๐Ÿฉธ Chapter 415: Portal Hypertension and Varices

Nelson Textbook of Pediatrics 22nd Edition โ€” Portal hypertension is defined as portal pressure >10-12 mm Hg. Etiologies: prehepatic (portal vein thrombosis โ€” most common cause of extrahepatic portal hypertension in children), intrahepatic (cirrhosis, biliary atresia, congenital hepatic fibrosis), posthepatic (Budd-Chiari, SOS/VOD). Clinical: variceal bleeding (hematemesis), splenomegaly, ascites. Management: acute variceal bleed (octreotide, endoscopic band ligation), primary/secondary prophylaxis (propranolol, band ligation), TIPS, liver transplant.

๐ŸŒ paeds.online โ€” Pakistan's Pediatric Platform

๐Ÿ“‹ 30 Clinical Scenarios โ€” Portal Hypertension & Varices

๐Ÿ“‡ Highโ€‘Yield Review Cards (Portal Hypertension)

๐Ÿฉบ Clinical Presentations: Portal Hypertension

Select a presentation for diagnostic clues and management.

๐Ÿ“‹ Stepwise Evaluation & Management of Portal Hypertension

๐Ÿ”‘ Key Principles โ€” Portal Hypertension (Nelson Ch.415)
โ€ข Prehepatic: Extrahepatic portal vein obstruction (EHPVO) โ€” most common cause in children, presents with variceal bleeding, preserved liver function.
โ€ข Intrahepatic: Cirrhosis (biliary atresia, autoimmune, metabolic), congenital hepatic fibrosis, nodular regenerative hyperplasia.
โ€ข Posthepatic: Budd-Chiari (hepatic vein obstruction), sinusoidal obstruction syndrome (SOS/VOD).
โ€ข Acute variceal bleed: Octreotide (somatostatin), endoscopic band ligation, balloon tamponade (temporary).
โ€ข Prophylaxis: Non-selective beta-blockers (propranolol) for primary prophylaxis; band ligation for large varices or secondary prophylaxis.

    โšก Reflex Prompts โ€” Portal Hypertension Decisions

    ๐Ÿ“– Portal Hypertension & Varices โ€” Core Summary