Portal Hypertension Research Paper

Portal Hypertension
Abdominal Ultrasound

Portal hypertension is a pathologic condition characterized by an excessive increase in the pressure within the portal vein or one of its branches. Typical portal vein pressure is 5 to 10 millimeters of mercury (abbreviated mmHg). When the pressure exceeds 5 mmHg above inferior vena cava pressure, it is characterized as portal hypertension. The portal vein carries nutrient rich blood from the digestive system to the liver. Normally, the veins come from the stomach, intestine, spleen, and pancreas. They merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked, it is hard for the blood to flow causing high pressure in
Presinusoidal venous hypertension often occurs in a patient with normal liver function when the portal vein and its branches are compressed before they enter the liver. Presinusoidal portal hypertension can be further divided into extrahepatic and intrahepatic forms. Extrahepatic presinusoidal portal hypertension can be caused by either thrombosis (formation of blood clots) of the portal veins or of the splenic veins. The causes of portal vein thrombosis in adults include trauma, sepsis (blood or tissue infection), hepatocellular carcinoma (cancer of the liver cells), pancreatic carcinoma (cancer of the pancreas), pancreatitis (inflammation of the pancreas), portacaval shunts (shunt between the portal vein and inferior vena cava), splenectomy (removal of the spleen), and hypercoagulable states (excessive blood clotting). This form of portal hypertension should be suspected in any patient that has a normal liver biopsy and any of the clinical signs of portal hypertension (ascites, splenomegaly, and varices). The intrahepatic presinusoidal portal hypertension is caused by primary biliary cirrhosis, congenital hepatic fibrosis, toxic substances, and schistosomiasis, all of which are diseases (or results of diseases), affecting the portal zones of the
It is broken down into presinusoidal and interhepatic portal hypertension. Presinusoidal portal hypertension can also be further divided into extrahepatic and intrahepatic forms. The most common cause of all types of portal hypertension is cirrhosis but there are many other causes including thrombosis, venous blockages, parasitic infection, metastatic liver disease, congenital hepatic fibrosis, and toxic substances. Some of the symptoms of portal hypertension include gastrointestinal bleeding, ascites, encephalopathy, and varices. Portosystemic venous collaterals, splenomegaly, enlargement of the portal vein, decreased portal vein velocity, increased congestion index, and reversal of portal vein flow are a few of the sonographic findings associated with portal hypertension. The effects of portal hypertension can be controlled through diet, medications, endoscopic therapy, surgery, or radiology. Because portal hypertension cannot be treated, treatment focuses on preventing or managing the complications, especially the bleeding from the varices. These treatments include endoscopic therapy, TIPS, DSRS, liver transplant, and devascularization. Using all of these clues, it is possible to diagnose portal hypertension with a high degree of sensitivity and specificity in most