Portal hypertension classification: Difference between revisions
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{{family tree| | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | |A01='''Portal Hypertension''' classification}} | {{family tree| | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | |A01='''Portal Hypertension''' classification}} | ||
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| colspan="2" style="background:#DCDCDC;" align="center" + |Pre-[[hepatic]] portal hypertension | | colspan="2" style="background:#DCDCDC;" align="center" + |Pre-[[hepatic]] portal hypertension | ||
| style="background:#F5F5F5;" + |Normal | | style="background:#F5F5F5;" align="center" + |Normal | ||
| style="background:#F5F5F5;" + |Normal | | style="background:#F5F5F5;" align="center" + |Normal | ||
| style="background:#F5F5F5;" + |Normal | | style="background:#F5F5F5;" align="center" + |Normal | ||
| style="background:#F5F5F5;" + | | | style="background:#F5F5F5;" + | | ||
* Increase in [[portal veins]] resistance | * Increase in [[portal veins]] resistance | ||
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| 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> | | 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:#DCDCDC;" align="center" + |Pre-sinusoidal disorders | ||
| style="background:#F5F5F5;" + |Normal | | style="background:#F5F5F5;" align="center" + |Normal | ||
| style="background:#F5F5F5;" + |Normal | | style="background:#F5F5F5;" align="center" + |Normal | ||
| style="background:#F5F5F5;" + |Normal | | style="background:#F5F5F5;" align="center" + |Normal | ||
| style="background:#F5F5F5;" + | | | style="background:#F5F5F5;" + | | ||
* [[Portal vein thrombosis]] | * [[Portal vein thrombosis]] | ||
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| style="background:#DCDCDC;" align="center" + |Sinusoidal disorders | | style="background:#DCDCDC;" align="center" + |Sinusoidal disorders | ||
| style="background:#F5F5F5;" + |Elevated | | style="background:#F5F5F5;" align="center" + |Elevated | ||
| style="background:#F5F5F5;" + |Elevated | | style="background:#F5F5F5;" align="center" + |Elevated | ||
| style="background:#F5F5F5;" + |Elevated | | style="background:#F5F5F5;" align="center" + |Elevated | ||
| style="background:#F5F5F5;" + | | | style="background:#F5F5F5;" + | | ||
* [[Cirrhosis]] | * [[Cirrhosis]] | ||
|- | |- | ||
| style="background:#DCDCDC;" align="center" + |Post-sinusoidal disorders | | style="background:#DCDCDC;" align="center" + |Post-sinusoidal disorders | ||
| style="background:#F5F5F5;" + |Elevated | | style="background:#F5F5F5;" align="center" + |Elevated | ||
| style="background:#F5F5F5;" + |Normal | | style="background:#F5F5F5;" align="center" + |Normal | ||
| style="background:#F5F5F5;" + |Elevated | | style="background:#F5F5F5;" align="center" + |Elevated | ||
| style="background:#F5F5F5;" + | | | style="background:#F5F5F5;" + | | ||
* [[Right heart failure]] | * [[Right heart failure]] | ||
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| 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> | | 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;" + |Elevated | | style="background:#F5F5F5;" align="center" + |Elevated | ||
| style="background:#F5F5F5;" + |Elevated | | style="background:#F5F5F5;" align="center" + |Elevated | ||
| style="background:#F5F5F5;" + |Normal | | style="background:#F5F5F5;" align="center" + |Normal | ||
| style="background:#F5F5F5;" + | | | style="background:#F5F5F5;" + | | ||
* Increased post-[[hepatic]] vessels resistance | * Increased post-[[hepatic]] vessels resistance | ||
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[[Category:Hepatology]] | [[Category:Hepatology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Up-To-Date]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 16:22, 7 December 2017
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Portal Hypertension Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Portal hypertension classification On the Web |
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American Roentgen Ray Society Images of Portal hypertension classification |
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Risk calculators and risk factors for Portal hypertension classification |
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 |
| |
| 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 |
| |
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]
- Stage I: Non-atrophic liver without subcapsular parenchymal atrophy.
- Stage II: Non-atrophic liver with subcapsular parenchymal atrophy.
- Stage III: Atrophic liver with subcapsular parenchymal atrophy.
- 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.