Preprocedural risk
When do you need to take the INR into account before procedures in cirrhotics?
When patients are on vitamin K antagonists
Name 2 of the 4 objective measures needed to predict outcome of PVT
initial site, extent, degree of luminal obstruction, and chronicity of clot formation
What is the first line imaging modality for BCS?
Doppler ultrasound
What does INCPH stand for?
Idiopathic non-cirrhotic portal hypertension
Why doesn't AASLD have a recommended platelet count to prevent bleeding prior to procedures in cirrhotics? Name 2 reasons.
Lack of definitive evidence for safety and efficacy.
What is the AASLD cutoff for giving platelets before a procedure?
AASLD does not have a cutoff. An individualized approach should be taken for marked thrombocytopenia
what is the risk factor for PVT that needs to be ruled out in cirrhotics?
HCC
Why is a full thrombophilia work up needed in all BCS patients, even if you have identified a cause?
More than one prothrombotic condition can be identified in at least 35% of patients with BCS
Name one of the more common diseases that falls under INCPH?
Nodular regenerative hyperplasia. Other correct answers: intrahepatic PV stenosis (also called obliterative portal venopathy), and incomplete septal cirrhosis
What factors determine whether a procedure is high risk?
High-risk procedures have increased risk of bleeding (estimated >1.5% risk of major bleeding) and/or hemorrhage, if it occurs, can be difficult to control or may lead to catastrophic consequences
What other Medicine sub-specialty can help in the workup for PVT risk factors in non-cirrhotics?
Hematology (myeloproliferative disorders)
What should BCS patients be regularly screened for?
Surveillance for HCC in patients with chronic HVT/BCS is recommended as in the general cirrhosis population, with ultrasound every 6 months with or without alpha-fetoprotein determination.
How do you make the diagnosis of INCPH?
Liver biopsy to rule out cirrhosis ± reticulin stain
Name two products you could use to correct fibrinogen in critically ill cirrhotics with low fibrinogen.
Cryoprecipitate or fibrinogen concentrate
Name 1 of 2 reasons to anticoagulate non-cirrhotics with recent PVT?
Prevent intestinal ischemia. Prevent chronic PVT and portal hypertension.
Which BCS patients require anticoagulation?
How does INCPH present?
Portal hypertension in the absence of cirrhosis or other known cause of noncirrhotic portal hypertension
Why are the INR or PTT not predictive of bleeding or clotting in cirrhotics?
because PT and PTT only partially evaluate the hemostasis system and neglect the inhibitors of coagulation and other procoagulant factors
Based on best available data, should you or should you not hold or delay anticoagulation before banding varices in cirrhotics with PVT?
Should not stop or delay anticoagulation before banding.
What is the treatment of choice for BCS patients who fail medical therapy or angioplasty?