Portal Hypertension Questions & Answers

Updated: Nov 30, 2017
  • Author: Jesus Carale, MD; Chief Editor: BS Anand, MD  more...
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Questions & Answers

Overview

What is the most common cause of portal hypertension?

What are the signs and symptoms of liver disease in portal hypertension?

What are the possible complications of portal hypertension?

What are the signs of portosystemic collateral formation due to portal hypertension?

What are the signs of hyperdynamic circulatory state in portal hypertension?

What are the signs and symptoms of portal hypertension and esophageal varices?

Which lab tests are performed in the evaluation of portal hypertension?

Which lab tests may be performed in the evaluation of portal hypertension?

Which imaging studies are performed in the evaluation of portal hypertension?

Which procedures are performed in the evaluation of portal hypertension?

What is the focus of treatment for portal hypertension?

What are emergent treatment options for portal hypertension?

What are the primary prophylaxis options for portal hypertension?

What are secondary prophylaxis options for portal hypertension?

What is the role of surgery in the treatment of portal hypertension?

What is the most common cause of portal hypertension?

What are important factors in the development of portal hypertension?

At what level is portal pressure hypertensive?

What is the role of the portal vein in the etiology of portal hypertension?

How does portal hypertension cause portosystemic collaterals to develop?

What anatomy is relevant to portal hypertension?

What is the initial factor in the etiology of portal hypertension?

What is the role of blood vessel radius in the pathophysiology of portal hypertension?

What role does liver disease play in the etiology of portal hypertension?

What is the role of hepatic vascular resistance in the pathophysiology of portal hypertension?

What role does endothelin-1 (ET-1) play in the etiology of portal hypertension?

What role does nitric oxide (NO) play in the etiology of portal hypertension?

What are the levels at which obstruction and increased resistance can occur in the pathophysiology of portal hypertension?

How are causes of portal hypertension classified?

What are prehepatic causes of portal hypertension?

What are the mechanisms of increased intrahepatic vascular resistance in the etiology of portal hypertension?

What are intrahepatic, predominantly presinusoidal causes of portal hypertension?

What are intrahepatic, predominantly sinusoidal causes of portal hypertension?

What is the role of Vitamin A in the etiology of portal hypertension?

What are the postsinusoidal causes of portal hypertension?

What are the posthepatic causes of portal hypertension?

What is the role of increased portal blood flow in the pathogenesis of portal hypertension?

What are manifestations of splanchnic vasodilation in portal hypertension?

How does the formation of varices contribute to the pathogenesis of portal hypertension?

How does increased portal pressure contribute to the pathogenesis of portal hypertension?

What are risk factors for variceal hemorrhage in portal hypertension?

How does bacterial infection trigger variceal bleeding in portal hypertension?

What is the prevalence of portal hypertension in the US?

What is the global incidence of portal hypertension?

What is the prevalence of esophageal varices in US?

How does the cause of portal hypertension vary geographically?

How does the prevalence of portal hypertension vary by sex?

How does the cause of portal hypertension vary by age?

How does severe and persistent upper GI hemorrhage affect the prognosis of portal hypertension?

What is the most common complication of portal hypertension?

What is the mortality rate for portal hypertension in patients with an esophageal varices bleeding episode?

Which complications are associated with portal hypertension and GI bleeding?

What are causes of complications of portal hypertension?

What is the prognosis of portal hypertension in patients with intrapulmonary vascular dilations (PVDs)?

What is the prognosis of portal hypertension in patients with esophageal varices?

Which factors are known to influence the prognosis of esophageal bleeding in portal hypertension?

What should be included in patient education about portal hypertension?

What information should patients with portal hypertension be given regarding alcohol use?

What information should patients with portal hypertension be given regarding beta-blockers?

What information should patients with portal hypertension be given regarding ascites?

Presentation

What should be the focus of medical history in patients with portal hypertension?

Which historical information helps determine the cause of portal hypertension?

What are the most common causes of GI bleeding in portal hypertension?

Which history findings are characteristic of upper GI bleeding in patients with portal hypertension?

What are the symptoms of liver disease in portal hypertension?

Which patient history I characteristic of complications of portal hypertension?

How should blood pressure and pulse be checked in patients with portal hypertension?

Which physical findings suggest portosystemic collateral formation in portal hypertension?

Which physical findings suggest liver disease in portal hypertension?

Which physical findings suggest hyperdynamic circulatory state in cases of portal hypertension?

What are signs of portal hypertension with esophageal varices?

DDX

Which conditions should be considered in the differential diagnoses of portal hypertension?

