Portal hypertension, a state where the pressure within the portal hepatic vein is increased, causes dilated veins (varices) of the portosystemic anastomosis. Varices most commonly occur in the lower oesophagus and hence are called oesophageal varices. The enlarged veins may rupture, leading to severe upper gastro-intestinal bleeding (UGIB).
Clerked a patient, who's a chronic alchoholic and smoker of more than a decade, who'd been diagnosed with oesophageal varices.
There's hepatomegaly. I could palpate the lower border of the liver about 3.5 cm below the costal margin. And the percussion note was dull in the 4th right intercostal space. The consistency was hard and there was no tenderness. The yellow discoloration of his sclerae revealed the presence of jaundice. I thought of liver cirrhosis as the underlying cause of the varices in this particular patient. Yet, of course, I couldn't be sure. It was a mere guess, but a logical one. Am still far from being qualified to make a diagnosis anyway.
Causes of portal hypertension:-
prehepatic:portal vein thrombosis, splenic vein thrombosis
intrahepatic: cirrhosis, schistosomiasis,sarcoidosis
post-hepatic: right heart failure, constrictive pericarditis.
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I bumped into Dr. Aaron twice today!! My heart missed a few beats. The first encouter was in the male medical ward when I was doing history taking ( my history taking became very disorganized in the end) and the second on the staircase.
do LFT. full blood count. x ray. watever la. i'd thought it's liver cirrhosis as well, considerin his history. ;)
ReplyDeletesomeone's got a crush. woot.
Jargon!
ReplyDeleteDr Aaron.... still no spy pic. :(
What did his LFTs and platelet count look like? CT of the abdomen and pelvis or sono if CT isn't available might be useful. I would also look at a Hep Profile since it sounds like a possible chronic Hep C patient.
ReplyDeleteOh yea, some advice from experience, keep the Blakemore tube at the bedside. -allen
ReplyDelete