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Portal Hypertension is a medical condition of Hypertension (High Blood Pressure) that involves the hepatic portal system or the system that involves the liver.

This condition involves the relationship between portal venous blood flow and the resistance offered to the blood flow within the liver.

Portal Hypertension be defined where there is a Hepatic Venous Pressure Gradient equal or greater than 6 mmHg. 

Cirrhosis from alcohol or chronic viral hepatitis is most common cause of portal hypertension, although there are other causes.

Symptoms Seen in Portal Hypertension:

–  Ascites
–  Enlarged spleen
–  Swollen veins
–  Hemorrhoids
–  Varices
–  Enlarged Spleen
–  and others

Causes of Portal Hypertension:

Most all causes circle around Liver changes (Hepatic).

Can be defined in 3 categories:

1.)  Prehepatic Causes
2.)  Hepatic Causes
3.)  Posthepatic Causes

Prehepatic Causes:
–  Splenic Vein Thrombosis
–  Portan Vein Thrombosis

Hepatic Causes:
–  Cirrhosis
–  Viral Hepatitis
–  Fatty Liver Disease
–  Bilary Atresia
–  Chronic Pancreatitis
–  Primary Sclerosing Cholangitis
–  Hereditary Heemorrhagic Telangiectasia
–  Schistosomiasis
–  Congenital Hepatic Fibrosis
–  Toxicity – from medications  (Vitamin A, Azthioprine, Methotrexate, Amiodarone, and others)
–  Toxicity – from Aresnic, Copper, and others

Posthepatic Causes:
–  Inferior Vena Cava Obstruction
–  Right sided Heart failure
–  Hepatic Vein Thrombosis
–  Budd-Chiari Syndrome

Diagnosis for Portal Hypertension

–  Testing the via HVPG (Hepatic Venous Pressure Gradient
–  Ultrasound
–  Abdominal CT and/or MRI

Treatment for Portal Hypertension:

***Largely depends on cause

Medications
  –  Propranolol
  –  Nadolol
  –  Isosorbide mononitrate
  –  Octreotide
  –  Terlipressin

2.)  Transjugular intrahepatic portosystemic shunting

3.)  Liver transplant

4.)  Treatment for Asictes is often required.