Portal hypertension

Posted by e-Medical PPT Friday, October 29, 2010
Portal hypertension is hypertension in the portal vein and its tributaries.Portal hypertension may be defined as a portal pressure gradient of 12 mm Hg or greater.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.
Consequences of portal hypertension are
* Ascites
* Hepatic encephalopathy
* Increased risk of spontaneous bacterial peritonitis
* Increased risk of hepatorenal syndrome
* Splenomegaly
* Portacaval anastomoses (esophageal varices, gastric varices, anorectal varices
* Haematemesis or melaena
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.
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