Portal hypertension

Last revised by Dr Jeremy Jones on 20 Sep 2021

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

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.

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Cases and figures

  • Case 1: recanalized paraumbilical vein
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  • 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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