Portal hypertension

Portal hypertension is defined as hepatic venous pressure gradient (HVPG) greater than 5 mmHg. HVPG is a surrogate for the portosystemic pressure gradient. Clinically significant portal hypertension is defined as a gradient greater than 10 mmHg and variceal bleeding may occur at a gradient greater than 12 mmHg. 

Causes can be split by their relation to the hepatic sinusoids 7:

  • dilated portal vein +/- mesenteric veins
  • contrast enhancement of paraumbilical vein: pathognomonic
  • collateral vessels/varices: these are many and can include 4
  • splenomegaly
  • ascites
  • cause of portal hypertension often identified, most commonly liver cirrhosis

Management ultimately depends on the underlying etiology and the associated complications. Generally, management options include:

  • lifestyle modifications: dietary sodium restriction (e.g. for ascites)
  • medications: propranolol (e.g. for varices), diuretics (e.g. for ascites)
  • interventional procedures
    • creation of shunts: transjugular intrahepatic portosystemic shunt (TIPS), surgical portosystemic shunt, surgical splenorenal shunt 
    • balloon dilatation of hepatic vein (e.g. for thrombosis/web in hepatic vein)
    • transhepatic clot thrombolysis (e.g. for portal vein thrombosis)
    • splenic artery embolization 3
    • liver transplantation

Dilatation of splenic veins at the splenic hilum without splenomegaly may occur in situations such as state of increased perfusion of splenic tissue associated with an immune response 6.

Hepatobiliary pathology

Article information

rID: 1911
Synonyms or Alternate Spellings:
  • Raised portal venous pressures
  • Raised portal venous pressure
  • Raised portal vein pressures
  • Raised portal vein pressure
  • Elevated portal vein pressures
  • Elevated portal venous pressures
  • Elevated portal venous pressure
  • Elevated portal vein pressure
  • Increased portal vein pressure
  • PV hypertension
  • Portal venous hypertension
  • Portal vein hypertension
  • Increased portal venous pressure
  • Increased portal venous pressures

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Cases and figures

  • Case 1: recanalized paraumbilical vein
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  • DIOS
    Case 2: CF
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  • Case 3: varices
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  • Case 3: dilated portal vein
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  • Case 4: recanalized paraumbilical vein
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  • Case 5
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  • Case 6
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