Chapter 158: Portal Hypertension

Chapter 158: Portal Hypertension is a topic covered in the Harrison's Manual of Medicine.

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INTRODUCTION

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.

CLASSIFICATION

(See Table 158-1)

TABLE 158-1: Classification of Portal Hypertension

Prehepatic

 Portal vein thrombosis

 Splenic vein thrombosis

 Massive splenomegaly (Banti’s syndrome)

Hepatic

 Presinusoidal

  Schistosomiasis

  Congenital hepatic fibrosis

 Sinusoidal

  Cirrhosis—many causes

  Alcoholic hepatitis

 Postsinusoidal

  Hepatic sinusoidal obstruction (venoocclusive syndrome)

Posthepatic

 Budd-Chiari syndrome

 Inferior vena caval webs

 Cardiac causes

  Restrictive cardiomyopathy

  Constrictive pericarditis

  Severe congestive heart failure

CONSEQUENCES

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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