FACTS & HINTS
High-Yield Facts
Clinical Points
Portal Hypertension
Raised venous pressure within the portal circulation.
Resistance to portal blood flow may occur due to intrahepatic obstruction (fibrosis of the liver from cirrhosis)
Resistance may also occur as a result of posthepatic obstruction (such as heart failure or Budd-Chiari syndrome) or prehepatic obstruction.
Clinical consequences are ascites in the abdomen, congestive splenomegaly, hepatic encephalopathy, and the enlargement of portocaval
venous anastomosesClinical Points
Budd-Chiari Syndrome
Caused by hepatic vein obstruction (for example by thrombosis or tumors)
Patients present with acute epigastric pain and shock
May also have insidious portal hypertension, ascites, jaundice, and cirrhosis
Surgery may relieve the obstruction
Liver transplantation may be neededpage 156
page 157Clinical Points
Abdominal Aortic Aneurysm
Localized enlargement of aorta as a result of congenital or acquired weakness of wall
Pulsations can be detected left of midline
Common site is just above bifurcation of aorta to common iliac arteries
Unrecognized rupture of an aneurysm has 90% mortality rate