Portal hypertension: Difference between revisions

	Portal Hypertension Microchapters
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	Portal hypertension;
	The portal vein and its tributaries- By Henry Vandyke Carter [Public domain], via Wikimedia Commons

VisualWikitext

Latest revision as of 18:23, 16 February 2018

For the patient information page on this topic, click here.

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

Synonyms and keywords:Hypertension of portal system, Portal vein hypertension, Portal high blood pressure, Portal vein high pressure.

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Portal Hypertension from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Treatment

Case Studies

Case #1

Template:Gastroenterology de:Portale Hypertension sv:Portahypertension

Template:WikiDoc Sources

References

↑ <"https://commons.wikimedia.org/wiki/File%3AGray591.png">via Wikimedia Commons

[1] <"https://commons.wikimedia.org/wiki/File%3AGray591.png">via Wikimedia Commons

[1]

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 {{Infobox_Disease |
    Name           = {{PAGENAME}} |
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-   Caption        = The portal vein and its tributaries. |
+   Caption        = The portal vein and its tributaries- By Henry Vandyke Carter [Public domain], via Wikimedia Commons<ref><"https://commons.wikimedia.org/wiki/File%3AGray591.png">via Wikimedia Commons</ref>|
-  DiseasesDB     = 10388 |
-  ICD10          = {{ICD10|K|76|6|k|70}} |
-  ICD9           = {{ICD9|572.3}} |
-  ICDO           = |
-  OMIM           = |
-  MedlinePlus    = |
-  eMedicineSubj  = radio |
-  eMedicineTopic = 570 |
-  eMedicine_mult = {{eMedicine2|med|1889}} |
-  MeshID         = D006975 |
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-{{SI}}
+'''For the patient information page on this topic, click [[Portal hypertension (patient information)|here]].'''
-{{CMG}}
-__NOTOC__
+{{Portal hypertension}}
-{{Editor Help}}
+{{CMG}} {{AE}} {{EG}}
+{{SK}}Hypertension of portal system, Portal vein hypertension, Portal high blood pressure, Portal vein high pressure.
+==[[Portal hypertension overview|Overview]]==
-==Overview==
+==[[Portal hypertension historical perspective|Historical Perspective]]==
-In [[medicine]], '''portal hypertension''' is [[hypertension]] (high blood pressure) in the portal stem which causes an obstruction in the [[portal vein]] and its branches. It is often defined as a portal pressure gradient (the difference in pressure between the portal vein and the [[hepatic vein]]s) of 12 mm Hg or greater. Many conditions can result in portal hypertension. In North America and Europe, it is usually the result of an intrahepatic block due to [[cirrhosis]] of the [[liver]]. However, in less industrialized parts of the world, climate permitting, the major cause is [[schistosomiasis]].
+==[[Portal hypertension classification|Classification]]==
-== Signs and symptoms==
+==[[Portal hypertension pathophysiology|Pathophysiology]]==
-Consequences of portal hypertension are caused by blood being forced down alternate channels by the increased resistance to flow through the portal system. They include:
-* [[Ascites]] (free fluid in the [[peritoneal cavity]])
-* [[Hepatic encephalopathy]]
-* Increased risk of [[spontaneous bacterial peritonitis]]
-* Increased risk of [[hepatorenal syndrome]]
-* [[Splenomegaly]] (enlargement of the spleen) with consequent sequestration therein of [[red blood cells]], [[white blood cells]], and [[platelets]], together leading to mild [[pancytopenia]]
-* [[Portacaval anastomosis|portacaval anastomoses]] ([[Esophageal varices]], [[hemorrhoid]]s, [[caput medusae]]), with [[esophageal varices]] posing an ongoing risk of life-threatening hemorrhage.<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:291</ref>
-== Differential Diagnosis ==
+==[[Portal hypertension causes|Causes]]==
-'''Prehepatic'''
-*Congenital abnormalities
-*Idiopathic tropical [[splenomegaly]]
-*[[Portal vein occlusion]]
-*[[Splenic Vein Thrombosis]]
-*Umbilical sepsis
-'''Intrahepatic'''
-*[[Alcoholic hepatitis]]
-*[[Boeck's Diesease]]
