Portal hypertension

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Portal hypertension is defined as portal venous pressure greater than 12 mmHg.

Pathology

Causes can be split in their relation to the hepatic sinusoids:

pre-sinusoidal
- portal vein thrombosis
- extrinsic compression of portal vein
- Schistosomiasis (S. mansoni or S. japonicum)
sinusoidal
- cirrhosis
post-sinusoidal

Subtypes

sinistral portal hypertension ⁵

Radiographic features

Ultrasound

dilated portal vein (>13mm): non-specific
biphasic or reverse flow in portal vein (late stage): ~~pathognomic~~pathognomonic
recanalisation of paraumbilical vein: ~~pathognomic~~pathognomonic
portal-systemic collateral pathways (collateral vessels/varices)
splenomegaly
ascites
cause of portal hypertension often identified, most commonly liver cirrhosis

CT and MRI

dilated portal vein +/- mesenteric veins
contrast enhancement of paraumbilical vein: pathognomonic
collateral vessels/varices: these are many and can include ⁴
- coronary venous collaterals: considered one of the commonest⁴
- oesophageal collaterals
- paraumbilical collaterals
- abdominal wall collaterals
- perisplenic collaterals
- retrogastric collaterals
- parapoesophageal collaterals
- omental collaterals
- retroperitoneal colleterals
- mesenteric colleterals
- spleno-renal collaterals
- gastro-renal collaterals
splenomegaly
ascites
cause of portal hypertension often identified, most commonly liver cirrhosis

Treatment and prognosis

dietary restriction
medication: propranolol, diuretics
interventional procedures
- transjugular intrahepatic portosystemic shunt (TIPS)
- surgical portosystemic shunt
- balloon dilatation of hepatic vein (in case of thrombosis/web in hepatic vein)
- transhepatic clot thrombolysis (in portal vein thrombosis)
- splenic artery ~~embolization~~ embolisation ³
- liver transplantation
treatment of complications

Complications

ascites
variceal bleeding (30-50% mortality with each bleed)
portal hypertensive gastropathy/enteropathy/colopathy
hepatic encephalopathy
hepatorenal syndrome
congestive splenomegaly and hypersplenism

~~-<a title="sinistral portal hypertension" href="/articles/sinistral-portal-hypertension">sinistral portal hypertension</a> 5~~
+<a href="/articles/sinistral-portal-hypertension">sinistral portal hypertension</a> 5
~~-<li>biphasic or reverse flow in portal vein (late stage): pathognomic</li>~~
~~-<li>recanalisation of paraumbilical vein: pathognomic</li>~~
+<li>biphasic or reverse flow in portal vein (late stage): pathognomonic</li>
+<li>recanalisation of paraumbilical vein: pathognomonic</li>
~~-<li>collateral vessels/varices : these are many and can include 4<ul>~~
+<li>collateral vessels/varices: these are many and can include 4<ul>
~~-<a title="coronary venous collateral" href="/articles/coronary-venous-collateral">coronary venous collaterals</a> : considered one of the commonest 4~~
+<a href="/articles/coronary-venous-collateral">coronary venous collaterals</a>: considered one of the commonest 4
~~-<li>splenic artery embolization 3~~
+<li>splenic artery embolisation 3

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