Chinese Medical Information Portal Website (Taiwan Medical Network-TMN) - OldDoc Wu's Series
(Established in March 1996)
(Posted Sep. 16, 1996; Updated May 14, 2009)
Portal hypertension
Any increase in the portal vein pressure (12 mm Hg or greater) due to anatomic or functional obstruction to blood flow in the portal venous system. Many conditions are associated with portal hypertension, of which cirrhosis is the most common cause. Indicators of portal hypertension are: esophageal varices, enlarged veins on the anterior abdominal wall (caput Medusae), and ascites.
Classification (1)
- PRESINUSOIDAL
- extrahepatic:
- portal vein obstruction (extrinsic compression, phlebitis, OC, coagulopathy, tumor invasion, pancreatitis, neonatal omphalitis)
- dynamic: traumatic/neoplastic arterioportal fistula
- segmental portal HTN: splenic/SMV occlusion
- intrahepatic (obstruction of portal venules):
- congenital hepatic fibrosis
- primary biliary cirrhosis
- Wilson's disease
- schistosomiasis
- sarcoid
- myelofibrosis
- idiopathic noncirrhotic fibrosis
- reticuloendotheliosis
- Felty syndrome
- chronic malaria
- toxic fibrosis (arsenic, copper, PVC vapors)
- SINUSOIDAL
- cirrhosis
- sclerosing cholangitis
- POSTSINUSOIDAL
- Budd-Chiari syndrome
- constrictive pericarditis
- congestive heart failure
Classification (2)
- Prehepatic
- Portal vein thrombosis
- Splenic vein thrombosis
- Congenital atresia or stenosis of portal vein
- Extrinsic compression (tumors)
- Splanchnic arteriovenous fistula
- Intrahepatic
- predominantly presinusoidal
- Schistosomiasis (early stage)
- Primary biliary cirrhosis (early stage)
- Idiopathic portal hypertension (early stage)
- Polycystic disease
- Hepatic metastasis
- Nodular regenerative hyperplasia
- Myeloproliferative diseases
- Granulomatous diseases (sarcoidosis, tuberculosis)
- predominantly sinusoidal and/or postsinusoidal
- Hepatic cirrhosis
- Acute alcoholic hepatitis
- Primary biliary cirrhosis (advanced stage)
- Schistosomiasis (advanced stage)
- Venoocclusive disease
- Budd-Chiari syndrome
- Idiopathic portal hypertension (advanced stage)
- Acute and fulminant hepatitis
- Congenital hepatic fibrosis
- Vitamin A toxicity -- noncirrhotic portal fibrosis.
- Peliosis hepatitis
- Posthepatic
- Inferior vena cava (IVC) obstruction
- Right heart failure
- Budd-Chiari syndrome
- Arterial-portal venous fistula
- Increased portal blood flow
- Increased splenic flow
- Tricuspid regurgitation
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(By Jau-Shin Wu, M.D.; Posted Sep. 16, 1996; Revised May 12, 2009)
(TMN) Since June 09, 2002
(Dr. Wu's Liver D) Since Jan. 01, 2008
(Olddoc)Since Jan. 01, 2008
(TMN) Since Jan. 01, 2008