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Know About Portal Hypertension

Increase in portal vein pressure above the normal level of 5-10 mm Hg or greater.

Portal hypertension is due to obstruction.

Causes can be divided into:

Prehepatic: portal vein thrombosis , congenital atresia , hypo plasia of umbilical vein,trauma, tumor.

Intrahepatic: liver cirrhosis hepatic fibrosis ( Wilson's disease, hemochromatosis, or congenital fibrosis)

post hepatic: obstruction occur at any level between liver and right heart, including hepatic vein thrombosis, inferior vena cava thrombosis, right side heart failure,Budd-Chiari syndrome.

Symptoms and signs:

Symptoms:
'Blood in vomit
'esophageal varices
'Blood in stool
'Dark stool
'Abdominal swelling
'Enlarged spleen
'Pancytopenia
'Gastrointestinal bleeding
'Ascites
'Pruritus
'Abdominal pain and fever

Signs

'Dilated veins in the anterior abdominal wall (umbilical epigastric vein shunts)
'Caput medusa (tortuous collaterals around the umbilicus)
'Rectal hemorrhoids
'Ascites - Shifting dullness and fluid wave (if significant amount of ascitic fluid is present)
'Paraumbilical hernia
'Jaundice
'Spider angiomas
'Gynecomastia
'Dupuytren contracture
'Muscle wasting
'Palmar erythema
'Asterixis
'Testicular atrophy
'Splenomegaly
'Bounding pulses
'Warm, well-perfused extremities
'Arterial hypotension

Complications

'Variceal bleeding
'Oesophageal, gastric, other
'Congestive gastropathy
'Hyperpleenism
'Ascites
'Renal failure
'Hepatic encephalopathy

Diagnosis of Portal Hypertension

'Liver function test (LFT)
Raised LFT indicates active liver damage.
Low albumin level indicates established cirrhosis.
Elevated prothrombin time indicates end stage liver disease with poor prognosis.
'Endoscopy- Helps document esophago-gastric varices.
'USG of liver and portal venous system helps diagnosis of PHT by demonstration of dilated collaterals around gastro-esophageal junction and dilated portal vein.
'Liver biopsy- to differentiate early cirrhosis
'Portovenography- percutaneous splenoportography (SPG) is commonly done for visualization of portal vein and its main tributaries.

Homeopathic management :

It is based on the symptoms and signs elicited.

1. Dolichos pruriens

Syndrome of portal hypertension of first degree. intensive, unbearable, "terrible" itch of skin , intensive pains in both hypochondriac regions dull pain under the angle of right scapula, constant yellow colour of the eyes, bitterness in the mouth , Stool constipated. cirrhosis of liver & hepatocellular insufficiency

2. Carduus Marianus

chief action is centered in the liver, and portal system, causing soreness, pain, jaundice. Has specific relation to the vascular system.Pain in region of liver especially Left lobe very sensitive. Fullness and soreness, with moist skin. Constipation; stools hard, difficult, knotty; alternates with diarrh'a. Hyper'mia of liver, with jaundice.

3. Magnesium Muriaticum

characteristic constipation. It has chronic liver affections like cirrhosis with tenderness and pain, extending to spine and epigastrium ad the pain is worse after food. Pressing pain in liver; worse lying on right side. Liver is enlarged with bloating of abdomen; yellow tongue.

4. Ptelea Trifoliata

aching and heaviness in the region of the liver is greatly aggravated by lying on the left side. Liver sore, swollen, sensitive to pressure. Indicated in end stages of cirrhosis.

5. Nux Vomica
The liver is swollen hard and sensitive to the touch and pressure of clothing is uncomfortable. The first remedy in cirrhosis of the liver. Colic may be present.

6. Lycopodium
The region of the liver is sensitive to the touch, and there is a feeling of tension in it, a feeling as if a cord were tied about the waist. Cirrhosis of liver. The pains are dull and aching .Fullness in the stomach after eating a small quantity.

Dr Guptha faculty for the icd10 coding training

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