Portal Hypertension

Definition and Pathophysiology

• Portal hypertension is a condition characterized by increased pressure in the portal vein, which carries blood from the digestive organs to the liver.
• Normal portal pressure: 5-10 mmHg
• Portal hypertension: >12 mmHg
• Causes:
  • Cirrhosis (most common cause)
  • Blood clots in the portal vein
  • Infection or inflammation of the portal vein
  • Congenital abnormalities of the portal vein

Consequences of Portal Hypertension

• Portal vein dilation
• Development of collateral vessels (e.g., esophageal varices, gastric varices)
• Increased risk of bleeding from these vessels
• Ascites (fluid accumulation in the abdominal cavity)
• Hepatic encephalopathy (brain dysfunction due to liver failure)

Clinical Features

• Symptoms:
  • Abdominal pain and distension
  • Nausea and vomiting
  • Fatigue
  • Diarrhea
• Signs:
  • Palpable spleen
  • Ascites
  • Caput medusae (dilated veins around the umbilicus)
  • Gastrointestinal bleeding

Diagnostic Tests

• Endoscopy: to visualize esophageal and gastric varices
• Imaging studies:
  • Ultrasound: to assess liver and portal vein anatomy
  • CT or MRI: to evaluate portal vein patency and liver disease
• Measurement of portal pressure: using hepatic venous pressure gradient (HVPG) or portal venous pressure

Management

• Treatment of underlying liver disease (e.g., cirrhosis)
• Endoscopic therapy: banding or sclerotherapy to treat esophageal varices
• Pharmacological therapy: beta blockers, nitrates, and somatostatin analogs to reduce portal pressure
• Transjugular intrahepatic portosystemic shunt (TIPS): a procedure to create a shunt between the portal vein and hepatic vein
• Liver transplantation: in severe cases of portal hypertension and liver failure

Portal Hypertension

• Characterized by increased pressure in the portal vein, which carries blood from digestive organs to the liver
• Normal portal pressure: 5-10 mmHg
• Portal hypertension: >12 mmHg

Causes of Portal Hypertension

• Cirrhosis: most common cause
• Blood clots in the portal vein
• Infection or inflammation of the portal vein
• Congenital abnormalities of the portal vein

Consequences of Portal Hypertension

• Portal vein dilation
• Development of collateral vessels, such as:
  • Esophageal varices
  • Gastric varices
• Increased risk of bleeding from these vessels
• Ascites: fluid accumulation in the abdominal cavity
• Hepatic encephalopathy: brain dysfunction due to liver failure

Clinical Features of Portal Hypertension

• Symptoms:
  • Abdominal pain and distension
  • Nausea and vomiting
  • Fatigue
  • Diarrhea
• Signs:
  • Palpable spleen
  • Ascites
  • Caput medusae: dilated veins around the umbilicus
  • Gastrointestinal bleeding

Diagnostic Tests for Portal Hypertension

• Endoscopy: to visualize esophageal and gastric varices
• Imaging studies:
  • Ultrasound: to assess liver and portal vein anatomy
  • CT or MRI: to evaluate portal vein patency and liver disease
• Measurement of portal pressure:
  • Hepatic venous pressure gradient (HVPG)
  • Portal venous pressure

Management of Portal Hypertension

• Treatment of underlying liver disease, such as cirrhosis
• Endoscopic therapy:
  • Banding
  • Sclerotherapy to treat esophageal varices
• Pharmacological therapy:
  • Beta blockers
  • Nitrates
  • Somatostatin analogs to reduce portal pressure
• Transjugular intrahepatic portosystemic shunt (TIPS): a procedure to create a shunt between the portal vein and hepatic vein
• Liver transplantation: in severe cases of portal hypertension and liver failure