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{{Portal hypertension}}
{{Portal hypertension}}
{{CMG}}; {{AE}}
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==Overview==
==Overview==
Based on the [[etiology]], portal hypertension may be classified as pre-[[hepatic]], intra-[[hepatic]], and post-[[hepatic]]. Intra-[[hepatic]] portal hypertension classified into pre-[[sinusoidal]], [[sinusoidal]], and post-[[sinusoidal]] disorders. Based on the function impairment in the [[liver]], portal hypertension may be classified as [[Cirrhosis|cirrhotic]] and non-[[Cirrhosis|cirrhotic]].
Based on the [[etiology]], portal hypertension may be classified as pre-[[hepatic]], intra-[[hepatic]], and post-[[hepatic]]. Intra-[[hepatic]] portal hypertension classified into pre-[[sinusoidal]], [[sinusoidal]], and post-[[sinusoidal]] disorders. Based on the functional impairment in the [[liver]], portal hypertension may be classified as [[Cirrhosis|cirrhotic]] and non-[[Cirrhosis|cirrhotic]].


==Classification==
==Classification==
* Based on the [[etiology]], portal hypertension may be classified as pre-[[hepatic]], intra-[[hepatic]], and post-[[hepatic]].  
* Based on the [[etiology]], portal hypertension may be classified as pre-[[hepatic]], intra-[[hepatic]], and post-[[hepatic]].  
* Intra-[[hepatic]] portal hypertension classified into pre-[[sinusoidal]], [[sinusoidal]], and post-[[sinusoidal]] disorders.
* Intra-[[hepatic]] portal hypertension classified into pre-[[sinusoidal]], [[sinusoidal]], and post-[[sinusoidal]] disorders.
* Based on the function impairment in the [[liver]], portal hypertension may be classified as [[Cirrhosis|cirrhotic]] and non-[[Cirrhosis|cirrhotic]].
* Based on the functional impairment in the [[liver]], portal hypertension may be classified as [[Cirrhosis|cirrhotic]] and non-[[Cirrhosis|cirrhotic]].<ref name="GrammatikopoulosMcKiernan2017">{{cite journal|last1=Grammatikopoulos|first1=Tassos|last2=McKiernan|first2=Patrick James|last3=Dhawan|first3=Anil|title=Portal hypertension and its management in children|journal=Archives of Disease in Childhood|year=2017|pages=archdischild-2015-310022|issn=0003-9888|doi=10.1136/archdischild-2015-310022}}</ref>
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{{family tree| | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | |A01='''Portal Hypertension''' classification}}
{{family tree| | | | | | |,|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|-|.| | | | | | | | | |}}
{{family tree| | | | | | B01 | | | | | | | | | | | | | | | | | | | B02 | | | | | | | | |B01='''''Functional'''''|B02='''''Etiology'''''}}
{{family tree| | | |,|-|-|^|-|-|.| | | | | |,|-|-|-|-|v|-|-|-|-|-|-|+|-|-|-|-|-|-|.| | |}}
{{family tree| | | C01 | | | | C02 | | | | C06 | | | C03 | | | | | C04 | | | | | C05 | |C01=[[Cirrhosis|Cirrhotic]]|C02=Non-[[Cirrhosis|cirrhotic]]|C03=Pre-[[hepatic]] portal hypertension|C04=Intra-[[hepatic]] portal hypertension|C05=Post-[[hepatic]] portal hypertension|C06=Without any underlying cause}}
{{family tree| | | | | | | | | | | | | | | |!| | | | | | | |,|-|-|-|+|-|-|-|.| | | | | |}}
{{family tree| | | | | | | | | | | | | | | D04 | | | | | | D01 | | D02 | | D03 | | | | |D01=Pre-[[sinusoidal]] disorders|D02=[[Sinusoidal]]<br>disorders|D03=Post-[[sinusoidal]] disorders|D04=Idiopathic portal hypertension}}
{{family tree/end}}
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{|
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Group
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Wedged hepatic venous pressure (WHVP)
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Free hepatic vein pressure (FHVP)
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hepatic vein pressure gradient (HVPG)
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Cause
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |Pre-[[hepatic]] portal hypertension
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" + |
* Increase in [[portal veins]] resistance
* [[Inflammatory]] [[portal vein]] closure due to [[thrombosis]]<ref name="pmid1475714">{{cite journal |vauthors=Králík J, Neoral C |title=[Rational therapy of prehepatic portal hypertension] |language=Czech |journal=Rozhl Chir |volume=71 |issue=10 |pages=513–22 |year=1992 |pmid=1475714 |doi= |url=}}</ref>
|-
| rowspan="3" style="background:#DCDCDC;" align="center" + |Intra-[[hepatic]] portal hypertension<ref name="pmid25092088">{{cite journal |vauthors=Bertocchini A, Falappa P, Grimaldi C, Bolla G, Monti L, de Ville de Goyet J |title=Intrahepatic portal venous systems in children with noncirrhotic prehepatic portal hypertension: anatomy and clinical relevance |journal=J. Pediatr. Surg. |volume=49 |issue=8 |pages=1268–75 |year=2014 |pmid=25092088 |doi=10.1016/j.jpedsurg.2013.10.029 |url=}}</ref>
| style="background:#DCDCDC;" align="center" + |Pre-sinusoidal disorders
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" + |
* [[Portal vein thrombosis]]
* [[Schistosomiasis]]
* [[Primary biliary cirrhosis]]
|-
| style="background:#DCDCDC;" align="center" + |Sinusoidal disorders
| style="background:#F5F5F5;" align="center" + |Elevated
| style="background:#F5F5F5;" align="center" + |Elevated
| style="background:#F5F5F5;" align="center" + |Elevated
| style="background:#F5F5F5;" + |
* [[Cirrhosis]]
|-
| style="background:#DCDCDC;" align="center" + |Post-sinusoidal disorders
| style="background:#F5F5F5;" align="center" + |Elevated
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |Elevated
| style="background:#F5F5F5;" + |
* [[Right heart failure]]
* [[Inferior vena cava obstruction|Inferior vena cava (IVC) obstruction]]
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |Post-[[hepatic]] portal hypertension<ref name="pmid18955865">{{cite journal |vauthors=Abd El-Hamid N, Taylor RM, Marinello D, Mufti GJ, Patel R, Mieli-Vergani G, Davenport M, Dhawan A |title=Aetiology and management of extrahepatic portal vein obstruction in children: King's College Hospital experience |journal=J. Pediatr. Gastroenterol. Nutr. |volume=47 |issue=5 |pages=630–4 |year=2008 |pmid=18955865 |doi=10.1097/MPG.0b013e31817b6eea |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Elevated
| style="background:#F5F5F5;" align="center" + |Elevated
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" + |
* Increased post-[[hepatic]] vessels resistance
|}


