Clinical meaning
Portal hypertension develops when hepatic fibrosis (usually from cirrhosis) increases resistance to portal venous flow through the liver sinusoids. Portal pressure exceeds 5 mmHg (clinically significant >10 mmHg), causing portosystemic collateral formation (varices), splanchnic vasodilation, ascites, and hepatorenal syndrome through complex neurohormonal activation.
Diagnosis & workup
Diagnostics & workup: - Order hepatic venous pressure gradient measurement (HVPG ≥10 clinically significant) - Order upper endoscopy for variceal screening - Order abdominal ultrasound with Doppler - Order liver function tests and synthetic function - Order CBC (thrombocytopenia suggests portal hypertension) - Order MELD score calculation
Risk factors: - Cirrhosis (most common cause: alcohol, HCV, NASH) - Portal vein thrombosis - Budd-Chiari syndrome - Schistosomiasis (global) - Hepatic sinusoidal obstruction syndrome - Right heart failure causing hepatic congestion - Myeloproliferative neoplasms