SlideShare a Scribd company logo
1 of 70
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]

More Related Content

What's hot

Gastro intestinal Bleeding
Gastro intestinal BleedingGastro intestinal Bleeding
Gastro intestinal Bleeding
shabeel pn
 
Lower Gastro-Intestinal Bleed
Lower Gastro-Intestinal BleedLower Gastro-Intestinal Bleed
Lower Gastro-Intestinal Bleed
Anshuman Aashu
 
Biliary stricture ppt
Biliary stricture pptBiliary stricture ppt
Biliary stricture ppt
Sumer Yadav
 

What's hot (20)

Gastro intestinal Bleeding
Gastro intestinal BleedingGastro intestinal Bleeding
Gastro intestinal Bleeding
 
Portal hypertension
Portal hypertensionPortal hypertension
Portal hypertension
 
Portal hypertension (1)
Portal hypertension (1)Portal hypertension (1)
Portal hypertension (1)
 
portal hypertension..classification and pathophysiology.
portal hypertension..classification and pathophysiology.portal hypertension..classification and pathophysiology.
portal hypertension..classification and pathophysiology.
 
Portal hypertension surgical management
Portal hypertension surgical management Portal hypertension surgical management
Portal hypertension surgical management
 
Mesenteric ischemia
Mesenteric ischemiaMesenteric ischemia
Mesenteric ischemia
 
Portal hypertension
Portal hypertensionPortal hypertension
Portal hypertension
 
Peptic Ulcer Bleeding
Peptic Ulcer BleedingPeptic Ulcer Bleeding
Peptic Ulcer Bleeding
 
Acute cholangitis
Acute cholangitisAcute cholangitis
Acute cholangitis
 
Lower Gastro-Intestinal Bleed
Lower Gastro-Intestinal BleedLower Gastro-Intestinal Bleed
Lower Gastro-Intestinal Bleed
 
Treatment of portal hypertension
Treatment of portal hypertensionTreatment of portal hypertension
Treatment of portal hypertension
 
Chronic pancreatitis
Chronic pancreatitisChronic pancreatitis
Chronic pancreatitis
 
management of portal hypertension by Dr.Zarin
management of portal hypertension by Dr.Zarinmanagement of portal hypertension by Dr.Zarin
management of portal hypertension by Dr.Zarin
 
Disorders of gall bladder
Disorders of gall bladderDisorders of gall bladder
Disorders of gall bladder
 
Biliary stricture ppt
Biliary stricture pptBiliary stricture ppt
Biliary stricture ppt
 
Evaluation of hematuria
Evaluation of hematuria Evaluation of hematuria
Evaluation of hematuria
 
Peritonitis
PeritonitisPeritonitis
Peritonitis
 
portal hypertension.pptx
portal hypertension.pptxportal hypertension.pptx
portal hypertension.pptx
 
Peritonitis and Ascites
Peritonitis and AscitesPeritonitis and Ascites
Peritonitis and Ascites
 
Cholangitis
CholangitisCholangitis
Cholangitis
 

Similar to Portal Hypertension

Upper gi bleeding
Upper gi bleeding Upper gi bleeding
Upper gi bleeding
drvicky666
 
VARICEAL HAEMORRHAGE WITH SPECIAL ATTENTION TO PORTAL HYPERTENSION
VARICEAL HAEMORRHAGE WITH SPECIAL ATTENTION TO PORTAL HYPERTENSIONVARICEAL HAEMORRHAGE WITH SPECIAL ATTENTION TO PORTAL HYPERTENSION
VARICEAL HAEMORRHAGE WITH SPECIAL ATTENTION TO PORTAL HYPERTENSION
Arkaprovo Roy
 
03 Perioperative Renal Failure In Cardiac Surgery
03 Perioperative Renal Failure In Cardiac Surgery03 Perioperative Renal Failure In Cardiac Surgery
03 Perioperative Renal Failure In Cardiac Surgery
guest2379201
 
03 Perioperative Renal Failure In Cardiac Surgery
03 Perioperative Renal Failure In Cardiac Surgery03 Perioperative Renal Failure In Cardiac Surgery
03 Perioperative Renal Failure In Cardiac Surgery
Dang Thanh Tuan
 

Similar to Portal Hypertension (20)

