Although it is not inevitable that portal hypertension accompanies cirrhosis, some distortion in the normal portal flow is almost inevitable, and the secondary effects of shunting of portal blood around the liver have a major role in the subsequent cardiovascular, renal, electrolyte imbalance and fluid retention, and encephalopathic complications of portal hypertension. Nonetheless, the principal danger from portal hypertension is from gastrointestinal bleeding from the thin-walled varices that serve as conduits for portal blood around the scarred liver, as well as from an increased incidence of gastric and perhaps duodenal ulcer. Gastritis-related bleeding is also common, and some investigators believe that this is a complication of portal hypertension rather than being acid-peptic. The risk of bleeding varices after another, unrelated operative procedure is increased in patients with tight ascites. Therefore, these patients should be diuresed as much as possible to the point at which blood urea nitrogen and creatinine levels rise, and then diuresis should be decreased. We prefer a combination of spironolactone and furosemlde in divided doses of up to 200 mg/day of spironolactone and up to 80 mg/day of furosemide. The usual doses required in our experience are 50 to 100 mg spironolactone daily in divided doses and 20 mg furosemide per day.
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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...