Portal hypertension

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Portal hypertension
Classification and external resources

The portal vein and its tributaries.
ICD-10K76.6
ICD-9572.3
DiseasesDB10388
eMedicineradio/570 med/1889
MeSHD006975
 
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Portal hypertension
Classification and external resources

The portal vein and its tributaries.
ICD-10K76.6
ICD-9572.3
DiseasesDB10388
eMedicineradio/570 med/1889
MeSHD006975

In medicine, portal hypertension is hypertension (high blood pressure) in the portal vein and its tributaries.

It is often defined as a portal pressure gradient (the difference in pressure between the portal vein and the hepatic veins) of 10 mmHg or greater.

Contents

Causes

Causes can be divided into prehepatic, intrahepatic, and posthepatic. Intrahepatic causes include liver cirrhosis, and hepatic fibrosis (e.g. due to Wilson's disease, hemochromatosis, or congenital fibrosis). Prehepatic causes include portal vein thrombosis or congenital atresia. Posthepatic obstruction occurs at any level between liver and right heart, including hepatic vein thrombosis, inferior vena cava thrombosis, inferior vena cava congenital malformation, and constrictive pericarditis.

Signs and symptoms

Consequences of portal hypertension are caused by blood being forced down alternate channels by the increased resistance to flow through the systemic venous system rather than the portal system. They include:

Diagnostics

HVPG (hepatic venous pressure gradient) measurement has been accepted as the gold standard for assessing the severity of portal hypertension,[2] and replaced the old one - contrast angiography.[3] Portal hypertension is defined as HVPG greater than 5mm Hg.[4]

Treatment

Prophylaxis of variceal bleeding

Both pharmacological (B-blocker like Propranolol and isosorbide mononitrate) and endoscopic (banding ligation) treatment have similar results. TIPS (transjugular intrahepatic portosystemic shunting) is superior to either of them at reducing rate of rebleeding. Disadvantages of TIPS include high cost and increased risk of hepatic encephalopathy, and it does not improve the mortality rate.

Management of active variceal bleeding

After resuscitation, which may require blood transfusion, the management of active variceal bleeding includes administering vasoactive drugs (somatostatin, octreotide or terlipressin), endoscopic banding ligation, balloon tamponade and TIPS.

Management of ascites

This should be gradual to avoid sudden changes in systemic volume status which can precipitate hepatic encephalopathy, renal failure and death. The management includes salt restriction, diuretics (spironolactone), paracentesis, transjugular intrahepatic portosystemic shunt (TIPS) and peritoneovenous shunt.

Control of hepatic encephalopathy

This includes reduction of dietary protein, followed by lactulose and use of oral antibiotics.

References

  1. ^ "Portal Hypertension". http://www.clevelandclinic.org/health/health-info/docs/0200/0252.asp?index=4912. Retrieved 2007-12-07. 
  2. ^ Damping Index of Doppler Hepatic Vein Waveform - Portal Hypertension: Discussion, http://www.medscape.com/viewarticle/564073_4
  3. ^ Appleton & Lange's review for the ultrasonography examination, By Carol Krebs, Charles S. Odwin, Arthur C. Fleischer, page 309
  4. ^ http://www.drfalkpharma.de/fileadmin/media/praesentationen/fs163/S4_P2.pdf

External links