FACTS & HINTS

High-Yield Facts

Clinical Points

Portal Hypertension

Raised venous pressure within the portal circulation.

Resistance to portal blood flow mayoccur due to intrahepatic obstruction (fibrosis of the liver from cirrhosis)

Resistance mayalso 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 anastomoses

Clinical Points

Budd-Chiari Syndrome

Caused byhepatic vein obstruction (for example bythrombosis or tumors)

Patients present with acute epigastric pain and shock

Mayalso have insidious portal hypertension, ascites, jaundice, and cirrhosis

Surgerymayrelieve the obstruction

Liver transplantation maybe needed

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Clinical 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% mortalityrate

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