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portal_hypertension

portal hypertension

see also:

Introduction

  • portal venous hypertension is primarily a result of cirrhosis

Aetiology

  • cirrhosis - by far the most common cause
  • pre-hepatic causes:
    • portal vein thrombosis - presents as N/V/D, abdo pain (intestinal ischaemia) +/- varices, splenomegaly
    • splenic vein thrombosis
    • arteriovenous fistula
    • splenomegaly - via increased portal blood flow
  • other hepatic causes
    • primary sclerosing cholangitis
    • chronic pancreatitis
    • hereditary haemorrhagic telangiectasia
    • congenital hepatic fibrosis
    • nodular regenerative hyperplasia
    • fibrosis of space of Disse
    • granulomatous or infiltrative liver diseases (Gaucher, mucopolysaccharidosis, sarcoidosis, lymphoproliferative malignancies, amyloid deposition, …)
    • hepatotoxicity (from arsenic, copper, vinyl chloride monomers, mineral oil, vitamin A, azathioprine, dacarbazine, methotrexate, amiodarone etc)
    • viral hepatitis
    • fatty liver disease
    • veno-occlusive disease
  • post-hepatic causes
    • IVC obstruction
    • right heart failure eg. constrictive pericarditis
    • Budd–Chiari syndrome aka hepatic vein thrombosis

Clinical features

  • porto–systemic collateral veins (some may require USS to determine)
  • ascites if cause is hepatic or post-hepatic (pre-hepatic causes will not result in ascites unless cirrhosis is also present)

Diagnosis

  • portal vein ultrasonography:
    • up to 40% have a dilated portal V > 13mm (but normal patients may have diameters larger than this too)
    • using Doppler, a slow velocity of <16 cm/s in addition to dilatation in the MPV are diagnostic of portal hypertension
  • The hepatic venous pressure gradient (HVPG) measurement has been accepted as the gold standard for assessing the severity of portal hypertension.
    • Portal hypertension is defined as HVPG greater than or equal to 5 mm Hg and is considered to be clinically significant when HVPG exceeds 10 to 12 mm Hg
portal_hypertension.txt · Last modified: 2018/08/11 18:23 (external edit)