| Portal hypertension Classification and external resources |
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| The portal vein and its tributaries. | |
| ICD-10 | K76.6 |
| ICD-9 | 572.3 |
| DiseasesDB | 10388 |
| eMedicine | radio/570 med/1889 |
| MeSH | D006975 |
In medicine, portal hypertension is hypertension (high blood pressure) in the portal vein and its branches. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated It is often defined as a portal pressure gradient (the difference in pressure between the portal vein and the hepatic veins) of 5 mm Hg or greater. Many conditions can result in portal hypertension. In North America and Europe, it is usually the result of cirrhosis of the liver. Cirrhosis is a consequence of chronic Liver Disease characterized by replacement of liver tissue by fibrous Scar tissue as well as regenerative The liver is a vital organ in the human body and is present in Vertebrates and some other animals [1] However, in less industrialized parts of the world, climate permitting, the major cause is schistosomiasis. Schistosomiasis (also known as bilharzia, bilharziosis or snail fever) is a Parasitic disease caused by several species of fluke
Contents |
Signs and symptoms
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)[2]
- 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 anastomoses (esophageal varices, hemorrhoids, caput medusae), with esophageal varices posing an ongoing risk of life-threatening hemorrhage. In Medicine ( Gastroenterology) ascites (also known as peritoneal cavity fluid, peritoneal fluid excess, hydroperitoneum or more The peritoneal cavity is a potential space between the parietal Peritoneum and visceral peritoneum Hepatic encephalopathy (sometimes hepatoencephalopathy) is a potentially-reversible Neuropsychiatric abnormality in the setting of Liver failure, whether Spontaneous bacterial peritonitis (SBP is a form of Peritonitis that occurs in patients with Cirrhosis. Hepatorenal syndrome (HRS refers to Acute renal failure that occurs in the setting of Cirrhosis or Fulminant Liver failure, sometimes also associated Splenomegaly is an enlargement of the Spleen, which usually lies in the left upper quadrant (LUQ of the Human abdomen. The term sequestration can have different meanings according to the context Red blood cells are the most common type of Blood cell and the Vertebrate body's principal means of delivering Oxygen to the body tissues via the Blood Platelets, or Thrombocytes, are small cytoplasmic bodies derived from cells They circulate in the Blood of Mammals and are involved Pancytopenia is a medical condition in which there is a reduction in the number of red and White blood cells as well as Platelets A portacaval anastomosis (also known as portal systemic anastomosis) is a specific type of Anastomosis that occurs between the veins of Portal circulation In Medicine ( Gastroenterology) esophageal varices are extremely dilated sub-mucosal Veins in the Esophagus. Hemorrhoids ( AmE) haemorrhoids ( BrE) emerods, or piles are varicosities or swelling and Inflammation Caput medusae is the appearance of distended and engorged Paraumbilical veins which are seen radiating from the Umbilicus across the abdomen to join Systemic In Medicine ( Gastroenterology) esophageal varices are extremely dilated sub-mucosal Veins in the Esophagus.
Treatment
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. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias Typically, this is done with either propranolol or nadolol. Propranolol ( INN) is a non-selective Beta blocker mainly used in the treatment of Hypertension. Nadolol ( Corgard) is a non-selective Beta-blocker used in the treatment of high blood pressure, migraine headaches, and chest pain 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 Inorganic chemistry, a nitrate is a salt of Nitric acid with an Ion composed of one Nitrogen and three Oxygen atoms Isosorbide mononitrate is a drug used principally in the treatment of Angina pectoris and acts by dilating the Blood vessels so as to reduce the Blood pressure 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. Octreotide (brand name Sandostatin, Novartis Pharmaceuticals) is an octapeptide that mimics natural Somatostatin pharmacologically though it Somatostatin (also known as growth hormone inhibiting hormone ( GHIH) or somatotropin release-inhibiting factor ( SRIF) is a Peptide hormone Terlipressin is an analogue of Vasopressin used as a vasoactive drug in the management of Hypotension. Arginine vasopressin ( AVP) also known as vasopressin, argipressin or antidiuretic hormone ( ADH) is a Hormone found in
Percutaneous interventions
Transjugular intrahepatic portosystemic shunting is the creation of a connection between the portal and the venous system. A transjugular intrahepatic portosystemic shunt, also TIPS, is an artificial channel in the Liver from the Portal vein to a Hepatic vein 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
The most definitive treatment of portal hypertension is a liver transplant. In Medicine, a distal splenorenal shunt procedure (DSRS also splenorenal shunt procedure and Warren shunt, is a surgical procedure in which Liver transplantation or hepatic transplantation is the replacement of a diseased Liver with a healthy liver Allograft. Liver transplantation or hepatic transplantation is the replacement of a diseased Liver with a healthy liver Allograft.
References
- ^ Portal Hypertension: Manifestations of Liver Disease: Merck Manual Home Edition. Merck (August 2006). Retrieved on 2007-11-08. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 1519 - Hernán Cortés enters Tenochtitlán and Aztec ruler Moctezuma welcomes him with great a Celebration
- ^ Portal Hypertension. Retrieved on 2007-12-07. Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. Events 43 BC - Marcus Tullius Cicero assassinated 1696 - Connecticut Route 108, one of the oldest highways
External links
- 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)
- 10-135e. at Merck Manual of Diagnosis and Therapy Home Edition
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