Portal hypertension

Classification according to ICD-10
K76.6	Portal hypertension
ICD-10 online (WHO version 2019)

Portal hypertension (also portal hypertension , portal vein high pressure) describes the increase in pressure in the portal vein (so-called portal venous pressure) above the normal range (3–6  mmHg ). Gastroesophageal varices are only expected from a pressure> 12 mmHg.

Etiology and pathogenesis

The portal pressure is equal to the product of the transhepatic blood flow and the flow resistance in its flow path. Both an increase in resistance and an increased portal blood flow consequently have an influence on the portal pressure.

Increased synthesis or release of vasodilating substances such as nitric oxide , substance P or calcitonin-gene-related peptide in the arterioles of the intestines lead to a hyperdynamic circulation and thus to an increased blood flow, which causes an increased portal pressure.

The most important cause of portal hypertension is cirrhosis of the liver ; The most important causes are summarized in the following table, sorted according to their location in the circuit.

hepatocellular causes	interstitial causes	endothelial causes
Ballooning of the hepatocytes Formation of regenerated knots	Capillarization of the sinusoids with obstruction of the passage of plasma into the Disse space Compression of the sinusoids Interruption of the portal venous sinusoidal flow by connective tissue Formation of arterioportal shunts Compression of the sinusoids by contractile myofibroblasts from stellate cells	Rarefaction and reduction of the fenestrae

Consequences of portal hypertension

1. Formation of portosystemic blood flow in vessels that allow a connection to the superior or inferior vena cava while bypassing the liver. This leads to the formation of collateral circulation in the following vascular regions:
   • Proximal stomach - so-called fundic varices
   • Distal esophagus (submucosal and periesophageal) - so-called esophageal varices
   • Submucosa of the rectum
   • spleen
   • Kidney (spontaneous splenorenal shunt)
   • Retroperitoneum
   • Veins of the abdominal wall as well as reopening of the umbilical vein (V. umbilicalis) as the so-called caput medusae
2. Gastrointestinal bleeding from esophageal and fundic varices
3. Restriction of detoxification functions, hormone, foreign substance and drug metabolism through extensive loss of the “first pass” elimination
4. Splenomegaly / hypersplenism , mild anemia , marked leukopenia and thrombopenia
5. Ascites ( ascites )
6. Hepatic encephalopathy

Cruveilhier-Baumgarten syndrome

Cruveilhier- Baumgarten syndrome (CBS) is portal hypertension caused by liver cirrhosis , associated with bypassing blood flow via veins in the abdominal wall around the navel (which in healthy people close after birth). CBS can be detected in 9–26% of patients with liver cirrhosis by means of sonographic examination.

Web links

Commons : Portals Hypertension  - Collection of images, videos and audio files

Individual evidence

1. ↑ Cruveilhier-von-Baumgarten syndrome. (pdf) Swiss Medical Forum, January 12, 2005, accessed December 27, 2017 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !