Pediatric emergency medicine trisk 2045 2045
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complete blood cell (CBC) count, platelet count, prothrombin time (PT), and
partial thromboplastin time (PTT). Additional laboratory studies may be
indicated on the basis of the differential diagnosis of the most likely cause of
the patient’s bleeding. Arterial blood gases should also be followed when
severe blood loss is associated with shock. The hematocrit is an unreliable
initial index of acute blood loss because it may be normal or only slightly
decreased and not accurately reflect the actual value in a rapid bleed.
TABLE 91.1
CAUSES OF PORTAL HYPERTENSION AND ESOPHAGEAL
VARICES
Location of lesion Example
Prehepatic
• Portal vein thrombosis
• Portal vein obstruction
(i.e., malignancy)
• Splenic vein obstruction
Intrahepatic
• Cirrhosis from biliary
atresia, primary
sclerosing cholangitis,
cystic fibrosis, α1 antitrypsin deficiency,
chronic hepatitis B/C,
autoimmune hepatitis,
chronic alcohol use
Posthepatic
• Budd–Chiari syndrome:
thrombosis or exterior
compression (i.e.,
malignancy)
• Inferior vena cava
obstruction
• Constrictive pericarditis
• Increased portal or
splenic blood flow
• Portal vein
sclerosis/venopathy (i.e.,
schistosomiasis, HIV,
cystic fibrosis)
• Schistosomiasis
• Idiopathic portal
hypertension
• Congenital hepatic
fibrosis
• Nonalcoholic fatty liver
disease
• Congestive heart failure
• Venoocclusive disease
