Portal Hypertension and Cirrhosis of Liver: Symptoms, Diagnosis & Management

Portal Hypertension and Cirrhosis of Liver: Symptoms, Diagnosis & Management

Question. Describe clinical features of portal hypertension. How will you investigate and manage a case of cirrhosis of liver.

Answer. Following are the clinical features of portal hypertension:

• Splenomegaly: Spleen gets enlarged to the size of 5–6 cm.
• Hypersplenism: It is common leading to anemia,thrombocytopenia and leukemia. Pancytopenia can also occur.
• Collateral vessels form at gastroesophageal junction which may rupture leading to hematemesis or malena.
• Ascites is present.
• Caput-medusae is seen around umbilicus and at times large umbilical collateral give rise to venous hum.
• Fetor hepaticus results from shunting of portal blood. In fetor hepaticus foul smell from breadth is present due to mercaptans.

“Understanding portal hypertension and cirrhosis through FAQs: Symptoms, diagnosis, and management explained”

Investigation of case of cirrhosis of liver 

1. Assessment of severity of cirrhosis of liver :

1. Liver biochemistry:
   • It may be normal in compensated cirrhosis.
   • SGOT / SGPT reflct the activity of the disease, which is low when cirrhosis is established,but increased in evolution of cirrhosis due to autoimmune hepatitis.
   • Alkaline phosphatase and transaminases may be slightly raised in decompensated cirrhosis.
   • Serum albumin reflcts liver cell function, its low level indicates cirrhosis.
   • Plasma bilirubin is normal in most of the cases but it gets increased in decompensated cirrhosis.
   • Low albumin, i.e. <2.5 g / L and rising bilirubin are signs of progressive liver damage and these constitute bad prognostic signs.
2. Hematology:
   • Anemia, leukopenia and thrombocytopenia or pancytopenia may be seen in cirrhosis.
   • Increased prothrombin time is a bad prognostic sign.
3. Ascitic flid examination: Ascites is transudate in nature.

“Importance of studying portal hypertension and cirrhosis for healthcare professionals: Questions explained”

2. Assessment of type or cause of cirrhosis of liver:

1. Blood biochemistry
   • Viral markers, i.e. HbSAg are of value in identifiation.
   • Serum autoantibodies, antinuclear, anti­smooth muscle and anti­mitochondrial antibodies level increase in cryptogenic cirrhosis and biliary cirrhosis.
   • Rise in alkaline phosphatase indicates biliary cirrhosis.
   • Serum immunoglobins: The IgG is increased in autoimmune hepatitis, IgA increases in alcoholic cirrhosis and IgM in primary biliary cirrhosis.
2. Imaging
   • Ultrasound examination: USG reveals changes in size, shape and echotexture of the liver.
   • Fatt change and firosis produce diffse increases echogenicity.
   • Presence of ascites, varices portal vein diameter and enlarge in size of spleen can be determined on ultrasound.
   • Barium meal swallow is done for esophageal varices.
   • Endoscopy can be done for detection and for treatment of varices
3. Liver biopsy: It is also necessary to confirm the diagnosis of cirrhosis.

“Common challenges in diagnosing and managing portal hypertension and cirrhosis effectively: FAQs provided”

Management of case of cirrhosis of liver No treatment can reverse cirrhosis or even ensure that no further progression occurs, but medical therapy can improve general health and treat the symptom of disease effctively.

The main objectives are:

1. Detect treatable causes
2. Prevent and correct malnutrition
3. Manage chronic cholestasis
4. Treat the complication.

“Factors influencing success with portal hypertension and cirrhosis knowledge: Q&A”

• Treatable causes: The treatable causes are alcohol abuse, drug ingestion, *hemochromatosis and Wilson’s disease, relief of biliary obstruction will prevent secondary biliary cirrhosis.
• Nutrition: In absence of ascites, a high energy 3000 kcal / day, protein rich (80–100 gm/day) diet should be advised.
  Salt restriction is strictly required if ascites are present.
  Fat intake is not restricted unless cholestasis is a feature.
  Complete absence of alcohol.
  Vitamin and other supplements are not required when good diet is taken.
• Drug treatment: Any drug should be avoided because as most of the drugs are metabolized in the liver which are liable to develop toxic reaction because they will unable to get metabolize.
• Liver transplantation: It is considered in all patients with chronic liver disease who develop liver failure.