Portal hypertension classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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 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 function 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pre-hepatic portal hypertension
- Pre-hepatic portal hypertension is due to increase in portal veins resistance.
- Inflammatory portal vein closure due to thrombosis is another reason for pre-hepatic portal hypertension.[2]
- In pre-hepatic portal hypertension wedged hepatic venous pressure (WHVP), free hepatic vein pressure (FHVP), and hepatic vein pressure gradient (HVPG) are normal.
Intra-hepatic portal hypertension
- Intra-hepatic portal hypertension is due to increase in intra-hepatic vascular resistance.
- Intra-hepatic portal hypertension is classified into pre-sinusoidal, sinusoidal, and post-sinusoidal based on the lesion site.[3]
Pre-sinusoidal disorders
- Elevated 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 (IVC) obstruction.
Post-hepatic portal hypertension
- Elevated wedged hepatic venous pressure (WHVP) and free hepatic vein pressure (FHVP).
- Normal hepatic vein pressure gradient (HVPG).[4]
Idiopathic portal hypertension (IPH)
- Idiopathic portal hypertension (IPH) is obstruction and stenosis of intra-hepatic portal vasculature.[5]
- Idiopathic portal hypertension (IPH) has 4 stages:[5]
- Stage I is non-atrophic liver without subcapsular parenchymal atrophy.
- Stage II is non-atrophic liver with subcapsular parenchymal atrophy.
- Stage III is atrophic liver with subcapsular parenchymal atrophy.
- Stage IV is 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.