What is the differential diagnoses of variceal hemorrhage in portal hypertension?

What are the differential diagnoses for Portal Hypertension?

Workup

Which physical findings from a rectal exam suggest portal hypertension with upper GI bleeding?

What is the role of ultrasonography in the diagnosis of portal hypertension?

What is the role of angiography in the diagnosis of portal hypertension?

Which histologic findings on liver biopsy suggest portal hypertension?

What is the role of lab studies in the diagnosis of portal hypertension?

What is the role of complete blood count (CBC) in the diagnosis of portal hypertension?

What is the role of liver function tests in the diagnosis of portal hypertension?

Why are cross-match tests performed in the evaluation of portal hypertension?

What is the role of coagulation tests in the evaluation of portal hypertension?

What is the role of blood urea nitrogen (BUN) and creatinine testing in the diagnosis of portal hypertension?

What does a high anion gap suggest in the evaluation of portal hypertension?

Why are viral hepatitis serologies obtained in the evaluation of portal hypertension?

Which lab tests are used to diagnose portal hypertension?

Which features on duplex Doppler ultrasonography suggest hepatic cirrhosis with portal hypertension?

What are the limitations of ultrasonography for the diagnosis of portal hypertension?

What is the role of CT scanning in the diagnosis of portal hypertension?

Which CT findings suggest portal hypertension?

What are the limitations of CT scanning in the diagnosis of portal hypertension?

What is the role of MRI in the diagnosis of portal hypertension?

What is the role of liver-spleen scanning in the diagnosis of portal hypertension?

What are the limitations of liver-spleen scans for the diagnosis of portal hypertension?

What is the role of direct portal measurements in the diagnosis of portal hypertension?

What is the role of hepatic venous pressure gradient (HVPG) monitoring in the evaluation of portal hypertension?

What is the role of a balloon catheter in the evaluation of portal hypertension?

What is the role of peripheral endothelin-1 (ET-1) and transforming growth factor-beta1 measurement in the evaluation of portal hypertension?

What are the indications for a portal hypertension screening endoscopy?

What are risk factors for rebleeding in portal hypertension?

What is the role of upper endoscopy in the diagnosis of portal hypertension?

What is the role of upper endoscopy in portal hypertension due to cirrhosis?

Which indirect indices are used to help diagnose portal hypertension?

When should surveillance endoscopy be performed in portal hypertensive due to cirrhosis?

What is the role of transient elastography in the diagnosis of portal hypertension?

What is the role of acoustic radiation force impulse imaging (ARFI) in the diagnosis of portal hypertension?

Treatment

What is the focus of treatment for portal hypertension?

What is included in pharmacologic therapy for portal hypertension?

What are the endoscopic and surgical options for portal hypertension?

How is portal hypertension managed in patients with liver cirrhosis and ascites?

When is a nasogastric tub indicated in the treatment of portal hypertension?

What is included in emergency department (ED) treatment of portal hypertension?

What is the role of surgery in the treatment of portal hypertension?

When is surgery considered in the treatment of portal hypertension?

Which surgical interventions are used in the treatment of portal hypertension?

What is the role of decompressive shunts in the treatment of portal hypertension?

How are total portosystemic shunts used in the treatment of portal hypertension?

How are partial portal systemic shunts used in the treatment of portal hypertension?

How are selective shunts used in the treatment of portal hypertension?

What is the role of devascularization in the treatment of portal hypertension?

Which devascularization procedures are used in the treatment of portal hypertension?

When is devascularization indicated in the treatment of portal hypertension?

What is the role of splenectomy in the treatment of portal hypertension?

How is gastroesophageal devascularization performed in the treatment of portal hypertension?

What is the role of liver transplantation in the treatment of portal hypertension?

What are the benefits of liver transplantation for the treatment of portal hypertension?

In which patient groups is liver transplantation indicated for the treatment of portal hypertension?

What is the role of transesophageal echocardiography (TEE) in the treatment of portal hypertension?

What is the role of endoscopic variceal ligation (EVL) in the treatment of portal hypertension?

What is the role of secondary prophylaxis in the treatment of portal hypertension?

What is the role of nonselective beta-blockers in the treatment of portal hypertension?

How frequently is endoscopic sclerotherapy performed in the treatment of portal hypertension?

What is the efficacy of combination therapy with EVL, nadolol and sucralfate for the treatment of portal hypertension?

What are possible complications of endoscopic variceal ligation (EVL) in the treatment of portal hypertension?

What are possible complications of specific therapeutic procedures used in the management of portal hypertension?

