# Portal Hypertension in Pediatrics — GCMD Library living collection

Updated: n/a · 3 episodes · 20 cited statements

## Episodes
### Overview and Natural History
- [Natural Course of Pediatric Portal Hypertension.](https://library.globalcastmd.com/watch/natural-course-of-pediatric-portal-hypertension-16031) — article · [machine version](https://library.globalcastmd.com/watch/natural-course-of-pediatric-portal-hypertension-16031.md)
- [Portal Hypertension with Dr. Alex Bondoc](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990) — podcast · 11:44 · [machine version](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990.md)

### Surgical Shunts
- [The role of surgical shunts in the treatment of pediatric portal hypertension](https://library.globalcastmd.com/watch/the-role-of-surgical-shunts-in-the-treatment-of-pediatric-portal-hypertension-16034) — article · [machine version](https://library.globalcastmd.com/watch/the-role-of-surgical-shunts-in-the-treatment-of-pediatric-portal-hypertension-16034.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=0) Introduction and Episode Overview (Ep 2)
- [0:53](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=53) Definition and Causes of Portal Hypertension (Ep 2)
- [2:27](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=147) Clinical Manifestations and Risk Factors (Ep 2)
- [3:40](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=220) Diagnostic Approach and Assessment (Ep 2)
- [5:37](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=337) Treatment: Medical Management and Surgical Shunts (Ep 2)
- [9:16](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=556) Complications, Follow-up, and Summary (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Portal hypertension is defined as a hepatic venous portal wedge pressure of greater than 5 millimeters of mercury. — Alex Bondoc (clinical) [Ep 2 · 0:53](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=53)
- Portal hypertension develops when resistance to portal blood flow increases. — Alex Bondoc (clinical) [Ep 2 · 0:53](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=53)
- In prehepatic portal vein thrombosis, the vast majority of pediatric patients have no predisposition to clotting despite hematology workup. — Alex Bondoc (clinical) [Ep 2 · 1:20](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=80)
- Biliary atresia is the number one cause worldwide of pediatric liver transplantation. — Alex Bondoc (epidemiological) [Ep 2 · 1:20](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=80)
- The most common clinical manifestation of portal hypertension is GI bleeding due to esophageal varices. — Alex Bondoc (clinical) [Ep 2 · 2:31](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=151)
- After the first episode of GI bleeding, the risk of complications including rebleeding, ascites, spontaneous bacterial peritonitis, and conditions associated with end-stage liver disease continues to occur. — Alex Bondoc (clinical) [Ep 2 · 2:31](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=151)
- Higher incidence of bleeding occurs with a wedge pressure of greater than 12 mmHg. — Alex Bondoc (clinical) [Ep 2 · 3:02](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=182)
- Portal vein velocity decreases in severe portal hypertension as intrahepatic resistance increases. — Alex Bondoc (clinical) [Ep 2 · 3:47](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=227)
- In transient elastography, a pressure greater than 15 kilopascals is highly suggestive of portal hypertension. — Alex Bondoc (clinical) [Ep 2 · 3:47](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=227)
- At Cincinnati Children's, varices are graded 1 through 4, where grade 4 means the entire esophagus is essentially collapsed, grade 3 is 2/3 collapsed, grade 2 is 1/3 collapsed, and grade 1 is just ridges under the mucosa. — Alex Bondoc (clinical) [Ep 2 · 5:09](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=309)
- Primary prophylaxis is not performed in pediatric patients with portal hypertension at Cincinnati Children's. — Alex Bondoc (clinical) [Ep 2 · 5:39](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=339)
- Octreotide can work well for esophageal varices but not as well for gastric varices or portal hypertensive gastropathy. — Alex Bondoc (clinical) [Ep 2 · 6:25](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=385)
- Data suggests that carvedilol might be a better option than propranolol for non-selective beta blockade in portal hypertension. — Alex Bondoc (clinical) [Ep 2 · 6:25](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=385)
- All patients with acute variceal bleeding should be started on IV antibiotics because of the high risk for bacterial translocation. — Alex Bondoc (clinical) [Ep 2 · 6:25](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=385)
- Patients with end-stage liver disease should not be shunted and should go to liver transplant instead. — Alex Bondoc (clinical) [Ep 2 · 7:05](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=425)
- The mesoportal (Rex) shunt provides physiologic flow and is by far the number one preferred shunt option when possible. — Alex Bondoc (opinion) [Ep 2 · 7:27](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=447)
- For prehepatic disease, a messorex shunt is the preferred option. — Alex Bondoc (clinical) [Ep 2 · 8:44](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=524)
- For hepatic disease, options include distal splenorenal shunt, central splenorenal shunt, or mesocaval H-type shunt. — Alex Bondoc (clinical) [Ep 2 · 8:44](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=524)
- For posthepatic disease, options include H-type mesocaval shunt, TIPS, or atrial caval shunt. — Alex Bondoc (clinical) [Ep 2 · 8:44](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=524)
- If platelet count starts dropping during follow-up, there is probably something wrong with the shunt. — Alex Bondoc (clinical) [Ep 2 · 9:23](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=563)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The Baveno 7 recommendations recommend against factor 7 use in acute variceal bleeding. — Cecilia Gigena summarizes what Dr. Alex Bondoc said [Ep 2 · 5:52](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=352)
- Baveno recommendations are made for adult patients, except for Baveno 5. — Cecilia Gigena summarizes what Dr. Alex Bondoc said [Ep 2 · 5:52](https://library.globalcastmd.com/watch/portal-hypertension-with-dr-alex-bondoc-6990?t=352)

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