Preliminary Diagnosis: Portal Hypertension
I. What imaging technique is first-line for this diagnosis?
Ultrasound of the liver utilizing gray scale, Color Doppler, and spectrum wave form analysis sonographic imaging.
II. Describe the advantages and disadvantages of this technique for diagnosing portal hypertension.
Advantages
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Highly portable and quick imaging modality.
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Does not expose patients to ionizing radiation.
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Able to characterize the velocity and directionality of flow of blood within the portal vein while analyzing the hepatic veins and hepatic arteries simultaneously.
Disadvantages
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Highly operator dependent imaging modality.
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May help plan treatment, but an invasive approach is needed to treat patients with portal hypertension.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
Catheter angiography.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing portal hypertension.
Advantages
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Offers exquisite measurements of portal pressure.
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May better detail any specific intraluminal abnormality.
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Offers both the option of diagnosing and treating etiologies for any secondary complications of portal hypertension.
Disadvantages
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Exposes patients to the risks of an invasive procedure.
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Typically exposes patients to large amounts of iodinated contrast, unless CO2 contrast is administered.
VI. What are the contraindications for the alternative imaging techniques?
Contraindicated in patients who are in a severely hypocoaguable state and may be contraindicated in patients in renal failure/insufficiency who do not have an adequate dialysis regimen.
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