Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of portal biliopathy secondary to extrahepatic portal vein obstruction (EHPVO). Clinical history significant for chronic portal hypertension, presenting with [jaundice/epigastric pain/cholangitis]. Review of systems positive for [pruritus/acholic stools/dark urine]. No history of biliary surgery or cholelithiasis.
Clinical Examination Findings
General: Patient appears [non-toxic/jaundiced]. Abdomen: Soft, non-tender, with palpable splenomegaly. Caput medusae noted. Liver span [normal/enlarged]. No clinical signs of decompensated cirrhosis (ascites/asterixis). Scleral icterus present.
Treatment Protocol
Management plan: 1. Endoscopic Retrograde Cholangiopancreatography (ERCP) for biliary decompression and stone/stricture management. 2. Consider biliary stenting if strictures are dominant. 3. Evaluation for surgical portosystemic shunting to decompress portal venous system. 4. Ursodeoxycholic acid (UDCA) for cholestasis. 5. Monitor liver function tests and coagulation profile.