TY - CHAP M1 - Book, Section TI - Portal Hypertension A1 - Nathan, Jaimie D. A1 - Campbell, Kathleen M. A1 - Ryckman, Frederick C. A1 - Alonso, Maria H. A1 - Tiao, Greg M. A2 - Ziegler, Moritz M. A2 - Azizkhan, Richard G. A2 - Allmen, Daniel von A2 - Weber, Thomas R. PY - 2014 T2 - Operative Pediatric Surgery, 2e AB - Etiology of portal hypertension may be classified as prehepatic, intrahepatic, or posthepatic.Extrahepatic portal vein obstruction (EPVO) is the most common type of prehepatic obstruction.Most cases of acute variceal bleeding can be controlled with fluid resuscitation, correction of coagulopathy, and pharmacologic support.Octreotide is the most commonly used pharmacologic intervention in the management of acute variceal bleeding.Upper endoscopy is an important intervention for both diagnostic and therapeutic purposes in acute variceal bleeding.Endoscopic sclerotherapy or band ligation can be used to control refractory variceal bleeding.Classification of portosystemic shunts: nonselective shunt, selective shunt, direct reconstruction of portal circulation.H-type mesocaval shunt is the most commonly used nonselective shunt.The most common selective shunt is the distal splenorenal shunt.EPVO is optimally managed by the mesentericoportal shunt (Rex shunt).Transjugular intrahepatic portosystemic shunt (TIPS) may be used as a bridge for liver transplantation in patients with intrinsic liver disease who have acute unresponsive variceal bleeding.If significant portal hypertensive complications are accompanied by progressive hepatic synthetic failure, liver transplantation is preferred. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1100952637 ER -