From the Guidelines
Cirrhosis is the most common cause of portal hypertension.
Relationship Between Cirrhosis and Portal Hypertension
- Portal hypertension is a common clinical syndrome characterized by a pathological increase in portal pressure and the formation of portal-systemic collaterals that bypass the liver 1.
- The most common cause of portal hypertension is cirrhosis, which leads to increased intrahepatic vascular resistance and portal blood flow 1.
- Cirrhosis can lead to portal hypertension due to architectural distortion of the liver secondary to fibrous tissue and regenerative nodules, as well as active intrahepatic vasoconstriction 1.
- The increased portal pressure gradient results from both an increase in resistance to portal flow (intrahepatic and collateral) and an increase in portal blood inflow 1.
- Portal hypertension can lead to various complications, including ascites, dilutional hyponatremia, refractory ascites, hepatorenal syndrome (HRS), and spontaneous bacterial peritonitis 1.
- The gold-standard test for portal hypertension is the measurement of hepatic venous pressure gradient (HVPG) 1.
From the Research
Relationship Between Cirrhosis and Portal Hypertension
The relationship between cirrhosis and portal hypertension is well-established, with portal hypertension being a major complication of cirrhosis 2, 3.
- Cirrhosis frequently leads to the development of portal hypertension, which can cause substantial morbidity and mortality 3.
- Portal hypertension is characterized by increased pressure in the portal vein, which can lead to complications such as ascites, esophageal varices, hepatic encephalopathy, and hepatorenal syndrome 2.
- The pathophysiology of portal hypertension in cirrhosis involves the formation of structurally abnormal nodules in the liver, leading to increased resistance to blood flow and subsequent increased pressure in the portal vein 3.
Clinical Manifestations
The clinical manifestations of portal hypertension in cirrhosis include:
- Gastroesophageal varices and ascites, which are two of the most common complications of portal hypertension 3.
- Hepatic encephalopathy, which is a condition characterized by cognitive impairment and altered mental status 2.
- Portal hypertensive gastropathy (PHG), which is a condition characterized by mucosal lesions in the stomach due to increased portal pressure 4.
Diagnosis and Treatment
The diagnosis and treatment of portal hypertension in cirrhosis involve:
- Measurement of hepatic venous pressure gradient (HVPG) to assess the severity of portal hypertension 4.
- Use of nonselective beta-blockers to reduce portal pressure and prevent complications such as variceal bleeding 5.
- Treatment of underlying liver disease, such as cirrhosis, to prevent progression of portal hypertension 5.
Pathophysiology
The pathophysiology of portal hypertension in cirrhosis is complex and involves: