Portal Hypertension Clinical Features Symptoms Diagnosis and Treatment

Portal Hypertension Clinical Features Symptoms Diagnosis and Treatment

Portal Hypertension

• Normal pressureChronic Long-term Complications Of Diabetes Mellitus. Read more ... » in portal vein is 5-10 mmHg. Vascular resistance in hepatic sinusoids is low.

Increased pressure in the portal vein caused by an obstruction of the flow of blood through the liver. Portal hypertensionDiabetes Insipidus (DI) Causes Diagnosis and Treatment. Read more ... » is found in diseases such as cirrhosis,

Portal hypertension is defined by a pathological increase in the pressure of the portal venous systemType of Anaemia Megaloblastic Anaemia And Treatment. Read more ... ».

Portal hypertension means pressure in portal vein >10 mmHg.

• It results from increased resistance to blood flow due to any cause.
• in which it is responsible for ascites, splenomegaly, and the formation of varices.
• There are no valves in the portal venous system, therefore, any resistance from the right side of heartCARDIAC MARKERS IN MI, AMI and Myocardial Injury. Read more ... » to the vessels of any organ results in direct transmis­sion of the raised pressure.

Portal Hypertension ClinicalType of Anaemia Megaloblastic Anaemia And Treatment. Read more ... » Features SymptomsType of Anaemia Megaloblastic Anaemia And Treatment. Read more ... » DiagnosisType of Anaemia Megaloblastic Anaemia And Treatment. Read more ... » and TreatmentType of Anaemia Megaloblastic Anaemia And Treatment. Read more ... »

Increased resistance can occur at :

• 1. Presinusoidal
• 2. Sinusoidal
• 3. Postsinusoidal levels. ,

Obstruction in presinusoidal veins may be :

• Outside the liver - portal vein thrombosis.
• Inside the liver - capillaries and venules.

Sinusoidal obstruction -

• In cirrhosis the increased resistance is sinusoidal.

Post sinusoidal obstruction

• may occur outside the liver.
• . In the hepatic veins – Budd Chiari syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... ».
• · In the inferior vena cava.
• · Within the liver – Veno-occlusive diseaseType of Anaemia Megaloblastic Anaemia And Treatment. Read more ... ».
• Functional resistance to portal blood flow may occur at several levels.
• Portal hypertension may also occur in massive sple­nomegaly or AV fistulas due to increased blood flow.
• The most common cause of portal hypertension is cirrhosis of liver.
• Portal hypertension is present in more than 60% of cirrhosis patients.

Portal vein obstruction

•  is the next common cause and may be :
• · Idiopathic – due to hypercoagulable states like polycythemia veraPolycythemia Vera My­elofibrosis Thrombocytosis Cause Diagnosis Treatment. Read more ... », essential thrombocythemia, protein C, protein S and antithrombin III defi­ciencies.
• · Cirrhosis
• · Infection
• · Pancreatitis
• · Abdominal trauma.
• Portal vein occlusion may result in hematamesis from oesophageal varices and ascites.

Non-cirrhotic portal hypertension is rare.

Classification of noncirrhotic portal hypertension

• Prehepatic
  • Portal vein thrombosis
    Splenic vein thombosis
    Splanchnic arteriovenous fistula
    Splenomegaly (lymphoma, Gaucher’s disease)
• Intrahepatic
  • Presinusoidal
    SchistosomiasisSchistosomiasis Flat Worms Signs and Symptoms with Diagnosis Treatment. Read more ... »
    Idiopathic portal hypertension/Noncirrhotic portal fibrosis/Hepatoportal sclerosis
    Primary biliary cirrhosisBiliary Cirrhosis (Primary and Secondary) Symptoms Diagnosis and Treatment. Read more ... »
    SarcoidosisSarcoidosis Causes Diagnosis Symptoms and Treatment. Read more ... »
    Congenital hepatic fibrosis
    Sclerosing cholangitis
    Hepatic arteriopetal fistula
  • Sinusoidal
    Arsenic poisoning
    Vinyl chloride toxicity
    Vitamin A toxicity
    Nodular regenerative hyperplasia
  • Postsinusoidal
    Sinusoidal obstruction syndrome (Veno-occlusive disease)
    Budd-Chiari syndrome
• Posthepatic
  • IVC obstruction
    CardiacDiabetes Insipidus (DI) Causes Diagnosis and Treatment. Read more ... » disease (constrictive pericarditisCOMPLICATIONS OF Acute Myocardial Infarction (AMI) AND TREATMENT -2. Read more ... », restrictive cardiomyopathyCardiomyopathy Clinical features Etiology Diagnosis Dilated Hypertrophic Restrictive cardiomyopathy with Treatment. Read more ... »)

Portal Hypertension Clinical Features Symptoms

• · Oesophageal variceal bleeding
• · Splenomegaly with hypersplenism
• · Ascites
• · AcuteType of Anaemia Megaloblastic Anaemia And Treatment. Read more ... » and chronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » hepatic encephalopathyCirrhosis and COMPLICATIONS of CIRRHOSIS with Treatment. Read more ... ».
• There is development of portal systemic collaterals. There is retrograde flow away from the liver from high pressure portal venous system to low pressure sys­temic venous circulation.
• Major collaterals are oesophageal varices, rectal, ret­roperitoneal, periumbilical or abdominal wall collaterals.
• On the abdomen, collaterals appear as tortuous epi­gastric vessels radiating from umbilicus upwards, the caput medusae. There is a progressive reduction in platelet count.
• A low platelet count may be the first clue to cirrhosis. ,
• A marked fall in platelets and WBCs can occur.

Portal Hypertension Diagnosis

• Diagnosis is made by the presence of : Splenomegaly, Ascites, Encephalopathy, Oesophageal varices.
• Varices are seen by fiberoptic oesophagoscopy.
• MRI (Magnetic resonance imaging) and CT (Comput­erized tomography) also show collateral circulation in portal hypertension.
• Portal venous pressure can be measured directly by skinny needle catheterization i.e. direct insertion of’ needle through skin to the hepatic veins.
• The wedged hepatic vein pressure is increased in si­nusoidal and post sinusoidal portal hypertension (cir­rhosis).
• It is normal in pre-sinusoidal portal hypertension. Mesenteric and hepatic angiography may sometimes be required before portal systemic shunt surgery.

Portal Hypertension Treatment

• Surgical decompression may be done to lower portal pressure.
• Decompression without surgery may be done by TIP-transjugular intrahepatic portosystemic shunt.
• Beta blockersHeart Failure Treatment Heart Failure GENERAL PRINCIPLES. Read more ... » such as propranolol, nadolol cause vasoconstriction and reduced cardiac output and reduce bleeding.
• HVPG (Hepatic Venous Pressure Gradient) = Wedged Hepatic Venous Pressure Minus Free Hepatic Venous Pressure.
• HVPG must be reduced to less than 12 mmHg
• Portal hypertension due to cirrhosis is not reversible. In alcoholic hepatitis and cirrhosis, chronic active hepatitis and other liver diseases, intensive treatment can give good results.