Portal hypertension occurs when blood pressure increases in the portal venous system, which normally carries blood from the gastrointestinal tract to the liver. It is defined as a hepatic venous pressure gradient over 10mm Hg. There are three types - pre-hepatic, intra-hepatic, and post-hepatic - depending on the site of vascular obstruction. Common causes include cirrhosis, schistosomiasis, and portal vein thrombosis. Clinical manifestations involve complications from increased portosystemic shunting and include ascites, esophageal varices, hemorrhoids, and hepatic encephalopathy. Diagnostic evaluations involve blood tests, imaging, and endoscopy. Treatment options include medications, endoscopic therapy, TIPS procedure,

1. Portal Hypertension
By,
Ms. Ekta S Patel
Assistant Professor.

2. Portal venous
pressure is the blood
pressure in the
hepatic portal vein,
and is normally
between 5-10 mmHg.

3. Portal
circulation

4. Portal circulation
collateralization

5. Meaning
✢ Portal hypertension is an increase in
the blood pressure within a system
of veins called the portal venous
system.

6. Definition
✢ It is defined as the elevation of
the hepatic venous pressure
gradient to > 10mm Hg

7. Types:

8. Causes:
✢ Depending on the site of
vascular obstruction;

9. Post- hepatic
Intra-
hepatic
Pre-
hepatic

10. Pre- hepatic
✢ Portal vein Thrombosis
✢ Pancreatitis
✢ Trauma
✢ Hypercoaguable states

11. Intra-hepatic
✢ Schistosomiasis
✢ Congenital hepatic
fibrosis
✢ Sarcoidosis
✢ Myeloproliferative
diseases
✢ Drugs
✢ Toxins
 Cirrhosis
 Fatty liver
 Metastatic
malignant
disease

12. Postheaptic:
•Hepatic vein thrombosis
(budd -chiari syndrome)
•Constrictive pericarditis
•Rt sided heart failure

13. Clinical manifestation:
✢ Ascites
✢ Hypersplenism

14. ✢ Increased portosysystemic shunting :
 Oesophageal varices
 Haemorrhoids
 Caput medusae

16. Caput medusae: is the appearance of distended and engorged
superficial epigastric veins, which are seen radiating from the
umbilicus across the abdomen.

17. ✢ Hepatic encephalopathy
✢ hepatorenal failure
✢ Gastrointestinal bleeding
✢ Reduced levels of platelets,
blood cells that help form blood
clots, or white blood cells

18. ✢ Abdominal pain
✢ Black, tarry color stool
✢ Melena
✢ Hematemesis
✢ Jaundice
✢ Pruritus
✢ Gynecomastia

20. ✢ Fatigue
✢ Increased irritability
✢ Altered sleep pattern
✢ Weight loss
✢ Spider angiomata

22. Diagnostic evaluation:
1. Blood Count
2. Liver Function Tests
3. Oesophagogastroduodenoscopy
4. Usg
5. Mri
6. Liver Angiography
7. Coeliac-mesenteric Arteriography
8. Splenic Portogram

24. Treatment :
✢ Endoscopic therapy :
Banding
Sclerotherapy

28. ✢ Medications:
✢ Beta blockers
✢ Lactulose: to treat mental
confusion.

29. ✢ Life style changes:

30. Transjugular Intrahepatic
Portosystemic Shunt (TIPS)

31. Distal Splenorenal Shunt

32. Devascularization

33. Paracentesis

34. Liver transplant