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Portal Hypertension

Walter M. Kim, MD, PhD and Jyoti Ramakrishna, MD, MPH Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Increased portal venous pressure >5 mm Hg that occurs in association with splanchnic vasodilatation, portosystemic collateral formation, and hyperdynamic circulation

  • Most commonly ...

DIAGNOSIS

HISTORY

  • Ascites; symptoms of heart failure including chest pain, shortness of breath, and/or edema

  • Hematemesis

  • Melena

  • Oliguria

  • Jaundice

  • Weakness/fatigue

  • History of chronic liver disease

  • Alcoholic he...

TREATMENT

GENERAL MEASURES

  • Avoid sedatives that may precipitate encephalopathy.

  • Limit sodium intake because cirrhotic patients avidly retain sodium (<2 g sodium per day).

MEDICATION

Therapy for encepha...

ONGOING CARE

DIET

In patients with cirrhosis, sodium restriction is important because cirrhotic patients avidly retain sodium. 

PATIENT EDUCATION

Refrain from drinking alcohol. Resources for patients who...

REFERENCES

1
Leung JC, Loong TC, Pang J, et al. Invasive and non-invasive assessment of portal hypertension. Hepatol Int.  2018;12(Suppl 1):44–55. [View Abstract on OvidMedline]
2
Hayes PC, Davis JM...

ADDITIONAL READING

  • Baffy G. Origins of portal hypertension in nonalcoholic fatty liver disease. Dig Dis Sci.  2018;63(3):563–576. [View Abstract on OvidMedline]

  • Bloom S, Kemp W, Lubel J. Portal hy...

CODES

ICD10

K76.6 Portal hypertension 

ICD9

572.3 Portal hypertension 

SNOMED

34742003 Portal hypertension (disorder) 

CLINICAL PEARLS

  • Portal hypertension can be diagnosed based on physical examination in the setting of known risk factors, specifically cirrhosis.

  • Endoscopic treatment is successful for acute variceal he...

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