Which specialist consultations are needed for the treatment of portal hypertension?

How is variceal hemorrhage prevented in patients with portal hypertension?

How frequently should surveillance endoscopy be performed in portal hypertension due to cirrhosis?

What does a high portal blood flow velocity indicate in patients with portal hypertension?

What is included in the emergent treatment of portal hypertension?

What is included in the emergent treatment of variceal bleeding in portal hypertension?

How are infections prevented during the emergent treatment of portal hypertension?

What is the role of somatostatin in the emergent treatment of portal hypertension?

What is the role of octreotide in the treatment of portal hypertension?

What is the role of vasopressin in the treatment of portal hypertension?

What is the role of terlipressin in the treatment of portal hypertension?

What is the role of vasoactive drugs in the treatment of portal hypertension?

What is the role of endoscopic therapy in the treatment of portal hypertension?

What is the role of endoscopic variceal ligation (EVL) in the emergent treatment of portal hypertension?

How is endoscopic variceal ligation (EVL) performed in the emergent treatment of portal hypertension?

What is the efficacy of endoscopic variceal ligation (EVL) and sclerotherapy compare in the emergent treatment of portal hypertension?

What are systemic complications of endoscopic variceal ligation (EVL) for the emergent treatment of portal hypertension?

What are the limitations of endoscopic variceal ligation (EVL) for the emergent treatment of portal hypertension?

What should be considered before selection of endoscopic variceal ligation (EVL) for the emergent treatment of portal hypertension?

What is the role of endoscopic injection sclerotherapy in the emergent treatment of portal hypertension?

How is endoscopic injection sclerotherapy performed for the emergent treatment of portal hypertension?

How quickly is bleeding in portal hypertension controlled using sclerotherapy?

Which agents are used as sclerosants in endoscopic injection sclerotherapy for portal hypertension?

What are the complications of endoscopic injection sclerotherapy for portal hypertension?

What is the role of balloon-tube tamponade in the emergent treatment of portal hypertension?

What are the possible of balloon-tube tamponade for portal hypertension?

What are the benefits of a Minnesota tube in balloon tube tamponade for the treatment of portal hypertension?

What is the role of percutaneous transhepatic embolization (PTE) in the emergent treatment of portal hypertension?

What is the role of cyanoacrylate monomer (superglue) in the emergent treatment of portal hypertension?

What is the role of transjugular intrahepatic portosystemic shunt (TIPS) in the emergent treatment of portal hypertension?

What are the indications for a transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension?

What are the experimental indications for a transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of portal hypertension?

What causes recurrent portal hypertension and bleeding after a transjugular intrahepatic portosystemic shunt (TIPS) procedure?

What are the possible complications of transjugular intrahepatic portosystemic shunt (TIPS) for the emergent treatment of portal hypertension?

What are the possible complications of transjugular intrahepatic portosystemic shunt (TIPS) related to portosystemic shunting for portal hypertension?

What is the role of surveillance in the management of portal hypertension?

What are characteristics of portal hypertension at a high risk of bleeding?

What is the preferred treatment for portal hypertension with medium or large varices and bleeding stigmata?

When are nonselective beta-blockers indicated in the treatment of portal hypertension?

What is included in the surveillance of portal hypertension?

What is the role of beta blockers in the management of portal hypertension?

How great is the decreased risk of initial bleeding in portal hypertension from nonselective beta-blockers?

What is the efficacy of beta-blockers for the treatment of portal hypertension?

What is the role of propranolol in the treatment of portal hypertension?

What are the contraindications for propranolol in the treatment of portal hypertension?

What is the duration of beta-blocker therapy in the treatment of portal hypertension?

What is the role of vasodilators in the primary prevention of portal hypertension?

What is the role of combination therapy in the primary prevention of portal hypertension?

What is the role of sclerotherapy in the primary prevention of portal hypertension?

What is the role of endoscopic variceal ligation (EVL) in the primary prevention of portal hypertension?

Medications

What are the goals of drug treatment for portal hypertension?

What are the benefits of vasoactive agents in the treatment of portal hypertension?

What is the role of vasoconstrictors in the treatment of portal hypertension?

What is the role of beta-blockers in the treatment of portal hypertension?

Which medications in the drug class Vasodilators are used in the treatment of Portal Hypertension?

Which medications in the drug class Vasopressin-Related are used in the treatment of Portal Hypertension?

Which medications in the drug class Beta-Blockers, Nonselective are used in the treatment of Portal Hypertension?

Which medications in the drug class Somatostatin Analogs are used in the treatment of Portal Hypertension?