Portal hypertension

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Portal hypertension
Classification and external resources
The portal vein and its tributaries.
ICD-10 K76.6
ICD-9 572.3
DiseasesDB 10388
eMedicine radio/570 med/1889
MeSH D006975

In medicine, portal hypertension is hypertension (high blood pressure) in the portal vein system, which is composed of the portal vein, and its branches and tributaries.



Causes can be divided into prehepatic, intrahepatic, and posthepatic.

Signs and symptoms



HVPG (hepatic venous pressure gradient) measurement has been accepted as the gold standard for assessing the severity of portal hypertension,3 and replaced the old one - contrast angiography.4 Portal hypertension is defined as HVPG greater than or equal to 5mm Hg.5


Portosystemic Shunts


It should be noted that with the advent of TIPS, these are very rarely performed anymore. TIPS has the advantage of being much easier to perform and it doesn't disrupt any of the liver's vascular, which will be needed for a given patient's hoped for liver transplant. In general non-selective shunts are emergent surgeries that are done as quickly as possible to minimize intraoperative blood loss. On the contrary a splenorenal shunt would be an elective procedure due to its great technical demands. Further, contributing to their rare use today is the fact that few, if any, current general surgery residents are trained in how to carry out these surgeries.

Prophylaxis of variceal bleeding

Both pharmacological (non-specific ß-blockers like Propranolol and isosorbide mononitrate) and endoscopic (banding ligation) treatment have similar results. TIPS (transjugular intrahepatic portosystemic shunting) is superior to either of them at reducing rate of rebleeding. Disadvantages of TIPS include high cost and increased risk of hepatic encephalopathy, and it does not improve the mortality rate.

Management of active variceal bleeding


Management of ascites


Control of hepatic encephalopathy

A standard treatment plan may involve lactulose, bowel enemas, and use of oral antibiotics such as neomycin, metronidazole, vancomycin, and the quinolones. Previously, restriction of dietary protein was recommended but this is now refuted by a clinical trial which showed no benefit.6 Instead, the maintenance of adequate nutrition is now advocated.7


  1. ^ Perkins, [edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster ; artist, James A. Robbins basic pathology (9th ed. ed.). Philadelphia, PA: Elsevier/Saunders. p. 608. ISBN 978-1-4377-1781-5. 
  2. ^ "Portal Hypertension". Retrieved 2007-12-07. 
  3. ^ Damping Index of Doppler Hepatic Vein Waveform - Portal Hypertension: Discussion, http://www.medscape.com/viewarticle/564073_4
  5. ^ http://www.drfalkpharma.de/fileadmin/media/praesentationen/fs163/S4_P2.pdf
  7. ^ http://www.patient.co.uk/doctor/Hepatic-Encephalopathy.htm

External links