View source for Portal hypertension

{{Infobox_Disease |
  Name           = {{PAGENAME}} |
  Image          = Gray591.png |
  Caption        = The portal vein and its tributaries. |
  DiseasesDB     = 10388 |
  ICD10          = {{ICD10|K|76|6|k|70}} |
  ICD9           = {{ICD9|572.3}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = radio |
  eMedicineTopic = 570 |
  eMedicine_mult = {{eMedicine2|med|1889}} |
  MeshID         = D006975 |
}}
{{SI}}
{{CMG}},'''Assistant Editor-in-Chief:''' [[User:Soumya Sachdeva|Soumya Sachdeva]]
__NOTOC__
==Overview==
In [[medicine]], '''portal hypertension''' is [[hypertension]] (high blood pressure) in the portal stem which causes an obstruction in the [[portal vein]] and its branches. It is often defined as a portal pressure gradient (the difference in pressure between the portal vein and the [[hepatic vein]]s) of 12 mm Hg or greater. Many conditions can result in portal hypertension. In North America and Europe, it is usually the result of an intrahepatic block due to [[cirrhosis]] of the
[[liver]]. However, in less industrialized parts of the world, climate permitting, the major cause is [[schistosomiasis]].

==Pathophysiology==
Portal venous pressure is determined by-portal blood flow and portal vascular resistance.Increased portal vascular resistance is often the main factor responsible for it.
The consequences of portal hypertension are due to blood being forced down alternate channels by the increased resistance to flow through the portal system.
Due to formation of alternate channels initially some of the portal blood and later most of it is shunted directly to the systemic circularion bypassing the liver

==Natural History and Complications==
There is an increased risk of
* [[Spontaneous bacterial peritonitis]]
* [[Hepatorenal syndrome]]
* [[Hepatic encephalopathy]]
* [[Congestive gastropathy]]
* [[Hypersplenism]]
* [[Ascites]]
* [[Variceal bleeding]]
* [[Renal failure]]

==Causes== 
'''Prehepatic'''
*Congenital abnormalities
*Idiopathic tropical [[splenomegaly]]
*[[Portal vein occlusion]]
*[[Splenic Vein Thrombosis]]
*Umbilical sepsis
'''Intrahepatic'''
*[[Alcoholic hepatitis]]
*[[Boeck's Diesease]]
*[[Chronic hepatitis]]
*[[Cirrhosis]]
*[[Fatty liver]]
*[[Fulminant hepatic failure]]
*[[Hodgkin's Lymphoma]]
*[[Osteomyelosclerosis]]
*Partial nodular transformation
*[[Schistosomiasis]]
*[[Wilson's Disease]]
'''Posthepatic'''
*[[Cardiomyopathy]]
*[[Congestive Heart Failure]]
*[[Constructive Pericarditis]]
*[[Inferior vena cava obstruction]]
*[[Tricuspid insufficiency]]

==Diagnosis==
===Physical Examination===
====Abdomen====
* [[Ascites]] (free fluid in the [[peritoneal cavity]])
* [[Hepatic encephalopathy]]
* [[Splenomegaly]] (enlargement of the spleen) with consequent sequestration therein of [[red blood cells]], [[white blood cells]], and [[platelets]], together leading to mild [[pancytopenia]]
* [[Portacaval anastomosis|portacaval anastomoses]] ([[Esophageal varices]], [[hemorrhoid]]s, [[caput medusae]]), with [[esophageal varices]] posing an ongoing risk of life-threatening hemorrhage.<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:291</ref>

===Investigations===
# Barim swallow - presence of varices is seen as filling defects(bag of worms appearnace)
# Upper gastrointestinal endoscopy - presence of cherry red spots.Very reliable
# Ultrasonography - to note the size of liver,spleen,poratl vein,splenic vein and to look for the presence of 
  collaterals
# Hepatic venous pressure drainage measurement - Gold standard for measuring portal hypertension.If ore than 5 mmHg 
  it is considered as significant
# Portal venography - patency and the calibre of portal vein and splenic vein , presence of collaterals
# Liver function tests for liver diseases
# Proctoscopy - rectal varices
# Barium enema - colonic varices

==Treatment==
===Medical management===
Treatment with a non-selective [[beta blocker]] is often commenced once [[portal hypertension]] has been diagnosed, and almost always if there has already been bleeding from esophageal varices. Typically, this is done with either [[propranolol]] or [[nadolol]]. The addition of a [[nitrate]], such as [[isosorbide mononitrate]], to the [[beta blocker]] is more effective than using beta blockers alone and may be the preferred regimen in those people with portal [[hypertension]] who have already experienced variceal bleeding. In acute or severe complications of the [[hypertension]], such as bleeding varices, intravenous [[octreotide]] (a [[somatostatin]] analogue) or intravenous [[terlipressin]] (an [[antidiuretic hormone]] analogue) is commenced to decrease the portal pressure.

===Percutaneous interventions===
[[Transjugular intrahepatic portosystemic shunt]]ing is the creation of a connection between the portal and the venous system. As the pressure over the venous system is lower than over a hypertensive portal system, this would decrease the pressure over the portal system and a decreased risk of complications.

===Surgical interventions===
*[[Distal splenorenal shunt procedure|Distal splenorenal shunt]]
*[[Liver transplant]]

The most definitive treatment of portal hypertension is a [[liver transplant]].

== References ==
{{Reflist}}
==External links==
* {{Chorus|00863}}

{{Gastroenterology}}
[[de:Portale Hypertension]]
[[fr:Hypertension portale]]
[[pl:Nadciśnienie wrotne]]
[[ru:Портальная гипертензия]]
[[sv:Portahypertension]]

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