Portal Hypertension

Portal Hypertension

Signs and symptoms

* Jaundice

* History of blood transfusion

* Intravenous drug abuse

* History of alcohol consumption

* Pruritus

* Hematemesis

* Melena

* Lethargy

* Increased irritability

* Altered sleep patterns

* Increased abdominal girth due to ascites

* Hematochezia

* Abdominal pain

* Fever

Signs of port systemic collateral formation

* Dilated veins in the anterior abdominal wall

* Venous pattern on the flanks

* Caput medusa

* Rectal hemorrhoids

* Ascites

* Paraumblical hernia

Signs of liver disease

* Ascites

* Jaundice

* Spider nevi

* Gynecomastia

* Dupuytren’s contracture

* Muscle wasting

* Palmar erythema

* Asterixis

* Testicular atrophy

* Splenomegaly



* Portal vein thrombosis

* Splenic vein thrombosis

* Extrinsic compression by tumor

* Arteriovenous fistula

Intrahepatic presinusoidal and/ or postsinusoidal

* Hepatic cirrhosis

* Acute alcoholic hepatitis

* Primary biliary cirrhosis

* Congenital hepatic fibrosis

* Vitamin A toxicity

* Budd chiari syndrome

* Pelisosis hepatitis

Intrahepatic, predominantly presinusoidal

* Shistosomiasis

* Primary biliary cirrhosis

* Nodular regenerative hyperplasia

* Polycystic disease

* Hepatic metastasis

* Granulomatous disease (sarcoidosis and tuberculosis)


Emergency treatment

* Each episode of variceal bleeding is associated with 30% mortality fever.

* Initial resuscitation with replacement of blood volume loss by packed or whole red blood cells or plasma expanders.

* Avoid intravascular volume and variceal overexpansion to prevent re bleeding.

* Prophylactic antibiotic use to decrease the rate of bacterial infections.


* Somatostatin- is an endogenous hormone that decreases the portal blood flow by vasoconstriction.

* Octreotide- it’s an analogue of somatostatin, also effective in reducing the complications of variceal bleeding after emergency sclerotherapy or variceal ligation

* Vasopressin- Most potent vasoconstrictor has more side effects.

* Terlipressin- has fewer adverse effects than vasopressin.

Endoscopic therapy

* Endoscopic therapy has the advantage of allowing specific therapy at the time of diagnosis.

* >80% of hemostasis can be achieved.

* Endoscopic injection sclerotherapy involves injecting sclerosant solution like sodium morrhuate, sodium tetradecyl sulfate, and ethanolamine oleate into the bleeding veins.

Endoscopic variceal ligation

Other interventions

* Balloon tube tamponade

* Minnesota tube

Primary prophylaxis

* Beta blockers- Propranolol and Nadolol

* Vasodilators- Isosorbide mononitrate

* Combination therapy- Propranolol and Isosorbide mononitrate

* Prophylactic sclerotherapy

* Prophylactic endoscopic variceal ligation

Surgical care

Decompressive shunts

* Total portal systemic shunts

* Partial portal systemic shunts

* Selective shunts

Devascularization procedures

* Splenectomy

* Liver transplantation