Portal hypertension classification: Difference between revisions

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Latest revision as of 16:22, 7 December 2017

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

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.^[1]

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	Increase in portal veins resistance Inflammatory portal vein closure due to thrombosis^[2]
Intra-hepatic portal hypertension^[3]	Pre-sinusoidal disorders	Normal	Normal	Normal	Portal vein thrombosis Schistosomiasis Primary biliary cirrhosis
	Sinusoidal disorders	Elevated	Elevated	Elevated	Cirrhosis
	Post-sinusoidal disorders	Elevated	Normal	Elevated	Right heart failure Inferior vena cava (IVC) obstruction
Post-hepatic portal hypertension^[4]		Elevated	Elevated	Normal	Increased post-hepatic vessels resistance

Idiopathic portal hypertension (IPH)

Idiopathic portal hypertension (IPH) is due to obstruction and stenosis of intra-hepatic portal vasculature.^[5]
Idiopathic portal hypertension (IPH) has 4 stages:^[5]
1. Stage I: Non-atrophic liver without subcapsular parenchymal atrophy.
2. Stage II: Non-atrophic liver with subcapsular parenchymal atrophy.
3. Stage III: Atrophic liver with subcapsular parenchymal atrophy.
4. Stage IV: Portal venous occlusive thrombosis.

References

↑ 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.
↑ Králík J, Neoral C (1992). "[Rational therapy of prehepatic portal hypertension]". Rozhl Chir (in Czech). 71 (10): 513–22. PMID 1475714.
↑ 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.
↑ 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.
↑ ^5.0 ^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.

Template:WH Template:WS

[GrammatikopoulosMcKiernan2017-1] 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.

[pmid1475714-2] Králík J, Neoral C (1992). "[Rational therapy of prehepatic portal hypertension]". Rozhl Chir (in Czech). 71 (10): 513–22. PMID 1475714.

[pmid25092088-3] 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.

[pmid18955865-4] 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.

[NakanumaTsuneyama2001-5] 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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@@ Line 13: / Line 13: @@
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+{{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| | | 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}}
@@ Line 23: / Line 23: @@
 <br>
 <br>
-{| class="wikitable"
+{|
-! colspan="2" |Group
+! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Group
-!Wedged hepatic venous pressure (WHVP)
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Wedged hepatic venous pressure (WHVP)
-!Free hepatic vein pressure (FHVP)
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Free hepatic vein pressure (FHVP)
-!Hepatic vein pressure gradient (HVPG)
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hepatic vein pressure gradient (HVPG)
-!Cause
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Cause
 |-
-| colspan="2" |Pre-[[hepatic]] portal hypertension
+| colspan="2" style="background:#DCDCDC;" align="center" + |Pre-[[hepatic]] portal hypertension
-|Normal
+| style="background:#F5F5F5;" align="center" + |Normal
-|Normal
+| style="background:#F5F5F5;" align="center" + |Normal
-|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" |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>
+| 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>
-|Pre-sinusoidal disorders
+| style="background:#DCDCDC;" align="center" + |Pre-sinusoidal disorders
-|Normal
+| style="background:#F5F5F5;" align="center" + |Normal
-|Normal
+| style="background:#F5F5F5;" align="center" + |Normal
-|Normal
+| style="background:#F5F5F5;" align="center" + |Normal
-|
+| style="background:#F5F5F5;" + |
 * [[Portal vein thrombosis]]
 * [[Schistosomiasis]]
 * [[Primary biliary cirrhosis]]
 |-
-|Sinusoidal disorders
+| style="background:#DCDCDC;" align="center" + |Sinusoidal disorders
-|Elevated
+| style="background:#F5F5F5;" align="center" + |Elevated
-|Elevated
+| style="background:#F5F5F5;" align="center" + |Elevated
-|Elevated
+| style="background:#F5F5F5;" align="center" + |Elevated
-|
+| style="background:#F5F5F5;" + |
 * [[Cirrhosis]]
 |-
-|Post-sinusoidal disorders
+| style="background:#DCDCDC;" align="center" + |Post-sinusoidal disorders
-|Elevated
+| style="background:#F5F5F5;" align="center" + |Elevated
-|Normal
+| style="background:#F5F5F5;" align="center" + |Normal
-|Elevated
+| style="background:#F5F5F5;" align="center" + |Elevated
-|
+| style="background:#F5F5F5;" + |
 * [[Right heart failure]]
 * [[Inferior vena cava obstruction|Inferior vena cava (IVC) obstruction]]
 |-
-| colspan="2" |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>
+| 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>
-|Elevated
+| style="background:#F5F5F5;" align="center" + |Elevated
-|Elevated
+| style="background:#F5F5F5;" align="center" + |Elevated
-|Normal
+| style="background:#F5F5F5;" align="center" + |Normal
-|
+| style="background:#F5F5F5;" + |
 * Increased post-[[hepatic]] vessels resistance
 |}
 === Idiopathic portal hypertension (IPH)===
-*[[Idiopathic]] portal hypertension (IPH) is [[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>
+*[[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>
 *Idiopathic portal hypertension (IPH) has 4 stages:<ref name="NakanumaTsuneyama2001" />
-*#Stage I is non-[[atrophic]] [[liver]] without subcapsular [[parenchymal]] atrophy.
+*#Stage I: Non-[[atrophic]] [[liver]] without subcapsular [[parenchymal]] atrophy.
-*#Stage II is non-[[atrophic]] liver with subcapsular [[parenchymal]] atrophy.
+*#Stage II: Non-[[atrophic]] liver with subcapsular [[parenchymal]] atrophy.
-*#Stage III is [[atrophic]] liver with subcapsular [[parenchymal]] atrophy.
+*#Stage III: [[Atrophic]] liver with subcapsular [[parenchymal]] atrophy.
-*#Stage IV is [[Portal vein thrombosis|portal venous occlusive thrombosis]].
+*#Stage IV: [[Portal vein thrombosis|Portal venous occlusive thrombosis]].
 ==References==
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 [[Category:Hepatology]]
 [[Category:Disease]]
-[[Category:needs content]]
+[[Category:Emergency medicine]]
+[[Category:Up-To-Date]]
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