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Dr Saeed Al-Shomimi KFHU Khobar
Anatomy ,[object Object],[object Object],[object Object],[object Object]
Blood Supply of the Liver Hepatic Arterial Autoregularity Vasodilatation
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Portal Hypertension Pre-sinusoidal Sinusoidal Post Sinusoidal BLOOD FLOW LIVER
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Variceal Bleeding ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Variceal Bleeding
Initial evaluation & stabilization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Radiologic shunt TIPSS Surgical Shunt Balloon  Tamponade Pharmacologic and endoscopic therapy are the usual  1 st  and  2 nd  interventions Endoscopic Treatment for  Acute Variceal Bleeding
Pharmacologic Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Endoscopic Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
sclerotherapy ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Band Ligation
Pharmacologic versus Endoscopic Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Balloon Temponade ,[object Object],[object Object],[object Object],[object Object]
Balloon positioning
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Tube Positioning and Gastric Balloon Inflation
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Gastric and Esophageal Balloon Inflation
[object Object],[object Object],[object Object],[object Object]
TIPS (Transjagular Intrahepatic Portosystemic Shunting) ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object]
 
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Surgical Therapy ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Prevention of Recurrent Variceal Bleeding
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Portosystemic Shunt ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
1 – Non selective Shunts ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
2 – Selective Shunts ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
3 – Partial Shunts ,[object Object],[object Object]
Esophagogastric Devascularization ,[object Object],[object Object],[object Object]
Orthotopic Liver Transplantation ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Prophylaxis
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]

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