What Is Portal Hypertension?

Portal hypertension (PHT) is also called portal hypertension, portal hypertension, and portal hypertension. Portal hypertension refers to a clinical syndrome caused by elevated pressure in the portal vein system. It is a comprehensive clinical manifestation of portal blood circulation disorders caused by multiple causes, rather than a single disease. Anything that causes portal blood flow disorders and / or increased blood flow can cause portal hypertension. Symptoms and signs vary according to the cause. The clinical manifestations are splenomegaly and hypersplenism, and then esophageal and gastric fundus varicose veins, vomiting, melena and ascites. May be accompanied by spider nevus, liver palms and liver dysfunction. Medication has little effect. Complications such as esophageal varices bleeding may require minimally invasive or surgical treatment.

Basic Information

nickname

Portal hypertension, portal hypertension, portal hypertension

English name

portal hypertension

Visiting department

Gastroenterology

Common causes

Cirrhosis, as well as primary bone marrow fibrosis, pancreatic true cysts, portal hypertension, and drug-induced liver cirrhosis

Common symptoms

Splenomegaly and hypersplenism; esophagus, gastric varicose veins, vomiting blood, melena and ascites; etc. with spider nevus, palms and liver function

Causes of portal hypertension and common diseases

The main causes of portal hypertension can be divided into two types: intrahepatic and extrahepatic.

1. Intrahepatic type < br According to the pathological morphology, it can be divided into two types: pre-sinus obstruction and post-sinus obstruction. A common cause of presinus obstruction is schistosomiasis cirrhosis. A common cause of retrosinus obstruction is cirrhosis after hepatitis.

2. Extrahepatic type < br is mainly caused by thrombosis of the extrahepatic portal vein trunk, which is mainly caused by obstruction of branches.
Common in the following diseases:

(1) Primary bone marrow fibrosis <br /> Splenomegaly, hepatomegaly, ascites, portal hypertension, and fatigue.

(2) Pancreatic true cysts <br /> Upper abdominal discomfort, nausea and vomiting, abdominal distension, lower limb edema, etc.

(3) Portal hypertension <br /> Splenomegaly, ascites, varicose veins in the lower esophagus, portal hypertension, etc.

(4) portal hypertension bowel disease <br /> stool blood, gastrointestinal bleeding, abdominal discomfort, abdominal pain, portal hypertension and so on.

(5) Drug-induced liver cirrhosis <br /> Large liver, liver ascites, portal hypertension, etc.

(6) Idiopathic non-sclerotic portal hypertension syndrome <br /> Portal hypertension, varicose veins in the lower esophagus, and splenomegaly.

(7) Fulminant liver failure < br Fever, fatigue, loss of appetite, ascites, low blood pressure, cerebral edema, severe liver damage, etc.

(8) Cystic fibrosis <br /> Large liver, portal hypertension, obstructive jaundice, etc.

(9) Cirrhosis < br fatigue, fatigue, loss of appetite, portal hypertension, and abnormal appetite.

(10) 1-antitrypsin deficiency <br /> liver coma, portal hypertension and so on.

(11) Gaucher's disease < br Glucocerebrosidosis, a familial disease of glucose and lipid metabolism, is a recessive inheritance of chromosomes. The liver and spleen are progressive, especially the splenomegaly is more obvious, the liver function is abnormal, and the growth is slow.

(12) Pediatric glycogen storage disease type IV < br is a type of glycogen metabolism disorder caused by congenital enzyme deficiency. Hepatomegaly, decreased muscle tone, splenomegaly, disappeared tendon reflexes, liver cirrhosis, growth disorders, etc.

(13) Alcoholic liver disease in the elderly < br Hepatomegaly, liver pain, loss of appetite, weight loss, nausea and vomiting, hypofunction of liver, portal hypertension, etc.

(14) Schistosomiasis of Japan <br Itching of the skin, bloating, hepatomegaly, fatigue, nausea and vomiting, advanced liver cirrhosis, portal hypertension, giant spleen, ascites, etc.

Differential diagnosis of portal hypertension

1. Hematemesis is the main symptom

The first is to exclude bleeding from ulcers and gastric cancer, and to consider the possibility of biliary tract bleeding. Patients with gastric cancer can sometimes vomit too much blood. Advanced patients with extensive lymph node metastasis can also compress the spleen vein and cause splenomegaly or ascites due to peritoneal metastasis. However, patients with gastric cancer often have a long history of anorexia and are often accompanied by pyloric obstruction. There is a clear history of melena before major bleeding and a history of repeated vomiting of coffee-like food. The abdomen can be palpable, and ascites can sometimes find cancer cells. Gastroscopy X-ray examination can further confirm the diagnosis.

2. Secondary splenomegaly

May also be accompanied by hypersplenism, sometimes difficult to distinguish from portal hypertension. Although most of these patients have a history of primary diseases that may cause splenomegaly, such as malaria, black fever, and schistosomiasis, most of the livers have no obvious lesions except for the splenomegaly, normal liver function, and no other symptoms of cirrhosis such as esophageal varices or ascites. However, it is sometimes difficult to determine whether it is the early manifestation of liver cirrhosis and extrahepatic portal hypertension.

3. With ascites as a prominent symptom

In addition to liver cirrhosis, there are many situations that need to be carefully identified. For example, those who have heart failure such as heart disease such as mitral valve stenosis or constrictive pericarditis often have significant ascites production, and may have abdominal wall varicose veins and liver Swelling may be misdiagnosed as cirrhosis and portal hypertension. However, if you ask the patient carefully, you have a history of rheumatic fever, pericarditis, hypertension, or angina pectoris, long-term symptoms of shortness of breath, and often edema of the lower extremities before the emergence of ascites. Physical examination can often reveal obvious abnormalities in the heart and lungs, large liver and With tenderness, most of the spleen is not obvious.

Portal hypertension

Physical examination

Note the presence of liver palms, spider moles, jaundice, bulging of abdominal wall veins, whether the liver and spleen are large, their degree and hardness, whether the surface is smooth, and whether there is ascites.

2. Laboratory inspection

Check the three routines of blood, urine and stool, platelet count, thrombin time, jaundice index, liver function, transaminase, serum albumin and globulin. When a tumor is suspected, check for tumor markers such as alkaline phosphatase (AKP), r-GT, and alpha-fetoprotein (AFP).

3.X-ray inspection

X-ray examination of barium meal for varicose veins in the esophagus and stomach.

4. Upper gastrointestinal endoscopy

The presence or absence of esophageal gastric varices was identified.

5. Other

ECG, liver ultrasound or CT. Renal vein angiography is required for those who intend to undergo anastomosis of the spleen and kidney.

Portal hypertension treatment principles

Divided into symptomatic treatment and symptomatic treatment. For the treatment of the cause, the appropriate treatment plan is selected according to the cause: when the medical treatment is not effective, such as endoscopic / endoscopic minimally invasive treatment and surgery; symptomatic treatment is to treat complications such as bleeding, ascites, and hypersplenism.