portal hypertension

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por·tal hy·per·ten·sion

hypertension in the portal system as seen in cirrhosis of the liver and other conditions causing obstruction to the portal vein.

portal hypertension

an increased venous pressure in the portal circulation caused by compression or occlusion in the portal or hepatic vascular system. It results in splenomegaly, large collateral veins, ascites, and, in severe cases, systemic hypertension and esophageal varices. Portal hypertension is frequently associated with cirrhosis.

hypertension

High blood pressure Cardiovascular disease An abnormal ↑ systemic arterial pressure, corresponding to a systolic BP of > 160 mm Hg and/or diastolic BP of 95 mm Hg and graded according to intensity of ↑ diastolic BP; HTN affects ± 60 million in the US Workup Evaluation of HTN requires clinical Hx for Pt, family Hx, 2 BP determinations, funduscopy, ID of bruits in neck & abdominal aorta, evaluation of peripheral edema, peripheral pulses and residual neurologic defects in stroke victims, chest films to determine cardiac size and lab parameters to rule out causes of secondary HTN Risk factors Race–blacks more common, ♂, family history of HTN, obesity, defects of lipid metabolism, DM, sedentary lifestyle, cigarette smoking, electrolyte imbalance–eg, ↑ sodium, phosphorus, ↓ potassium, tin Treatment Diet–eg, sodium restriction, ↓ calories, alcohol and cigarettes–the weight gain accompanying smoking cessation tends to offset the minimal ↓ in BP, calcium supplements, lifestyle manipulation–eg, biofeedback, ↑ exercise; antihypertensives–eg, diuretics–benzothiadiazines, loop diuretics, potassium-sparing diuretics, sympatholytic agents–central and peripheral-acting α-adrenergics, β-adrenergics, mixed α- and β-blockers, direct vasodilators, ACE inhibitors–the preferred agent to use ab initio, dihydropiridine CCBs. See ACCT, ACE inhibitor, Borderline hypertension, Borderline isolated systolic hypertension, Calcium channel blocker, Drug-induced hypertension, Essential hypertension, Exercise hypertension, Familial dyslipemic hypertension, Gestational hypertension, Idiopathic intracranial hypertension, Isolated systolic hypertension, Malignant hypertension, MRC, Obetension, Paradoxic hypertension, Pill hypertension, Pregnancy-induced hypertension, Pseudohypertension, Pulmonary hypertension, Refractory hypertension, Renovascular hypertension, SHEP, STOP-Hypertension, TAIM, TOHP-1, TOMHSTyramine hypertension, White coat hypertension.
Hypertension
Class I–mild Diastolic pressure 90-104 mm Hg
Class II–moderate Diastolic pressure 105-119 mm Hg
Class III–severe Diastolic pressure > than 120 mm Hg
Hypertension types
Essential hypertension Idiopathic HTN The major form comprising 90% of all HTN
Malignant hypertension A sustained BP > 200/140 mm Hg, resulting in arteriolar necrosis, most marked in the brain, eg. cerebral hemorrhage, infarcts, and hypertensive encephalopathy, eyes, eg papilledema and hypertensive retinopathy and kidneys, eg acute renal failure and hypertensive nephropathy; if malignant HTN is uncorrected or therapy refractory, Pts may suffer a hypertensive crisis in which prolonged high BP causes left ventricular hypertrophy and CHF
Paroxysmal hypertension Transient or episodic waves of ↑ BP of any etiology, punctuated by periods of normotension, typical of pheochromocytoma
Portal hypertension ↑ portal vein pressure caused by a backflow of blood through splenic arteries, resulting in splenomegaly and collateral circulation, resulting in esophageal varices and/or hemorrhoids; PH may be intra- or extrahepatic, and is often due to cirrhosis, or rarely portal vein disease, venous thrombosis, tumors or abscesses
Pulmonary hypertension A condition defined as a 'wedge' systolic/diastolic pressure > 30/20 mm Hg–Normal: 18-25/12-16 mm Hg, often secondary to blood stasis in peripheral circulation, divided into passive, hyperkinetic, vasoocclusive, vasoconstrictive and secondary forms. See Pulmonary HTN.
Renovascular hypertension see there.
Secondary hypertension
Aging
Cardiovascular Open heart surgery, coarctation of aorta, ↑ cardiac output–anemia, thyrotoxicosis, aortic valve insufficiency
Cerebral ↑ Intracranial pressure
Endocrine Mineralocorticoid excess, congenital adrenal hyperplasia, glucocorticoid excess, eg Cushing syndrome, hyperparathyroidism, acromegaly
Gynecologic Pregnancy, oral contraceptives
Neoplasia Renin-secreting tumors, pheochromocytoma
• ↓ Peripheral vascular resistance AV shunts, Paget's disease of bone, beri-beri
Renal disease Vascular, parenchymal

por·tal hy·per·ten·sion

(pōr'tăl hī'pĕr-ten'shŭn)
Elevation of pressure in the hepatic portal circulation due to cirrhosis or other fibrotic change in liver tissue; when pressure exceeds 10 mmHg, a collateral circulation may develop to maintain venous return from structures drained by the portal vein; engorgement of collateral veins can lead to esophageal varices and, less often, caput medusae.

portal hypertension

Increased blood pressure in the PORTAL VEIN, that carries blood from the intestines and spleen to the liver. The commonest cause is CIRRHOSIS of the liver. The rise in pressure in the veins at the lower end of the oesophagus causes them to become stretched and irregular (varicose) and there is a real danger of severe bleeding from these oesophageal varices. This can be controlled by the use of balloons inserted into the oesophagus and then inflated. Injections of hardening solution into the varices to close them off (sclerotherapy) may be helpful. A blood shunting operation is sometimes performed.

