Portal Hypertension

High blood pressure in the hepatic portal system

Aetiology

  • Caused by increased portal venous flow or increased resistance

Prehepatic

  • Blockage of the portal vein before the liver due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities

Intrahepatic

  • Due to distortion of the liver architecture
    • Presinusoidal e.g. schistosomiasis
    • Post sinusoidal e.g. cirrhosis - most common cause

Post hepatic

  • Budd Chiari

Clinical presentation

  • Caput medusa
    • Round ligament rechannels → blood from portal system enters abdominal veins
  • Splenomegaly (→ thrombocytopenia)
  • S+S of cirrhosis

Investigations

  • Look for underlying cause

Management

  • Manage underlying cause

Complications

  • Ascites
  • Oesophageal and anorectal varices