What complications might a patient develop in response to portal hypertension? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply
1. Hepatomegaly
2. Splenomegaly
3. Ascites and variceal hemorrhage
4. Atherosclerotic plaques
5. Portal system pressure 5 to 10 mm Hg
1,2,3
Rationale 1: In the early stages of portal hypertension, blood collects in the sinusoids of the liver to compensate for the elevated pressure. As the pressure remains elevated, the liver enlarges.
Rationale 2: The spleen is a part of the portal system and as pressure increases, blood will back up in the system and also collect in the spleen.
Rationale 3: Ascites is a marker for severe progression of liver disease. The high pressure frequently causes the esophageal and/or gastric varices to rupture and bleed. The most common site for a variceal bleed is the submucosa of the distal end of the esophagus.
Rationale 4: The cardiovascular consequences related to portal hypertension and hepatic failure include hypotension, peripheral edema, arrhythmias, and heart failure.
Rationale 5: This is a normal range of portal pressure. Portal hypertension is defined as portal pressure 20 mm Hg.
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