Hypertension syndrome

Hypertensive syndrome in surgery is considered from several perspectives.

Arterial hypertension is important because it can cause a lot of vascular complications, both during and after the operation: hemorrhages, ischemia, crises, etc. Hypertension syndrome is established by simply measuring the arterial pressure on the peripheral arteries. The surgeon must call a therapist for consultation for its differential diagnosis and treatment. In preparation for the operation, its correction is carried out by an anesthesiologist.

Pulmonary hypertension syndrome is an increase in blood pressure in the pulmonary circulation. It is a secondary process complicating pulmonary, cardiac and diaphragmatic pathology of various origins: trauma, inflammatory diseases, degenerative processes, malformations, embolic complications, rapid and massive transfusion of fluids, etc. Clinically, hypertension syndrome is accompanied by attacks of causeless fever (chills, profuse sweating; especially at night) without a significant increase in body temperature; attacks of dyspnea, cough with transient cyanosis; but the auscultatory picture does not correspond to external manifestations; pulmonary edema or hemopleurisy may develop as a compensatory reaction aimed at independent unloading of the pulmonary circulation through the lymphatic system. From the cardiovascular system, instability of blood pressure, tachycardia, sometimes with extrasystole, an increase in CVP above 12 cm H2O are noted. The ECG reveals signs of overload of the right heart. The diagnosis is confirmed by chest X-ray: expansion and compaction of the lung root, increased pulmonary pattern against the background of general or uneven decrease in pneumatization of the lung tissue, the presence of Kerley lines (small, low-intensity, horizontally located lines from the root to the periphery of the lungs). Differential diagnostics and relief of pulmonary hypertension is the competence of resuscitators.

Portal hypertension syndrome is a pathological condition caused by impaired blood circulation and increased pressure in the portal vein. Clinical manifestations, despite many causes, are ultimately the same: formation of splenomegaly, varicose veins of the esophagus and stomach with bleeding, ascites. This issue was most fully considered by M.D. Patsiora (1974). According to the type of blockade, portal hypertension syndrome is divided into 4 types: suprahepatic (heart disease resulting in cirrhosis - Pick's disease, hepatic vein thrombosis - Chiari disease, thrombosis, compression, stenosis of the inferior vena cava, Budd-Chiari disease); intrahepatic (cirrhosis, fibrosis, liver tumors, dysplasia, polycystic disease); extrahepatic (impaired blood flow in the portal vein due to fibrosis, thrombosis, stenosis, compression); mixed. Blood flow can be in a state of compensation, subcompensation and decompensation. In 70% of cases, portal hypertension is caused by liver cirrhosis. Complete diagnostics are possible only in a surgical hospital.

Organ and cavity hypertension syndrome is caused either by a violation of the passage of biological fluids and gases through hollow organs or ducts with their expansion, sometimes with the formation of pseudocysts (hydronephrosis, intestinal obstruction, cystic hypoplasia of the liver, lungs, etc.), or with compression of the organ in the serous cavity (pneumothorax, brain compression, cardiac tamponade, etc.).

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