CV

Portal Hypertension

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Portal Hypertension, Hepatic Vein Pressure Gradient, HPVG

  • See Also
  1. Cirrhosis
  2. Esophageal Varices
  1. Liver disease (Cirrhosis) results in scarring
  2. Scarring narrows and compresses hepatic sinusoids
    1. Results in resistance to flow
    2. Increases portal pressure
  3. Portal pressure increases over critical threshold
    1. Portal-systemic venous pressure gradient >12 mmHg
  4. Vessels form at portal-systemic junctures
    1. Distal Esophagus
    2. Stomach
  5. Existing vessels dilate
    1. Secondary dilation of left gastric vein
    2. Esophageal Varices develop
  1. Extrahepatic Causes (Portal VeinOcclusion)
    1. Umbilical vein infection
    2. Trauma
    3. Chronic Pancreatitis
    4. Polycythemia Vera
    5. Pro-thrombotic conditions
  2. Hepatic Causes
    1. Liver malignancy involving sinusoids
    2. Amyloidosis involving liver
    3. Fatty Liver
  • Associated Conditions
  1. Hypersplenism
  2. Esophageal Varices
  • Diagnosis
  1. Hepatic Vein Pressure Gradient (HPVG)
    1. Measured with hepatic vein catheterization
    2. Free hepatic vein pressure - hepatic vein wedge
    3. HPVG >5 mmHg is Portal Hypertension
    4. HPVG >10 mmHg is significant Portal Hypertension
  2. Upper endoscopy
    1. Esophageal size predicts HPVG
  • Management
  1. Goal is to lower risk of Bleeding Esophageal Varices
  2. See Esophageal Varices for Management
  • References
  1. Trevillyan (1997) Am Fam Physician 55(5):1851-1862 [PubMed]