A temporary measure
Accelerates hepatic encephalopathy
Non-shunt operations
1 point
Retrosternal discomfort, fever, oesophageal ulceration or strictures, oesophageal perforation, and mediastinitis.
The most common causes of ascites are portal hypertension, hypoalbuminemia, and liver congestion.
Discomfort to the patient
Manifestations include low-grade fever, fetor hepaticus, ascites, jaundice, bleeding tendency, anemia, gynaecomastia in males, atrophy of female breasts, palmar erythema, and spider naevi.
It gives a good idea about the functions of the liver.
Child A, 5 - 7 points
Due to liver affection.
Porto-systemic collaterals are connections between the portal vein and systemic veins that develop due to portal hypertension.
Emergency surgery
The distal end of the portal vein is divided and then anastomosed to the IVC.
The incidence of thrombosis is high.
The Hassab-Khairy operation includes a splenectomy, ligation of right & left gastric vessels, short gastric vessels, left gastroepiploic vessels, and all vessels at the lower 5-10 cm of the esophagus, leaving only the right gastroepiploic vessels.
Low albumin level and high bilirubin level.
Immunological test for hepatitis markers.
Varices as multiple, smooth, and rounded filling defects, i.e., grape-like appearance.
40 mmHg
Prothrombin time is used instead of nutritional status.
Somatostatin has a stronger action.
Pancytopenia (anemia, leucopenia, and thrombocytopenia).
Duplex ultrasound to measure the amount and direction of blood flow in the portal vein.
Liver congestion leads to failure in inactivating ADH and aldosterone, causing salt and water retention.
2 points, indicating minimal neurological disorders
A meso-caval shunt involves the insertion of a graft (synthetic vein) between the superior mesenteric vein and the inferior vena cava (IVC).
Elderly or cardiac patients.
Esophageal transection aims to interrupt the submucosal venous plexus, which remains intact after the Hassab-Khairy operation.
Fiber-optic upper endoscopy and barium swallow.
Hypercellularity.
The liver is usually congested.
Poorly controlled ascites
It includes intra-variceal injection of 5 ml ethanolamine oleate to produce thrombosis and peri-variceal injection of 0.5 ml aethoxysclerol to produce fibrosis.
Colicky abdominal pain, diarrhea, coronary spasm causing anginal pain.
A method where the gastric balloon is inflated by 200 ml of air and pulled upwards to press the gastric fundus.
Prothrombin time is prolonged and concentration is low.
Budd-Chiari syndrome and right ventricular failure (RVF) & tricuspid insufficiency (TI).
A firm mass in the left hypochondrium, pain which may present as a dull ache (stretching of the capsule) or dragging (pulling on the ligaments), and pressure symptoms like dyspepsia or dyspnea.
Hypersomnia, inverted sleep rhythm, apathy, micturition or defecation in unsuitable places, and childish behavior.
Splenectomy followed by anastomosing the proximal end of the splenic vein to the left renal vein.
1 - 2 mg%
I.V Vitamin K.
Restoration of blood volume using fresh blood transfusion.
Vasoconstriction of splanchnic arterioles, which reduces portal venous pressure.
Due to connections between the splenic vein and the pancreatic vein called the pancreatic siphon; to avoid this, the whole splenic vein should be disconnected from the pancreas (modified Warren operation).
It stops hematemesis with no risk of encephalopathy.
Liver transplantation is indicated for end-stage liver disease.
When portal venous pressure exceeds 20 mmHg (25-30 cm H2O).
Ultrasonography, CT scan, digital subtraction angiography (D.S.A), and splenoportography.
Hepatic encephalopathy is caused by absorbed ammonia reaching the systemic circulation.
Liver biopsy.
The liver usually appears normal.
By evacuating blood from the GIT using strong laxatives, stomach wash, repeated enema or colonic lavage, oral lactulose, and neomycin.
The liver may appear shrunken as in cirrhosis or enlarged as in schistosomiasis.
A Warren shunt is a selective shunt operation where the distal end of the splenic vein is anastomosed to the left renal vein (distal spleno-renal shunt), along with ligation of the left gastric vein and right gastroepiploic veins.
SGOT and SGPT.
Cirrhotic liver, splenomegaly, and presence of ascites.
Pre-sinusoidal causes like schistosomiasis, sinusoidal causes like liver cirrhosis, and post-sinusoidal causes like veno-occlusive disease.
Glypressin has the same action as vasopressin but controls variceal bleeding better.
It is very expensive.
Congenital atresia of the portal vein, portal vein thrombosis due to neonatal umbilical sepsis, intra-abdominal sepsis, oral contraceptive pills, and extrinsic compression (e.g., cancer of the head of the pancreas).
A dye is injected into the spleen to demonstrate the anatomy of portal circulation and the site of obstruction.
Anorexia, dyspepsia, indigestion, and malabsorption.
Secondary hypersplenism is characterized by splenomegaly and pancytopenia (anemia, leucopenia, and thrombocytopenia) due to overactivity of the spleen, along with an active bone marrow.
