Portal Hypertension is an increase in the pressure within the portal vein (the vein that carries blood from the digestive organs to the liver). The increase in pressure is caused by a blockage in the blood flow through the liver.

1. Portal Hypertension

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. Intra-
hepatic
Post- hepatic
Pre-
hepatic

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

11. Intra-hepatic
✢ Schistosomiasis
hepatic✢ Congenital
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. History
2. Physical Examination
3. Blood Count: CBC
4. Liver Function Tests:AST &ALT, PT- INR,APTT
4. Oesophagogastroduodenoscopy
5. Usg
6. Mri
7. LiverAngiography
8. Coeliac-mesentericArteriography
9. Splenic Portogram

24. Treatment :
✢ Endoscopic therapy : This is usually the first line of treatment for
variceal bleeding and consists of either banding or sclerotherapy.
 Banding: Banding is a procedure in which a gastroenterologist
uses rubber bands to block off the blood vessel to stop bleeding.
 Sclerotherapy: Sclerotherapy is occasionally used when
banding cannot be used and is a procedure in which a blood-
clotting solution is injected into the bleeding varices to stop
bleeding.

28. ✢ Medical Management
✢ Beta blockers: eg. Nadolol or Propranol may be prescribed alone or in
combination with endoscopic therapy to reduce the pressure in varices and further
reduce the risk of bleeding.
✢ Lactulose: can help treat confusion and other mental changes associated with
encephalopathy. eg. Syp. Dulcolax

29. ✢ Life style changes:
Maintaining good nutritional habits and keeping a healthy lifestyle may help you
avoid portal hypertension. Some of the things you can do to improve the function
of your liver include the following:
Do not use alcohol or street drugs.
Do not take any over-the-counter or prescription drugs or herbal medicines without
first consulting your doctor or nurse.
Follow the dietary guidelines given by your health care provider, including eating
a low-sodium (salt) diet. You will probably be required to consume no more than 2
grams of sodium per day. Reduced protein intake may be required if confusion is a
symptom.

30. Other Treatment Options for Portal Hypertension
If endoscopic therapy, drug therapy, and/or dietary changes don't
successfully control variceal bleeding, you may require one of the following
procedures to reduce the pressure in these veins. Decompression procedures
include:
Transjugular intrahepatic portosystemic shunt (TIPS): This procedure
involves placing a stent (a tubular device) in the middle of the liver. The
stent connects the hepatic vein with the portal vein, which reroutes blood
flow in the liver and helps relieve pressure in abnormal veins.
Distal splenorenal shunt (DSRS): This procedure connects the vein from
your spleen to the vein from the left kidney in order to reduce pressure in
the varices and control bleeding.
Devascularization: A surgical procedure that removes the bleeding varices;
this procedure is done when a TIPS or a surgical shunt is not possible or is
unsuccessful in controlling the bleeding.

31. Paracentesis. This is a procedure in which the accumulation
of fluid in the abdomen (ascites) is directly removed. The
results are usually temporary and the procedure will need to
be repeated as needed.
Liver Transplant: A liver transplant is a surgical procedure
that removes a liver that no longer functions properly (liver
failure) and replaces it with a healthy liver from a deceased
donor or a portion of a healthy liver from a living donor.

32. Transjugular Intrahepatic Portosystemic
Shunt (TIPS)

33. Distal Splenorenal Shunt
(DSRS)

34. Devascularization

35. Paracentesis

36. Liver transplant

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