Portal hypertension: Difference between revisions

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==Overview==
==Overview==

Revision as of 01:37, 29 June 2012

Portal hypertension
The portal vein and its tributaries.
ICD-10 K76.6
ICD-9 572.3
DiseasesDB 10388
eMedicine radio/570  med/1889
MeSH D006975

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Assistant Editor-in-Chief: Soumya Sachdeva

Overview

In medicine, portal hypertension is hypertension (high blood pressure) in the portal stem which causes an obstruction in the portal vein and its branches. It is often defined as a portal pressure gradient (the difference in pressure between the portal vein and the hepatic veins) of 12 mm Hg or greater. Many conditions can result in portal hypertension. In North America and Europe, it is usually the result of an intrahepatic block due to cirrhosis of the liver. However, in less industrialized parts of the world, climate permitting, the major cause is schistosomiasis.

Pathophysiology

Portal venous pressure is determined by-portal blood flow and portal vascular resistance.Increased portal vascular resistance is often the main factor responsible for it. The consequences of portal hypertension are due to blood being forced down alternate channels by the increased resistance to flow through the portal system. Due to formation of alternate channels initially some of the portal blood and later most of it is shunted directly to the systemic circularion bypassing the liver

Natural History and Complications

There is an increased risk of

Causes

Prehepatic

Intrahepatic

Posthepatic

Diagnosis

Physical Examination

Abdomen

Treatment

Medical management

Treatment with a non-selective beta blocker is often commenced once portal hypertension has been diagnosed, and almost always if there has already been bleeding from esophageal varices. Typically, this is done with either propranolol or nadolol. The addition of a nitrate, such as isosorbide mononitrate, to the beta blocker is more effective than using beta blockers alone and may be the preferred regimen in those people with portal hypertension who have already experienced variceal bleeding. In acute or severe complications of the hypertension, such as bleeding varices, intravenous octreotide (a somatostatin analogue) or intravenous terlipressin (an antidiuretic hormone analogue) is commenced to decrease the portal pressure.

Percutaneous interventions

Transjugular intrahepatic portosystemic shunting is the creation of a connection between the portal and the venous system. As the pressure over the venous system is lower than over a hypertensive portal system, this would decrease the pressure over the portal system and a decreased risk of complications.

Surgical interventions

The most definitive treatment of portal hypertension is a liver transplant.

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:291

External links

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