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

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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