Portal hypertensia
Contents:
Description:
Portal hypertensia — the increase in pressure in system of a portal vein (normal pressure — 7 mm hg) developing as a result of difficulty of a blood-groove on any site of this vein.
Increase in over 12 — 20 mm hg leads to expansion of a portal vein. Varicose expanded veins are easily broken off that leads to bleeding.
Symptoms of Portal hypertensia:
* Expansion of saphenas of a front abdominal wall ("head of the Jellyfish"), veins of the lower 2/3 gullet, stomach, hemorrhoidal veins
* Bleeding from varicose veins — esophageal and gastric bleedings (vomiting "a coffee thick", black kcal), hemorrhoidal bleedings
* Pains in an anticardium, feeling of weight in podreberye, nausea, locks, etc.
* Hypostases
* There can be jaundice
Reasons of Portal hypertensia:
Intra hepatic reasons
* Cirrhosis
* Nodal growth (at a pseudorheumatism, Felti's syndrome)
* Acute alcoholic hepatitis
* Reception of tsitostatik (methotrexate, Azathioprinum, Mercaptopurinum)
* Intoxication vitamin A
* Schistosomiasis
* Sarcoidosis
* Alveococcosis
* The disease was Punished
* Wilson's disease
* Inborn fibrosis of a liver (hepatoportal sclerosis)
* Disease to Gosha
* Liver polycystosis
* Liver tumors
* Hemochromatosis
* Myeloproliferative diseases
* Influence of toxics (vinyl chloride, arsenic, copper)
Prehepatic reasons
* Prelum of a trunk of a portal or splenic vein
* Surgical interventions on a liver, bilious ways; removal of a seoyezenka
* Injury of a portal vein as a result of an injury or wound
* Increase in a seleznka at a polycythemia, an osteomyelofibrosis, a hemorrhagic trombotsitemiya
* Inborn anomalies of a portal vein
Post-hepatic reasons
* Badd's syndrome — Kiari
* Chronic cardial compression (for example, at pericardium calcification) causes increase in pressure in the lower vena cava, strengthening resistance to a venous blood-groove in a liver
* Thrombosis or prelum of the lower vena cava.
Major importance has a phlebectasia of the lower third of a gullet and a greater cul-de-sac since varicose veins are easily broken off that leads to bleeding.
Treatment of Portal hypertensia:
* Treatment of a basic disease
* Propranolol of 20 — 180 mg 2 times a day in a combination to sclerotherapy or bandaging of varicose vessels
* Bleeding stop: терлипрессин 1 mg in struyno, then 1 mg is each 4 hours within 24 hours — works more steadily and is long, than vasopressin. Somatostatin of 250 mg intravenously bolyusno, further 250 mg intravenously kapelno within an hour (infusions can be continued up to 5 days) reduces the frequency of repeated bleedings twice. Somatostatin worsens blood circulation in kidneys and a water salt metabolism therefore at ascites it is necessary to appoint it carefully. Endoscopic sclerotherapy ("the gold standard" of treatment): prepost a tamponade and enter somatostatin. The sclerosing drug administered in varicose expanded veins leads to their obstruction. Manipulation is effective in 80% of cases. A gullet tamponade by means of Sengsteyken's probe — Bleykmora. After introduction of the probe to a stomach to cuffs force air, pressing veins of a stomach and the lower third of a gullet. It is not necessary to keep an esophageal cylinder in a mumpish state more than 24 hours. Endoscopic bandaging of varicose veins of a gullet and stomach elastic rings. Efficiency is same as at sclerotherapy, but the procedure is difficult in the conditions of the proceeding bleeding. Prevents repeated bleedings, but does not influence survival.
* Planned surgical treatment of varicose veins of a gullet and stomach is carried out for the prevention of repeated bleedings in case of inefficiency of prevention of bleedings propranolol or sclerotherapy. Survival is defined by a functional condition of a liver. After operation the probability of ascites, peritonitis, a gepatorenalny syndrome decreases
* Transplantation of a liver is shown to patients with the cirrhosis which transferred not less than 2 episodes of the bleedings which demanded carrying out hemotransfusion.
