, portal 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
. However, in less industrialized parts of the world, climate permitting, the major cause is schistosomiasis
. One of the best known cases in recent years is Katie MacLennan
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:
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
. 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
analogue) or intravenous terlipressin
(an antidiuretic hormone
analogue) is commenced to decrease the portal pressure.
Transjugular intrahepatic portosystemic shunting
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.
The most definitive treatment of portal hypertension is a liver transplant.