NMS. Surgery

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Part IV ♦ Gastrointestinal Disorders

Quick Cuts • Pyogenic liver abscesses are treated with antibiotics and drainage. • Amebic liver abscesses are treated with metronidazole. • Hydatid cysts are treated with albendazole and surgical resection of the cysts with care not to spill contents.

PORTAL HYPERTENSION I. Etiology: Abnormal elevation of portal venous pressure greater than 5–6 mm Hg. II. Classification: A. Prehepatic: Rare, due to portal vein thrombosis or congenital atresia. B. Intrahepatic: Most common. 1. Cirrhosis: Most common cause in the United States. 2. Schistosomiasis: a. Most common cause worldwide. b. Portal hypertension is due to parasitic ova in small portal venules. 3. Wilson disease 4. Hemochromatosis C. Posthepatic: Rare. 1. Budd – Chiari syndrome: Hepatic vein thrombosis. 2. Right heart failure III. Clinical presentation: A. Ascites, esophageal varices, hemorrhoids, caput medusa. B. May also see signs of liver failure (e.g., encephalopathy, variceal hemorrhage, malnutrition, coagulopathy). IV. Diagnosis: A. History B. Clinical exam C. Direct portal pressure measurement V. Treatment: A. Medical: Management of liver failure, including ascites and variceal bleeding. 1. Ascites a. Salt/water restriction and diuretics. b. Transjugular intrahepatic portosystemic shunt (TIPS). 2. Variceal hemorrhage a. Esophagogastroduodenoscopy (EGD). b. Treatment includes banding and sclerotherapy. c. Pharmacotherapy: (1) Nadolol used for bleeding prophylaxis. (2) Acute bleeding treatment includes vasopressin, somatostatin, and nitroglycerin.