Chapter 158: Portal Hypertension
Portal hypertension is defined as elevation of the hepatic venous pressure gradient to >5 mmHg, which occurs as a consequence of cirrhosis (Chap. 157: Cirrhosis and Alcoholic Liver Disease). It is caused by increased intrahepatic resistance to the passage of blood flow through the liver due to cirrhosis together with increased splanchnic blood flow due to vasodilatation within the splanchnic vascular bed.
(See Table 158-1)
Portal vein thrombosis
Splenic vein thrombosis
Massive splenomegaly (Banti’s syndrome)
Congenital hepatic fibrosis
Hepatic sinusoidal obstruction (venoocclusive syndrome)
Inferior vena caval webs
Severe congestive heart failure
The primary complications of portal hypertension are gastroesophageal varices with hemorrhage, ascites (Chap. 45: Ascites), hypersplenism, hepatic encephalopathy, spontaneous bacterial peritonitis (Chap. 45: Ascites), hepatorenal syndrome (Chap. 45: Ascites), hepatocellular carcinoma (Chap. 72: Tumors of the Gastrointestinal Tract).
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