding pulses
Warm, well-perfused extremities
Arterial hypotension
8.SPECIFIC DATA LIKE GRADING ETC9.TESTS TO BE ORDERED
Liver function tests
Prothrombin time
Serum Albumin
Viral hepatitis serologies
Platelet count
Antinuclear antibody
Antimitochondrial antibody
Antismooth muscle antibody
Iron indices
Alpha1-antitrypsin
SERUM Ceruloplasmin
24-hour urinary copper
Duplex-Doppler ultrasonography
CT scan
MRI
Liver-spleen scan
Angiography
Endoscopy
10.ASSESSMENT /PLAN
o
Medical Care
Endoscopic injection sclerotherapy
Endoscopic variceal ligation (EVL)
Balloon-tube tamponade
Endoscopic administration of cyanoacrylate monomer(superglue)
o
Surgical Care
Total portal systemic shunts
Side-to-side portacaval shunt
Partial portal systemic shunts
Distal splenorenal shunt
Splenectomy
Gastroesophageal devascularization

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