Management of Portal Hypertension
Initial Management
- The American College of Gastroenterology recommends restricting sodium intake to 2,000 mg/day as a fundamental first step in managing ascites 1
- Complete alcohol abstinence is essential, especially in alcoholic liver disease, with 75% 3-year survival in those who stop drinking compared to 0% in those who continue 2, 1
- The initial management for patients with portal hypertension should focus on sodium restriction, diuretic therapy, and addressing the underlying cause, particularly alcohol abstinence in alcoholic liver disease 1
Diuretic Therapy
- Spironolactone 100 mg once daily is recommended as the initial diuretic 1
- Furosemide 40 mg once daily should be added if response is inadequate 1
- Titrate doses as needed, with maximum doses typically reaching 400 mg/day of spironolactone and 160 mg/day of furosemide 1
Management of Specific Complications
- Large-volume paracentesis is recommended for rapid relief of tense ascites 1
- Administer intravenous albumin (8g/L of fluid removed) to prevent circulatory dysfunction 1
- Endoscopic band ligation (EBL) is the first-line treatment for bleeding varices 3
- Non-selective beta-blockers (e.g., propranolol) reduce portal pressure and should be used for prevention of first bleeding or rebleeding 3
Monitoring and Follow-up
- Regular monitoring of serum electrolytes, creatinine, and weight is essential 1
- Measure 24-hour urinary sodium excretion if weight loss is less than expected 1
- Schedule prompt outpatient follow-up after hospital discharge, ideally within one week 1