Kenneth Kee

Portal Hypertension, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions (eBook, ePUB)

• Format: ePub

Produktbeschreibung

This book describes Portal Hypertension, Diagnosis and Treatment and Related Diseases
Portal hypertension is the presence of abnormal high blood pressure in the hepatic portal vein.
Portal hypertension is defined as a portal pressure of 12 mm Hg or more (normal 5-10 mm Hg).
In the normal patient, free hepatic vein pressure (FHVP) is identical to inferior vena cava pressure.
FHVP is defined as an internal zero reference point.
Wedged hepatic venous pressure (WHVP) is the pressure gauged by inflating a balloon at the catheter tip, thus blocking a hepatic vein branch.
Measurement of the WHVP gives a close evaluation of portal pressure.
The hepatic venous pressure gradient (HVPG) is the difference in pressure between the portal vein and the inferior vena cava.
The HVPG is equal to the WHVP value minus the FHVP value (i.e., HVPG = WHVP - FHVP).
The normal HVPG is 3-6 mm Hg.
Portal hypertension is defined as a persistent rise of portal pressure above normal.
1. An HVPG of 8 mm Hg is believed to be the threshold above which ascites potentially can develop.
2. An HVPG of 12 mm Hg is the threshold for the possible formation of varices.
High portal pressures may prompt patients to a higher danger of variceal hemorrhage
Numerous disorders are related with portal hypertension with hepatic cirrhosis being the most frequent cause of this disorder.
The normal liver has the capability to contain large alterations in portal blood flow without large changes in portal pressure.
Portal hypertension happens from a combination of higher portal venous inflow and higher resistance to portal blood flow.
Patients with cirrhosis reveal higher splanchnic arterial flow and venous inflow into the liver.
Higher splanchnic arterial flow is thought to be partly by:
1.Reduced peripheral vascular resistance
2.Increased cardiac output in the patient with cirrhosis.
Nitric oxide appears to be the major driving force
Higher resistance across the sinusoidal vascular bed of the liver is produced by fixed factors and dynamic factors
Symptoms:
Symptoms of Budd-Chiari syndrome are due to reduced outflow of blood from the liver, with resulting hepatic congestion and portal hypertension
Diagnosis:
Check the patient's blood pressure and pulse with the patient in the supine and seated positions.
Signs of portosystemic collateral formation are:
a.Dilated veins in the anterior abdominal wall - May indicate umbilical epigastric vein shunts
b.Venous pattern on the flanks - May indicate portal-parietal peritoneal shunting
c.Caput medusae (tortuous paraumbilical collateral veins)
d.Rectal hemorrhoids
e.Ascites
Laboratory studies are directed towards investigating the causes of cirrhosis, which is the most frequent cause of portal hypertension.
The rate and volume of bleeding in the patient should be evaluated.
Measure the platelet count and prothrombin time (PT), send blood for renal and liver function tests (LFTs), and measure serum electrolyte levels.
Ultrasound, CT Scanning and MRI may show features suggestive of hepatic cirrhosis with portal hypertension
Upper Gastrointestinal Endoscopy is an essential diagnostic and treatment tool.
Portal hypertension measurement will confirm portal hypertension.
The portal hypertension itself is difficult to treat effectively, except by:
A.Treating the underlying cause.
B.Liver transplantation, if indicated
Portal venous pressure can be reduced by:
a. Beta blockers ± nitrates
b. Shunt procedures
Endoscopic procedures such as TIPS can decompress the portal venous system to prevent rebleeding from varices
Surgical procedures such as portosystemic shunts prevent bleeding
Liver transplant is required if other treatments failed.

TABLE OF CONTENT
Introduction
Chapter 1 Portal Hypertension
Chapter 2 Causes
Chapter 3 Symptoms...

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Produktdetails

• Verlag: Kenneth Kee
• Erscheinungstermin: 29. Januar 2018
• Englisch
• ISBN-13: 9781370747481
• Artikelnr.: 75905468

Autorenporträt

Dr. Kenneth Kee is a well-known medical doctor from Singapore who has been practicing medicine since 1972.
He graduated from the University of Singapore and furthered his studies with a Master of Science in Health Management in 1991, followed by a Ph.D. in Healthcare Administration in 1993.
Dr. Kee established Kee Clinic in 1974, located in the Holland Drive area of Singapore. The clinic has been a prominent feature of the community, offering general medical services for 5 decades.
Dr Kee also served his country Singapore as a national service police Inspector at night from 1975 to 1985 while working at his clinic during the day.
He had served as a police guard to the Woodland Petroleum Tanks at night during the Indonesian Confrontation period, took part in police rounds at night in the Beach Road area and taught First aid and emergency resuscitation to Police recruits.
He received the Singapore Police Bicentennial 2020 Medallion on 1st March 2024 as recognition for his work in the Singapore Police.
Even as he grew older, Dr. Kee continued to work actively in his clinic, although he eventually reduced his consultation hours.
Beyond his medical career, Dr. Kee is also an author.
He started writing about medical conditions in 2007, using blogs and other online platforms to share his knowledge with a broader audience.
Over time, he published various books, many of which provide simple and accessible guides to different health conditions.
His works include "A Family Doctor's Tale," "My Personal Singapore History," and numerous medical guides, available through platforms like Amazon.
His books often combine his personal experiences as a family doctor with insights into Singapore's healthcare system and history.
Dr. Kee has written extensively on health topics, contributing to both medical literature and general knowledge resources.

Dr. Kenneth Kee has written numerous books, primarily focused on health education and personal experiences as a family doctor. Some of his notable titles include:
"A Family Doctor's Tale"
This book is a blend of Dr. Kee's personal experiences and his reflections on being a family doctor in Singapore. It's a great choice if you're looking for a narrative that combines both medical knowledge and human stories.
"Specialized Medical Conditions"
Books like **"Congestive Heart Failure: Diagnosis and Treatment"** focus on specific conditions, offering in-dept...