Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Portal Hypertension and Varices

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In one line

·Scarring inside the liver blocks blood flow and raises pressure in the portal vein, making veins in the esophagus and stomach swell and burst.

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Normal physiology

·Blood from the stomach, intestines, pancreas, and spleen drains into the portal vein, flows through the liver to get filtered and processed, and then exits through the hepatic veins into the inferior vena cava and back to the heart.

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What goes wrong

·Scarring inside the liver (cirrhosis) turns soft, spongy tissue into hard, knotty lumps that squeeze and block the tiny blood channels, so blood can't flow through smoothly anymore.

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Hallmark signs

·Swollen belly (ascites)
·Vomiting blood or black tarry stools (melena)
·Swollen veins visible on the belly skin (caput medusae)
·Swollen legs and ankles (edema)
·Confusion or sleepiness (hepatic encephalopathy)
·Yellow skin and eyes (jaundice)
·Easy bruising or bleeding
·Enlarged spleen (splenomegaly)

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Red flags · escalate now

·Vomiting bright red blood or large amounts of blood
·Black, tarry, or bloody stools (signs of bleeding in the gut)
·Sudden confusion, extreme sleepiness, or trouble waking up (brain toxin buildup)
·Fast heart rate, dizziness, or fainting (may mean dangerous blood loss)
·Belly that swells quickly and feels tight or painful (fluid buildup or infection)

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Workup

·Complete blood count (CBC)
·Prothrombin time (PT) and International Normalized Ratio (INR)
·Comprehensive metabolic panel (CMP) including liver enzymes (ALT, AST, alkaline phosphatase, bilirubin) and albumin
·Upper endoscopy (esophagogastroduodenoscopy, EGD)
·Abdominal ultrasound with Doppler to measure portal vein blood flow
·Hepatic venous pressure gradient (HVPG) measurement during liver vein catheterization
·Type and crossmatch (blood typing for transfusion)
·Serum ammonia level

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Treatment

·Non-selective beta-blocker (propranolol or nadolol) by mouth, daily
·Endoscopic variceal ligation (EVL) - placing tight rubber bands around the swollen veins during an endoscopy
·Octreotide IV drip (25–50 mcg/hour after a 50 mcg bolus) for 2–5 days during active bleeding
·Red blood cell transfusion (target hemoglobin 7–9 g/dL, not higher)
·Ceftriaxone 1 g IV once daily for 7 days (or norfloxacin 400 mg by mouth twice daily)
·Transjugular intrahepatic portosystemic shunt (TIPS) - inserting a metal tube through the liver to create a shortcut for blood to bypass the scarred tissue
·Lactulose by mouth or enema (starting 15–30 mL every 1–2 hours until bowel movement, then adjust to 2–3 soft stools per day)

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NCLEX trap

·Give blood slowly and carefully (aim for hemoglobin around 7, not higher) and start octreotide (a medicine that shrinks the swollen veins). Pouring in too much fluid raises the pressure inside the portal vein even more, which makes the bleeding worse and causes more fluid to leak into the belly.
·Start octreotide IV and get the GI doctor to do an upper endoscopy (a camera down the throat) to band the varices (put tiny rubber bands around them to shut them off). The balloon tube is a last-resort backup if banding fails or can't be done right away — it can cause serious harm like tearing the esophagus or choking if used carelessly.
·Stop the bleeding first — that is the immediate life threat. Once the bleeding is controlled, then treat the confusion with lactulose (a syrup that clears toxins from the gut) and the belly fluid with a low-salt diet and diuretics (water pills).
·Give ceftriaxone (or another similar antibiotic) for 5–7 days as soon as the bleeding starts, even if there is no fever or infection yet. The bleeding creates an open door for bacteria from the gut to slip into the bloodstream, and antibiotics cut the risk of sepsis and death by about half.
·Keep the beta-blocker going for life. It lowers the pressure inside the portal vein and cuts the chance of another bleed. Stopping it lets the pressure rise again, and the varices can burst a second time.
·A big spleen (splenomegaly) and belly fluid (ascites) show that portal high blood pressure (hypertension) is present — the pressure in the portal vein is high — but they do NOT tell you whether varices have formed or whether they are likely to bleed. Only an upper endoscopy (the camera) can see the varices and grade their size and risk.

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