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Concept
Portal hypertension
Summary
Portal hypertension is abnormally increased portal venous pressure – blood pressure in the portal vein and its branches, that drain from most of the intestine to the liver. Portal hypertension is defined as a hepatic venous pressure gradient greater than 5 mmHg. Cirrhosis (a form of chronic liver failure) is the most common cause of portal hypertension; other, less frequent causes are therefore grouped as non-cirrhotic portal hypertension. When it becomes severe enough to cause symptoms or complications, treatment may be given to decrease portal hypertension itself or to manage its complications.
Signs and symptoms of portal hypertension include:
Ascites (free fluid in the peritoneal cavity),
Abdominal pain or tenderness (when bacteria infect the ascites, as in spontaneous bacterial peritonitis).
Increased spleen size (splenomegaly), which may lead to lower platelet counts (thrombocytopenia)
Anorectal varices
Swollen veins on the anterior abdominal wall (sometimes referred to as caput medusae)
In addition, a widened (dilated) portal vein as seen on a CT scan or MRI may raise the suspicion about portal hypertension. A cutoff value of 13 mm is widely used in this regard, but the diameter is often larger than this is in normal individuals as well.
The causes for portal hypertension are classified as originating in the portal venous system before it reaches the liver (prehepatic causes), within the liver (intrahepatic) or between the liver and the heart (post-hepatic). The most common cause is cirrhosis (chronic liver failure). Other causes include:
Prehepatic causes
Portal vein thrombosis
Splenic vein thrombosis
Arteriovenous fistula (increased portal blood flow)
Splenomegaly and/or hypersplenism (increased portal blood flow)
Hepatic causes
Cirrhosis of any cause.
alcohol use disorder
chronic viral hepatitis
biliary atresia
Primary biliary cirrhosis
Primary sclerosing cholangitis
Chronic pancreatitis
Hereditary haemorrhagic telangiectasia
Schistosomiasis
Congenital hepatic fibrosis
Nodular regenerative hyperplasia
Fibrosis of space of Disse
Granulomatous or infiltrative liver diseases (Gaucher disease, mucopolysaccharidosis, sarcoidosis, lymphoproliferative malignancies, amyloidosis, etc.
Official source
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