=== Pre-hepatic portal hypertension ===
=== Idiopathic portal hypertension (IPH)===
* Pre-[[hepatic]] portal hypertension is due to increase in [[portal veins]] resistance.
*[[Idiopathic]] portal hypertension (IPH) is due to [[obstruction]] and [[stenosis]] of intra-[[hepatic]] [[Portal system|portal vasculature]].<ref name="NakanumaTsuneyama2001">{{cite journal|last1=Nakanuma|first1=Yasuni|last2=Tsuneyama|first2=Koichi|last3=Makoto|first3=Ohbu|last4=Katayanagi|first4=Kazuyoshi|title=Pathology and Pathogenesis of Idiopathic Portal Hypertension with an Emphasis on the Liver|journal=Pathology - Research and Practice|volume=197|issue=2|year=2001|pages=65–76|issn=03440338|doi=10.1078/0344-0338-5710012}}</ref>
* [[Inflammatory]] [[portal vein]] closure due to [[thrombosis]] is another reason for pre-[[hepatic]] portal hypertension.<ref name="pmid1475714">{{cite journal |vauthors=Králík J, Neoral C |title=[Rational therapy of prehepatic portal hypertension] |language=Czech |journal=Rozhl Chir |volume=71 |issue=10 |pages=513–22 |year=1992 |pmid=1475714 |doi= |url=}}</ref>
*Idiopathic portal hypertension (IPH) has 4 stages:<ref name="NakanumaTsuneyama2001" />
* In pre-[[hepatic]] portal hypertension wedged hepatic venous pressure (WHVP), free hepatic vein pressure (FHVP), and hepatic vein pressure gradient (HVPG) are normal.
*#Stage I: Non-[[atrophic]] [[liver]] without subcapsular [[parenchymal]] atrophy.
 
*#Stage II: Non-[[atrophic]] liver with subcapsular [[parenchymal]] atrophy.
=== Intra-hepatic portal hypertension ===
*#Stage III: [[Atrophic]] liver with subcapsular [[parenchymal]] atrophy.
* Intra-[[hepatic]] portal hypertension is due to increase in intra-[[hepatic]] [[vascular resistance]].
*#Stage IV: [[Portal vein thrombosis|Portal venous occlusive thrombosis]].
 
* Intra-[[hepatic]] portal hypertension is classified into pre-[[sinusoidal]], [[sinusoidal]], and post-[[sinusoidal]] based on the lesion site.
 