33
3333
33
 
Hepatic Failure
Hepatic FailureHepatic Failure
Hepatic Failure
 
Portal hypertension
Portal hypertensionPortal hypertension
Portal hypertension
 
portal hypertension UG class by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
 portal hypertension UG class by Prof. Ajay Khanna, IMS, BHU, Varanasi, India portal hypertension UG class by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
portal hypertension UG class by Prof. Ajay Khanna, IMS, BHU, Varanasi, India
 
PORTAL HTN spleno renal shunt.ppt
PORTAL HTN spleno renal shunt.pptPORTAL HTN spleno renal shunt.ppt
PORTAL HTN spleno renal shunt.ppt
 
Ugi bleeding
Ugi bleedingUgi bleeding
Ugi bleeding
 
Portal hypertension & management
Portal hypertension & management Portal hypertension & management
Portal hypertension & management
 
30
3030
30
 
Upper gi bleeding
Upper gi bleeding  Upper gi bleeding
Upper gi bleeding
 
shmabhavi.pptx
shmabhavi.pptxshmabhavi.pptx
shmabhavi.pptx
 
Portal Hypertension
Portal HypertensionPortal Hypertension
Portal Hypertension
 
Upper gi bleeding
Upper gi bleeding Upper gi bleeding
Upper gi bleeding
 
Portal Hypertension.ppt
Portal Hypertension.pptPortal Hypertension.ppt
Portal Hypertension.ppt
 
Hepatectomy anaesthesia
Hepatectomy anaesthesia Hepatectomy anaesthesia
Hepatectomy anaesthesia
 
Upper gi bleeding
Upper gi bleedingUpper gi bleeding
Upper gi bleeding
 
VARICEAL HAEMORRHAGE WITH SPECIAL ATTENTION TO PORTAL HYPERTENSION
VARICEAL HAEMORRHAGE WITH SPECIAL ATTENTION TO PORTAL HYPERTENSIONVARICEAL HAEMORRHAGE WITH SPECIAL ATTENTION TO PORTAL HYPERTENSION
VARICEAL HAEMORRHAGE WITH SPECIAL ATTENTION TO PORTAL HYPERTENSION
 
Acute GI Bleedding .ppt
Acute GI Bleedding .pptAcute GI Bleedding .ppt
Acute GI Bleedding .ppt
 
03 Perioperative Renal Failure In Cardiac Surgery
03 Perioperative Renal Failure In Cardiac Surgery03 Perioperative Renal Failure In Cardiac Surgery
03 Perioperative Renal Failure In Cardiac Surgery
 
03 Perioperative Renal Failure In Cardiac Surgery
03 Perioperative Renal Failure In Cardiac Surgery03 Perioperative Renal Failure In Cardiac Surgery
03 Perioperative Renal Failure In Cardiac Surgery
 
portalhypertension
portalhypertensionportalhypertension
portalhypertension
 

More from Saeed Al-Shomimi

Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...
Saeed Al-Shomimi
 
Retroperitoneal Collections
Retroperitoneal CollectionsRetroperitoneal Collections
Retroperitoneal Collections
Saeed Al-Shomimi
 
How to do - Abdominal Trauma
How to do - Abdominal TraumaHow to do - Abdominal Trauma
How to do - Abdominal Trauma
Saeed Al-Shomimi
 
Breast Cancer during pregnancy
Breast Cancer during pregnancyBreast Cancer during pregnancy
Breast Cancer during pregnancy
Saeed Al-Shomimi
 
Antibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisAntibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute Panceriatitis
Saeed Al-Shomimi
 
Esophaegeal resection & reconstruction
Esophaegeal resection & reconstructionEsophaegeal resection & reconstruction
Esophaegeal resection & reconstruction
Saeed Al-Shomimi
 
A v fistula in heamodialysis
A v fistula in heamodialysisA v fistula in heamodialysis
A v fistula in heamodialysis
Saeed Al-Shomimi
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular Trauma
Saeed Al-Shomimi
 
Risk Factors of Breast Cancer
Risk Factors of Breast CancerRisk Factors of Breast Cancer
Risk Factors of Breast Cancer
Saeed Al-Shomimi
 
Surgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSurgical Management in Ulcerative Colitis
Surgical Management in Ulcerative Colitis
Saeed Al-Shomimi
 
Endocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasEndocrine Tumors Of The Pancreas
Endocrine Tumors Of The Pancreas
Saeed Al-Shomimi
 

More from Saeed Al-Shomimi (20)

Pathophysiology of wound healing
Pathophysiology of wound healingPathophysiology of wound healing
Pathophysiology of wound healing
 
Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...Can we apply the same indications of ESD for primary gastric cancer to remnan...
Can we apply the same indications of ESD for primary gastric cancer to remnan...
 
