Portal Hypertension

General Principles

  • Portal hypertension is the main complication of cirrhosis and is characterized by increased resistance to portal flow and increased portal venous inflow. Portal hypertension is established by measuring the pressure gradient between the hepatic vein and the portal vein (normal portosystemic pressure gradient is approximately <5 mm Hg).
  • Direct and indirect clinical consequences of portal hypertension appear when the portosystemic pressure gradient exceeds 10 mm Hg.
  • Causes of portal hypertension in patients without cirrhosis include idiopathic portal hypertension, schistosomiasis, congenital hepatic fibrosis, sarcoidosis, cystic fibrosis, arteriovenous fistulas, splenic and PVT, HVT (Budd–Chiari syndrome), myeloproliferative diseases, nodular regenerative hyperplasia, and focal nodular hyperplasia.

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