Portal hypertension

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.