-*[[Chronic hepatitis]]
-*[[Cirrhosis]]
-*[[Fatty liver]]
-*[[Fulminant hepatic failure]]
-*[[Hodgkin's Lymphoma]]
-*[[Osteomyelosclerosis]]
-*Partial nodular transformation
-*[[Schistosomiasis]]
-*[[Wilson's Disease]]
-'''Posthepatic'''
-*[[Cardiomyopathy]]
-*[[Congestive Heart Failure]]
-*[[Constructive Pericarditis]]
-*[[Inferior vena cava obstruction]]
-*[[Tricuspid insufficiency]]
-==Treatment==
+==[[Portal hypertension differential diagnosis|Differentiating Portal Hypertension from other Diseases]]==
-===Medical management===
-Treatment with a non-selective [[beta blocker]] is often commenced once [[portal hypertension]] has been diagnosed, and almost always if there has already been bleeding from esophageal varices. Typically, this is done with either [[propranolol]] or [[nadolol]]. The addition of a [[nitrate]], such as [[isosorbide mononitrate]], to the [[beta blocker]] is more effective than using beta blockers alone and may be the preferred regimen in those people with portal [[hypertension]] who have already experienced variceal bleeding. In acute or severe complications of the [[hypertension]], such as bleeding varices, intravenous [[octreotide]] (a [[somatostatin]] analogue) or intravenous [[terlipressin]] (an [[antidiuretic hormone]] analogue) is commenced to decrease the portal pressure.
-===Percutaneous interventions===
+==[[Portal hypertension epidemiology and demographics|Epidemiology and Demographics]]==
-[[Transjugular intrahepatic portosystemic shunt]]ing is the creation of a connection between the portal and the venous system. As the pressure over the venous system is lower than over a hypertensive portal system, this would decrease the pressure over the portal system and a decreased risk of complications.
-===Surgical interventions===
+==[[Portal hypertension risk factors|Risk Factors]]==
-*[[Distal splenorenal shunt procedure|Distal splenorenal shunt]]
-*[[Liver transplant]]
-The most definitive treatment of portal hypertension is a [[liver transplant]].
+==[[Portal hypertension screening|Screening]]==
-== References ==
+==[[Portal hypertension natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
-{{Reflist}}
-==External links==
-* [http://videos.med.wisc.edu/videoInfo.php?videoid=249 VIDEO - Portal Hypertension: Shunt Surgery in the Era of Transplant and TIPS], Alysandra Lal, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)
-* {{MerckHome|10|135|e}}
+==Diagnosis==
-* {{Chorus|00863}}
+[[Portal hypertension history and symptoms|History and Symptoms]] | [[Portal hypertension physical examination|Physical Examination]] | [[Portal hypertension laboratory findings|Laboratory Findings]] | [[Portal hypertension electrocardiogram|Electrocardiogram]] | [[Portal hypertension x ray|X Ray]] | [[Portal hypertension CT|CT]] | [[Portal hypertension MRI|MRI]] | [[Portal hypertension ultrasound|Ultrasound]] | [[Portal hypertension other imaging findings|Other Imaging Findings]] | [[Portal hypertension other diagnostic studies|Other Diagnostic Studies]]
-* [http://www.clevelandclinic.org/health/health-info/docs/0200/0252.asp?index=4912 Overview] at [[Cleveland Clinic]]
+==Treatment==
-{{SIB}}
+[[Portal hypertension medical therapy|Medical Therapy]] | [[Portal hypertension surgery|Surgery]] | [[Portal hypertension primary prevention|Primary Prevention]] |  [[Portal hypertension secondary prevention|Secondary Prevention]] | [[Portal hypertension cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] |
-{{Gastroenterology}}
+[[Portal hypertension future or investigational therapies|Future or Investigational Therapies]]
+==Case Studies==
-[[Category:Gastroenterology]]
+[[Portal hypertension case study one|Case #1]]
-[[Category:Hepatology]]
-[[Category:Mature chapter]]
-[[Category:Disease state]]
-[[Category:Needs patient information]]
+{{Gastroenterology}}
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+==References==
+[[Category:Gastroenterology]]
+[[Category:Hepatology]]
+[[Category:Disease]]
+[[Category:Emergency medicine]]
+[[Category:Up-To-Date]]


Portal hypertension
The portal vein and its tributaries- By Henry Vandyke Carter [Public domain], via Wikimedia Commons^[1]