Retroperitoneal Collections
Retroperitoneal CollectionsRetroperitoneal Collections
Retroperitoneal Collections
 
Tube thoracostomy
Tube thoracostomyTube thoracostomy
Tube thoracostomy
 
How to do - Abdominal Trauma
How to do - Abdominal TraumaHow to do - Abdominal Trauma
How to do - Abdominal Trauma
 
Breast Cancer during pregnancy
Breast Cancer during pregnancyBreast Cancer during pregnancy
Breast Cancer during pregnancy
 
Antibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute PanceriatitisAntibiotic prophylaxis in sever Acute Panceriatitis
Antibiotic prophylaxis in sever Acute Panceriatitis
 
Gallstone
GallstoneGallstone
Gallstone
 
Esophaegeal resection & reconstruction
Esophaegeal resection & reconstructionEsophaegeal resection & reconstruction
Esophaegeal resection & reconstruction
 
A v fistula in heamodialysis
A v fistula in heamodialysisA v fistula in heamodialysis
A v fistula in heamodialysis
 
DVT Current Concept
DVT Current ConceptDVT Current Concept
DVT Current Concept
 
Diabetic Foot Examination
Diabetic Foot ExaminationDiabetic Foot Examination
Diabetic Foot Examination
 
Solitary Thyroid Nodule
Solitary Thyroid NoduleSolitary Thyroid Nodule
Solitary Thyroid Nodule
 
Massive Blood Transfusion
Massive Blood TransfusionMassive Blood Transfusion
Massive Blood Transfusion
 
Lower Limb Vascular Trauma
Lower  Limb  Vascular  TraumaLower  Limb  Vascular  Trauma
Lower Limb Vascular Trauma
 
Risk Factors of Breast Cancer
Risk Factors of Breast CancerRisk Factors of Breast Cancer
Risk Factors of Breast Cancer
 
Liver Trauma
Liver TraumaLiver Trauma
Liver Trauma
 
Surgical Management in Ulcerative Colitis
Surgical Management in Ulcerative ColitisSurgical Management in Ulcerative Colitis
Surgical Management in Ulcerative Colitis
 
Endocrine Tumors Of The Pancreas
Endocrine Tumors Of The PancreasEndocrine Tumors Of The Pancreas
Endocrine Tumors Of The Pancreas
 
Ischemic Colitis
Ischemic ColitisIschemic Colitis
Ischemic Colitis
 

Recently uploaded

Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
mahaiklolahd
 

Recently uploaded (20)

💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
Coimbatore Call Girls in Thudiyalur : 7427069034 High Profile Model Escorts |...
 
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
9630942363 Genuine Call Girls In Ahmedabad Gujarat Call Girls Service
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
 
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
 
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
Night 7k to 12k Navi Mumbai Call Girl Photo 👉 BOOK NOW 9833363713 👈 ♀️ night ...
 
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
(Low Rate RASHMI ) Rate Of Call Girls Jaipur ❣ 8445551418 ❣ Elite Models & Ce...
 
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
 
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Hosur Just Call 9630942363 Top Class Call Girl Service Available
 
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
Coimbatore Call Girls in Coimbatore 7427069034 genuine Escort Service Girl 10...
 
Call Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service Available
 
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
Independent Call Girls In Jaipur { 8445551418 } ✔ ANIKA MEHTA ✔ Get High Prof...
 
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
Night 7k to 12k Chennai City Center Call Girls 👉👉 7427069034⭐⭐ 100% Genuine E...
 
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
 
Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service AvailableTrichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
Trichy Call Girls Book Now 9630942363 Top Class Trichy Escort Service Available
 
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
 
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Hyderabad Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls  * UPA...
Call Girl in Indore 8827247818 {LowPrice} ❤️ (ahana) Indore Call Girls * UPA...
 

Portal Hypertension