Portal hypertension

In medicine, portal hypertension is hypertension (high blood pressure) 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 veins) of 12 mm Hg or greater. Many conditions can result in portal hypertension, but it is usually the result of cirrhosis of the liver.

Signs and symptoms

Consequences of portal hypertension are caused by blood being forced down alternate channels by the increased resistance to flow through the portal system. They include:

Ascites (free fluid in the peritoneal cavity)
Esophageal varices (dilated veins in the wall of the esophagus that are prone to bleed)
Rectal varices
Hepatic encephalopathy
Palmar erythema
Clubbing
Distended abdominal wall veins (caput medusae)
Increased risk of spontaneous bacterial peritonitis
Increased risk of hepatorenal syndrome

Treatment

Medical management

Treatment with a non-selective beta blocker is generally commenced once portal hypertension has been diagnosed, typically with propranolol. In acute or severe complications of the hypertension, such as bleeding varices, intravenous terlipressin (an antidiuretic hormone analogue) is commenced to decrease the portal pressure.

Percutaneous interventions

Transjugular intrahepatic portosystemic shunting 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

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

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