Portal hypertension

Question 1

What is portal hypertension?

Answer 1

Pathological elevation of portal venous pressure (>6mm Hg) due to obstructions in portal blood flow (due to pre-hepatic, hepatic or post-hepatic causes)

Question 2

What are the causes of portal hypertension?

Answer 2

(Pre-hepatic)Portal vein thrombosis, Splenic vein thrombosis, Hepatosplenic schistosomiasis
(Hepatic) Cirrhosis
(Post-hepatic) Budd-Chiari syndrome, Right-sided heart failure, Constrictive pericarditis

Question 3

What are the clinical features of portal hypertension?

Answer 3

(↑ Blood flow via portosystemic anastomoses) Paraumbilical veins and epigastric veins → caput medusae
Rectal veins → hemorrhoidal or anorectal varices
Oesophageal → (hematemesis) + gastric varices (melena)
Splenomegaly
GI bleeding upper / lower
Ascites

Question 4

How is portal hypertension diagnosed?

Answer 4

Clinical
US (i.e. increase bloodflow via duplex ultrasonography)
Abdominal CT

Question 5

What is the treatment for portal hypertension?

Answer 5

(Medical)
Betablocker (i.e., propranolol or nadolol) inhibits beta-2-adrenergic receptors causing constriction of portal and systemic veins
Transjugular intrahepatic portosystemic shunt (TIPS) draining blood from portal to systemic venous system
Total portosystemic shunts draining blood from portal to vena cava

Question 6

What are the complications of portal hypertension?

Answer 6

Oesophageal variceal bleed 
Portal hypertensive gastropathy (cirrhosis or portal vein thrombosis leading to GI ulcers or GI bleed) 
Ascites
Spontaneous bacterial peritonitis
Pulmonary complications due to cirrhosis