Portal Hypertension

Dr.Shahzad Ahmad DaulaMID,DMLT,DDC

The University of Lahore

Portal Hypertension

An elevation of pressure >6mmHg in the portal venous system.Portal vein Normally <13mm in diameter.

Superior mesenteric veinSuperior mesenteric vein

Splenic veinSplenic vein

Portal veinis

not a true vein

20 %

80 %

Portal venous pressure

> 10 mm HgIncreased resistance to

portal flow

Prehepatic

Hepatic

Posthepatic

Prehapatic(portal vein obstruction)

• Thrombosis of portal vein

• Congenital atresia / stenosis

• Extrinsic compression

Hepatic

• Cirrhosis

• Schistosomiasis

Posthepatic

• Budd-Chiari syndrome

• Cardiac disease

Portal hypertensionhas no symptoms

AscitesAscites

VariceaVariceal l

BleedinBleedingg

Caput MedusaeCaput Medusae

HaemorrhoidsHaemorrhoids

Investigations in

Ascites• CT with IV contrast• Aspiration of fluid

•Portal pressure measurement

AscitesAscites

Shrunken Shrunken LiverLiver

Portal vein Portal vein thrombosisthrombosis SplenomegalySplenomegaly

Investigations in

Ascites• CT with IV contrast• Aspiration of fluid

•Portal pressure measurement

Portal Pressure Measurement

• Wedged hepatic venous

pressure

• Splenic pulp pressure

• Catheterization of umbilical

vein

Treatment

• Medical Treatment• Peritoneo-venous shunting• TIPS• Liver transplantation

Medical Treatment

• Salt restriction• Diuretics• Paracenteses

Peritoneo-venous shunt

(LeVeen shunt, Denver shunt)

TIPS

TIPS

… in summary

• Pressure > 06 mm Hg

• Secondary to resistance to

flow• Presents as ascites / variceal

bleeding

… in summary

• Ascites can be treated with• Medical treatment

• PJ shunt• TIPS

• Liver transplantation