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Portal Hypertension

Introduction

- Prolonged elevation of the portal venous pressure (2 – 5 mmHg).
- Clinical complications develop @ > 12 mmHg.

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Differential diagnosis

Presinusoidal

Extrahepatic
- portal vein thrombosis: cancer
- splenic vein thrombosis: pancreatitis, haematological, portal sepsis

Intrahepatic
- schistosomiasis
- sarcoidosis
- myeloproliferative disease

Sinusoidal (hepatic)
- cirrhosis *
- congenital hepatic fibrosis

Post-sinusiodal
- intrahepatic: veno-occlusive disease **
- extrahepatic: Budd-Chiari syndrome

* partially post-sinusoidal obliteration
** non-thrombotic obliteration of hepatic venules

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Clinical Features of Portal Hypertension

Consequences - 'VASE'
V: varices (oesophageal, gastric, anorectal, caput medusae - if patent umbilical vein)
A: ascites
S: splenomegaly (hypersplenism - decreased Hb &WCC & platelets)

E : portal hypertensive enteropathy (mucosal congestion & bleeding - stomach, small bowel, colon)

Budd-Chiari syndrome
Caused by thrombosis of the hepatic vein or IVC.

Clinical features
- portal hypertension
- ascites: rapid, painful
- hepatomegaly: with jaundice

Causes
- trauma
- infiltration: cancer
- hypercoagulable state: OCP, PRV, dehydration

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