Portal Hypertension Quiz

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Questions and Answers

Which of the following is the first step in the approach to patients who have had a variceal bleed?

Repeat endoscopy for surveillance of varices

Prevent further bleeding

Treat the acute bleed (correct)

Replace fluid and red blood cells

What is the hemoglobin level at which transfusion should be started according to the recent randomized trial?

4.0 g/dL

1.1 g/dL (correct)

3.0 g/dL

2.5 g/dL

What is the minimum ascites protein level required to start transfusion according to the recent randomized trial?

3.0 g/dL

2.0 g/dL

1.1 g/dL

2.5 g/dL (correct)

Which of the following is NOT a component of the treatment for acute bleeding?

Repeat endoscopy Signup and view all the answers

What is the abbreviation for Serum-Ascites Albumin Gradient?

SAAG Signup and view all the answers

When should primary prophylaxis be initiated according to the text?

Before variceal bleed Signup and view all the answers

What is the main goal in the approach to patients who have had a variceal bleed?

Prevent further bleeding Signup and view all the answers

What is the abbreviation for grams per deciliter?

g/dL Signup and view all the answers

What is the abbreviation for restricted transfusion?

RT Signup and view all the answers

When is repeat endoscopy for surveillance of varices considered unnecessary?

After primary prophylaxis Signup and view all the answers

Which of the following is the definition of portal hypertension?

Elevation of the hepatic venous pressure gradient (HVPG) to >5 mmHg Signup and view all the answers

Which of the following processes contribute to the development of portal hypertension?

Increased intrahepatic resistance to the passage of blood flow through the liver Signup and view all the answers

What is the initial stage of compensated cirrhosis characterized by?

HVPG between 5 and 10 mmHg Signup and view all the answers

When is there substantial risk of decompensation in portal hypertension?

When clinically significant portal hypertension develops (HVPG ≥10 mmHg) Signup and view all the answers

What is the median mortality rate in cases of decompensated portal hypertension?

95% Signup and view all the answers

Which of the following is NOT an intrahepatic cause of portal hypertension?

Cirrhosis Signup and view all the answers

Which is the most common cause of portal hypertension in the United States?

Cirrhosis Signup and view all the answers

What percentage of patients with cirrhosis have clinically significant portal hypertension?

<blockquote> 60% </blockquote> Signup and view all the answers

What is the primary consequence of increased intrahepatic resistance in portal hypertension?

Impaired blood flow through the liver Signup and view all the answers

What is the primary consequence of increased splanchnic blood flow in portal hypertension?

Vasodilation within the splanchnic vascular bed Signup and view all the answers

Which of the following is a primary complication of portal hypertension?

Gastroesophageal varices with hemorrhage Signup and view all the answers

What is the estimated percentage of patients with cirrhosis who develop varices over their lifetimes?

5-15% Signup and view all the answers

Which of the following is a factor that predicts the risk of bleeding from esophageal varices?

Severity of cirrhosis Signup and view all the answers

What is the recommended frequency of upper endoscopies for routine surveillance of patients with cirrhosis?

Every 2 years if the liver disease is active Signup and view all the answers

Which treatment option is effective for primary prophylaxis of bleeding from esophageal varices?

Nonselective beta blockade (NSBB) Signup and view all the answers

Which imaging technique can be helpful in demonstrating changes of portal hypertension with intraabdominal collateral circulation?

Contrasted-enhanced abdominal imaging by computed tomography (CT) or MRI Signup and view all the answers

What is the main category of treatment for esophageal varices as a complication of portal hypertension?

Primary prophylaxis and prevention of rebleeding Signup and view all the answers

Which of the following disorders can lead to the development of portal vein thrombosis?

Polycythemia vera Signup and view all the answers

Which of the following is a symptom of portal hypertension?

Enlarged spleen Signup and view all the answers

What is the risk of bleeding from varices in patients with a gradient >12 mmHg?

At risk Signup and view all the answers

Study Notes

Approach to Variceal Bleed

Resuscitation and stabilization are the first steps in the approach to patients who have had a variceal bleed
Transfusion should be started when hemoglobin level falls below 7-8 g/dL according to the recent randomized trial
In patients with ascites, transfusion should be started when the ascites protein level is below 1.5 g/dL according to the recent randomized trial

Treatment of Acute Bleeding

Octreotide, vasopressin, and endoscopy are components of the treatment for acute bleeding
Transjugular intrahepatic portosystemic shunt (TIPS) is not a component of the treatment for acute bleeding

Definitions and Concepts

SAAG stands for Serum-Ascites Albumin Gradient
g/dL stands for grams per deciliter
RT stands for restricted transfusion
Portal hypertension is defined as a hepatic venous pressure gradient (HVPG) >5 mmHg
Processes contributing to the development of portal hypertension include increased intrahepatic resistance and increased splanchnic blood flow

Complications and Consequences

The primary consequence of increased intrahepatic resistance is increased portal pressure
The primary consequence of increased splanchnic blood flow is increased portal pressure
Variceal bleeding is a primary complication of portal hypertension
The median mortality rate in cases of decompensated portal hypertension is around 50%

Epidemiology and Risk Factors

The most common cause of portal hypertension in the United States is cirrhosis
Around 90% of patients with cirrhosis have clinically significant portal hypertension
The estimated percentage of patients with cirrhosis who develop varices over their lifetimes is around 90%
A gradient >12 mmHg predicts a high risk of bleeding from esophageal varices

Diagnosis and Surveillance

Repeat endoscopy for surveillance of varices is considered unnecessary if varices are not seen on the initial endoscopy
Upper endoscopies for routine surveillance of patients with cirrhosis are recommended every 2-3 years
CT or MRI can be helpful in demonstrating changes of portal hypertension with intraabdominal collateral circulation

Treatment and Management

Primary prophylaxis should be initiated when the hepatic venous pressure gradient (HVPG) is ≥12 mmHg
Non-selective beta blockers are effective for primary prophylaxis of bleeding from esophageal varices
The main category of treatment for esophageal varices as a complication of portal hypertension is endoscopic and pharmacological therapy

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Description

Test your knowledge on portal hypertension with this quiz! Learn about the causes, symptoms, and complications of this condition, including the impact on liver function and blood flow. Challenge yourself with questions on hepatic venous pressure gradient (HVPG) and intrahepatic resistance.