Portal Hyeprtension

Question 1

Define portal hypertension

Answer 1

Increased pressure in the hepatic portal system
Normal 5-8mmHg
Clinically significant >10-12mmHg

Question 2

What are the causes/risk factors of portal hypertension?

Answer 2

Pre-hepatic
• Portal vein thrombosis

Intrahepatic
• Cirrhosis
• Alcoholic hepatitis
• Schistosomiasis
• Veno-occlusive disease

Post-hepatic
• Budd-Chiari syndrome
• Right heart failure
• Constrictive pericarditis
• Inferior vena caval obstruction

Question 3

What are the symptoms of portal hypertension?

Answer 3

• Asymptomatic
• GI bleeding e.g. haematemesis, melaena
• Abdominal distension (ascites)

Question 4

What are the signs of portal hypertension?

Answer 4

• Splenomegaly
• Dilated abdominal veins
• Oesophageal varices
• Hepatic encephalopathy

Question 5

What investigations are carried out for portal hypertension?

Answer 5

• A Liver Screen to find the underlying cause –see cirrhosis.
• Liver USS to see the direction of flow of blood in the portal system.
• Measure hepatic venous pressure gradient (HVPG).
• OGD and Endoscopy to visualise varices.

Question 6

What is the management for portal hypertension?

Answer 6

• It is difficult to treat portal hypertension on its own.
• Treatment is focused on treating the underlying cause if possible.

Conservative:
• Salt restriction
• Fluid restriction

Medical:
• Non-selective beta blockers –reduces portal pressure and the risk of oesophageal bleeding.
• Terlipressin: Reduced portal venous pressure

Surgical:
• TIPS
• Liver transplant, if indicated

Question 7

What are the complications of portal hypertension?

Answer 7

• Bleeding from oesophageal/ rectal varices
• Ascites and complications of ascites: SBP
• Congestive splenomegaly causing anaemia, thrombocytopaenia and leukopaenia
• Hepatorenal syndrome: a life-threatening condition that consists of a rapid deterioration in kidney function in individuals with cirrhosis or fulminant liver failure
• Hepatic hydrothorax: a transudative pleural effusion in patients with portal hypertension without any underlying primary cardiopulmonary cause
• Hepatopulmonary syndrome - triad of: Hepatic dysfunction, Hypoxaemia, Extreme vasodilation (intrapulmonary vascular dilatation)
• Hepatic encephalopathy