Portal hypertension

Portal hypertension forces the blood flow backward, causing the portal veins to enlarge and the emergence of bleeding varices across the esophagus and stomach from the pressure in the portal vein. Portal hypertension is most commonly caused by cirrhosis, but can also be seen in portal vein obstruction from unknown causes.

por·tal hy·per·ten·sion

(pōr'tăl hī'pĕr-ten'shŭn)
Elevation of pressure in the hepatic portal circulation due to cirrhosis or other fibrotic change in liver tissue.

hypertension

persistently high blood pressure. Detected sporadically in animals partly due to the technical difficulties in diagnosis and the lack of recognizable signs. Greyhounds normally have a higher blood pressure than is found in crossbred dogs with features resembling essential hypertension in humans. Secondary hypertension due to advanced renal disease, hyperthyroidism and hyperadrenocorticism does occur in dogs and cats. Temporary episodes of hypertension occur in all animals suffering severe pain, and in horses with acute laminitis.

endocrine hypertension
that occurring in association with diseases of the endocrine glands.
Goldblatt hypertension
see Goldblatt kidney.
inherited hypertension
see rat hypertension (below).
neurogenic hypertension
produced experimentally in laboratory animals by the imposition of surgical and psychological insults on the central nervous system.
ocular hypertension
persistently elevated intraocular pressure in the absence of any other signs of glaucoma; it may or may not progress to chronic simple glaucoma.
portal hypertension
abnormally increased pressure in the portal circulation caused by impedance of blood flow through a diseased liver or portal vein.
pulmonary hypertension
results from high-pressure blood flow from the right ventricle or impedance to blood flow through the lungs or through the left heart. Chronic hypertension causes endothelial degeneration and fibroplasia of vessel walls. The end result may be cor pulmonale or pulmonary edema. See also altitude sickness, cor pulmonale.
rat hypertension
several strains of spontaneously hypertensive rats have been bred.
renal hypertension
secondary hypertension.
systemic venous hypertension
elevation of systemic venous pressure, usually detected by inspection of the jugular veins.

portal

1. an avenue of entrance; porta.
2. pertaining to an entrance, especially the porta hepatis.

portal-azygos anastomosis
a form of portacaval shunt with the portal vein bypassing the liver and emptying directly into the azygos vein.
portal biliary bacterial circulation
a continuous normal circulation of bacteria brought to the liver in the portal vein from the gut and excreted back into the gut via the biliary system.
portal canal
tissue space situated between three or more hepatic lobules; carries the blood and lymphatic vessels and connective tissue.
portal-caval
see portacaval.
portal circulation
circulation of blood from the capillaries of one organ to those of another; applied especially to the passage of blood from the gastrointestinal tract and spleen through the portal vein to the liver. See also circulatory system.
portal of entry
the pathway by which bacteria or other pathogenic agents gain entry to the body.
portal fibrosis
see biliary fibrosis.
portal hypertension
see portal obstruction.
portal obstruction
obstruction of portal venous blood flow through external pressure on the portal vein, by abscess or tumor or by hepatic fibrosis constricting the hepatic vascular bed, causes interference with digestion and absorption and eventually venous return so that ascites and diarrhea develop.
portal system
an arrangement by which blood collected from one set of capillaries passes through a large vessel or vessels and another set of capillaries before returning to the systemic circulation, as in the pituitary gland and liver.
Includes the hepatic portal system consisting of portal vein and its tributaries from the stomach, intestine, pancreas and spleen, the vessels into which the portal vein divides in the liver and the hepatic veins that enter into the caudal vena cava.
portal systemic shunt
see portacaval shunt.
portal triad
anatomically close association of interlobular bile duct, branches of hepatic artery and portal vein.
portal vascular anomalies
see portacaval anastomosis.
portal vein
a short, thick trunk formed by the union of the caudal mesenteric and splenic veins; at the porta hepatis, it divides into successively smaller branches, following branches of the hepatic artery, until it forms a capillary system of sinusoids that permeates the entire substance of the liver.
portal vein obstruction
acute, complete obstruction causes a syndrome similar to that of intestinal obstruction without signs suggesting liver involvement; partial occlusion causes shrinkage and eventual atrophy of the relevant section of the liver.
portal vein rupture
rare complication of epiploic foraminal herniation; sudden death from internal hemorrhage results.
portal venule absence
a congenital defect resulting in the development of multiple shunts within the liver, hepatoportal fibrosis and ascites, general immaturity and hepatic encephalopathy.
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