Portal hypertension classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Based on the etiology, portal hypertension may be classified as pre-hepatic, intra-hepatic, and post-hepatic. Intra-hepatic portal hypertension classified into pre-sinusoidal, sinusoidal, and post-sinusoidal disorders. Based on the functional impairment in the liver, portal hypertension may be classified as cirrhotic and non-cirrhotic.

Classification

• Based on the etiology, portal hypertension may be classified as pre-hepatic, intra-hepatic, and post-hepatic.
• Intra-hepatic portal hypertension classified into pre-sinusoidal, sinusoidal, and post-sinusoidal disorders.
• Based on the functional impairment in the liver, portal hypertension may be classified as cirrhotic and non-cirrhotic.

Portal Hypertension classification

Functional

Etiology

Cirrhotic

Non-cirrhotic

Without any underlying cause

Pre-hepatic portal hypertension

Intra-hepatic portal hypertension

Post-hepatic portal hypertension

Idiopathic portal hypertension

Pre-sinusoidal disorders

Sinusoidal disorders

Post-sinusoidal disorders

Group		Wedged hepatic venous pressure (WHVP)	Free hepatic vein pressure (FHVP)	Hepatic vein pressure gradient (HVPG)	Cause
Pre-hepatic portal hypertension		Normal	Normal	Normal	Increase in portal veins resistance Inflammatory portal vein closure due to thrombosis
Intra-hepatic portal hypertension	Pre-sinusoidal disorders	Normal	Normal	Normal	Portal vein thrombosis Schistosomiasis Primary biliary cirrhosis
	Sinusoidal disorders	Elevated	Elevated	Elevated	Cirrhosis
	Post-sinusoidal disorders	Elevated	Normal	Elevated	Right heart failure Inferior vena cava (IVC) obstruction
Post-hepatic portal hypertension		Elevated	Elevated	Normal	Increased post-hepatic vessels resistance

 Idiopathic portal hypertension (IPH)

• Idiopathic portal hypertension (IPH) is due to obstruction and stenosis of intra-hepatic portal vasculature.
• Idiopathic portal hypertension (IPH) has 4 stages:
  1. Stage I: Non-atrophic liver without subcapsular parenchymal atrophy.
  2. Stage II: Non-atrophic liver with subcapsular parenchymal atrophy.
  3. Stage III: Atrophic liver with subcapsular parenchymal atrophy.
  4. Stage IV: Portal venous occlusive thrombosis.