Image result for portal hypertensionPortal Hypertension is a medical condition of Hypertension (High Blood Pressure) of the hepatic portal system.

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

Can be defined where these 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:

  • Ascites
  • Enlarged spleen
  • Varices
  • and others

Causes:

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

  • Testing the via HVPG (Hepatic Venous Pressure Gradient)

Treatment:

***Largely depends on cause

Medications

  • Propranolol
  • Nadolol
  • Isosorbide mononitrate
  • Octreotide
  • Terlipressin

Transjugular intrahepatic portosystemic shunting

Liver transplant

Treatment for Asictes is often required.

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