Harrison's Manual of Medicine
Chapter 158: Portal Hypertension
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)
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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