Portal hypertension
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224966746
2008-07-11T06:10:44Z
GreenReaper
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{{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 |
}}
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 5 mm Hg or greater. Many conditions can result in portal hypertension. In North America and Europe, it is usually the result of [[cirrhosis]] of the [[liver]].<ref> {{cite web|url=http://www.merck.com/mmhe/sec10/ch135/ch135d.html |title=Portal Hypertension: Manifestations of Liver Disease: Merck Manual Home Edition |accessdate=2007-11-08 |date=August 2006 |publisher=Merck }}</ref> However, in less industrialized parts of the world, climate permitting, the major cause is [[schistosomiasis]].
== 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]])<ref name="titlePortal Hypertension">{{cite web |url=http://www.clevelandclinic.org/health/health-info/docs/0200/0252.asp?index=4912 |title=Portal Hypertension |accessdate=2007-12-07 |format= |work=}}</ref>
* [[Hepatic encephalopathy]]
* Increased risk of [[spontaneous bacterial peritonitis]]
* Increased risk of [[hepatorenal syndrome]]
* [[Splenomegaly]] (enlargement of the spleen) with consequent [[sequestration]] therein of [[red blood cells]], [[white blood cells]], and [[platelets]], together leading to mild [[pancytopenia]]
* [[Portacaval anastomoses]] ([[esophageal varices]], [[hemorrhoid]]s, [[caput medusae]]), with [[esophageal varices]] posing an ongoing risk of life-threatening hemorrhage.
==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]]
*[[Liver transplant]]
The most definitive treatment of portal hypertension is a [[liver transplant]].
==References==
<div class='references-small'>
<references/>
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==External links==
* [http://videos.med.wisc.edu/videoInfo.php?videoid=249 VIDEO - Portal Hypertension: Shunt Surgery in the Era of Transplant and TIPS], Alysandra Lal, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)
* {{MerckHome|10|135|e}}
* {{Chorus|00863}}
* [http://www.clevelandclinic.org/health/health-info/docs/0200/0252.asp?index=4912 Overview] at [[Cleveland Clinic]]
* [http://www.childliverdisease.org Children's Liver Disease Foundation]
{{Gastroenterology}}
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Cardiovascular diseases]]
[[de:Portale Hypertension]]
[[es:Hipertensión portal]]
[[fr:Hypertension portale]]
[[pl:Nadciśnienie wrotne]]
[[pt:Hipertensão portal]]
[[ru:Портальная гипертензия]]
[[sv:Portahypertension]]