Portal hypertension
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Overview
| Portal hypertension Classification and external resources | |
 | |
|---|---|
| The portal vein and its tributaries. | |
| ICD-10 | K76.6 |
| ICD-9 | 572.3 |
| DiseasesDB | 10388 |
| eMedicine | radio/570 med/1889 |
| MeSH | D006975 |
In medicine, portal hypertension is hypertension (high blood pressure) in the portal stem which causes an obstruction in the portal vein and its branches. It is often defined as a portal pressure gradient (the difference in pressure between the portal vein and the hepatic veins) of 12 mm Hg or greater. Many conditions can result in portal hypertension. In North America and Europe, it is usually the result of an intrahepatic block due to cirrhosis of the liver. However, in less industrialized parts of the world, climate permitting, the major cause is schistosomiasis.
Signs and symptoms
Consequences of portal hypertension are caused by blood being forced down alternate channels by the increased resistance to flow through the portal system. They include:
- Ascites (free fluid in the peritoneal cavity)
- Hepatic encephalopathy
- Increased risk of spontaneous bacterial peritonitis
- Increased risk of hepatorenal syndrome
- Splenomegaly (enlargement of the spleen) with consequent sequestration therein of red blood cells, white blood cells, and platelets, together leading to mild pancytopenia
- portacaval anastomoses (Esophageal varices, hemorrhoids, caput medusae), with esophageal varices posing an ongoing risk of life-threatening hemorrhage.[1]
Differential Diagnosis
Prehepatic
- Congenital abnormalities
- Idiopathic tropical splenomegaly
- Portal vein occlusion
- Splenic Vein Thrombosis
- Umbilical sepsis
Intrahepatic
- Alcoholic hepatitis
- Boeck's Diesease
- Chronic hepatitis
- Cirrhosis
- Fatty liver
- Fulminant hepatic failure
- Hodgkin's Lymphoma
- Osteomyelosclerosis
- Partial nodular transformation
- Schistosomiasis
- Wilson's Disease
Posthepatic
- Cardiomyopathy
- Congestive Heart Failure
- Constructive Pericarditis
- Inferior vena cava obstruction
- Tricuspid insufficiency
Treatment
Medical management
Treatment with a non-selective beta blocker is often commenced once portal hypertension has been diagnosed, and almost always if there has already been bleeding from esophageal varices. Typically, this is done with either propranolol or nadolol. The addition of a nitrate, such as isosorbide mononitrate, to the beta blocker is more effective than using beta blockers alone and may be the preferred regimen in those people with portal hypertension who have already experienced variceal bleeding. In acute or severe complications of the hypertension, such as bleeding varices, intravenous octreotide (a somatostatin analogue) or intravenous terlipressin (an antidiuretic hormone analogue) is commenced to decrease the portal pressure.
Percutaneous interventions
Transjugular intrahepatic portosystemic shunting is the creation of a connection between the portal and the venous system. As the pressure over the venous system is lower than over a hypertensive portal system, this would decrease the pressure over the portal system and a decreased risk of complications.
Surgical interventions
The most definitive treatment of portal hypertension is a liver transplant.
References
External links
- VIDEO - Portal Hypertension: Shunt Surgery in the Era of Transplant and TIPS, Alysandra Lal, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)
- 10-135e. at Merck Manual of Diagnosis and Therapy Home Edition
fr:Hypertension portalesv:Portahypertension
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