==== Pre-sinusoidal disorders ====
* Elevated [[Portal venous system|portal venous]] pressure.
* Normal wedged hepatic venous pressure (WHVP) free hepatic vein pressure (FHVP), and hepatic vein pressure gradient (HVPG).
* Common underlying conditions are [[portal vein thrombosis]], [[schistosomiasis]], and [[primary biliary cirrhosis]].
 
==== Sinusoidal disorders ====
* Elevated wedged hepatic venous pressure (WHVP), free hepatic vein pressure (FHVP), and hepatic vein pressure gradient (HVPG).
* The most common underlying condition is [[cirrhosis]].
 
==== Post-sinusoidal disorders ====
* Normal free hepatic vein pressure (FHVP).
* Elevated wedged hepatic venous pressure (WHVP) and hepatic vein pressure gradient (HVPG).
* Common underlying conditions are [[right heart failure]] and [[Inferior vena cava obstruction|inferior vena cava (IVC) obstruction]].
 
=== Post-hepatic portal hypertension ===
* Post-[[hepatic]] portal hypertension is due to increased post-[[hepatic]] vessels resistance.
 
* Elevated wedged hepatic venous pressure (WHVP) and free hepatic vein pressure (FHVP).
* Normal hepatic vein pressure gradient (HVPG).


==References==
==References==
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Latest revision as of 16:22, 7 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Based on the etiology, portal hypertension may be classified as pre-hepatic, intra-hepatic, and post-hepatic. Intra-hepatic portal hypertension classified into pre-sinusoidal, sinusoidal, and post-sinusoidal disorders. Based on the functional impairment in the liver, portal hypertension may be classified as cirrhotic and non-cirrhotic.

Classification



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Portal Hypertension classification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Functional
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Etiology
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cirrhotic
 
 
 
Non-cirrhotic
 
 
 
Without any underlying cause
 
 
Pre-hepatic portal hypertension
 
 
 
 
Intra-hepatic portal hypertension
 
 
 
 
Post-hepatic portal hypertension
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Idiopathic portal hypertension
 
 
 
 
 
Pre-sinusoidal disorders
 
Sinusoidal
disorders
 
Post-sinusoidal disorders
 
 
 
 



Group Wedged hepatic venous pressure (WHVP) Free hepatic vein pressure (FHVP) Hepatic vein pressure gradient (HVPG) Cause
Pre-hepatic portal hypertension Normal Normal Normal
Intra-hepatic portal hypertension[3] Pre-sinusoidal disorders Normal Normal Normal
Sinusoidal disorders Elevated Elevated Elevated
Post-sinusoidal disorders Elevated Normal Elevated
Post-hepatic portal hypertension[4] Elevated Elevated Normal
  • Increased post-hepatic vessels resistance

 Idiopathic portal hypertension (IPH)

References

  1. ↑ Grammatikopoulos, Tassos; McKiernan, Patrick James; Dhawan, Anil (2017). "Portal hypertension and its management in children". Archives of Disease in Childhood: archdischild-2015–310022. doi:10.1136/archdischild-2015-310022. ISSN 0003-9888.
  2. ↑ Králík J, Neoral C (1992). "[Rational therapy of prehepatic portal hypertension]". Rozhl Chir (in Czech). 71 (10): 513–22. PMID 1475714.
  3. ↑ Bertocchini A, Falappa P, Grimaldi C, Bolla G, Monti L, de Ville de Goyet J (2014). "Intrahepatic portal venous systems in children with noncirrhotic prehepatic portal hypertension: anatomy and clinical relevance". J. Pediatr. Surg. 49 (8): 1268–75. doi:10.1016/j.jpedsurg.2013.10.029. PMID 25092088.
  4. ↑ Abd El-Hamid N, Taylor RM, Marinello D, Mufti GJ, Patel R, Mieli-Vergani G, Davenport M, Dhawan A (2008). "Aetiology and management of extrahepatic portal vein obstruction in children: King's College Hospital experience". J. Pediatr. Gastroenterol. Nutr. 47 (5): 630–4. doi:10.1097/MPG.0b013e31817b6eea. PMID 18955865.
  5. ↑ 5.0 5.1 Nakanuma, Yasuni; Tsuneyama, Koichi; Makoto, Ohbu; Katayanagi, Kazuyoshi (2001). "Pathology and Pathogenesis of Idiopathic Portal Hypertension with an Emphasis on the Liver". Pathology - Research and Practice. 197 (2): 65–76. doi:10.1078/0344-0338-5710012. ISSN 0344-0338.

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