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Portal Hypertension: Intrahepatic Mechanisms

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Vascular Liver Disease

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Abstract

Portal hypertension is one of the most life-threatening complications of cirrhosis, leading to the development of ascites and esophageal varices. Increased intrahepatic resistance is the initial event in the development of portal hypertension. Anatomical lesions contribute approximately to 70% of the increased intrahepatic vascular resistance. These include regenerative nodules, capillarization of sinusoids, sinusoidal collapse, and hepatocyte enlargement. The remaining 30% represents the dynamic component of the increased intrahepatic vascular resistance. Hepatic stellate cells play a central role in the regulation of sinusoidal resistance. These cells are transformed to a myofibroblast-like cell type with increased constrictive properties. Increased levels of vasoconstrictors and decreased levels of vasodilators lead to HSC constriction and subsequently to an increase in intrahepatic vascular resistance. On the other hand, higher concentrations of vasodilators induce hepatic arterial vasodilatation and a lower vascular resistance of the hepatic artery in cirrhosis. Additionally, vascular architectural changes are present in cirrhosis and recent investigations have focused on the presence of neoangiogenesis and vascular remodeling in the intrahepatic circulation.

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  1. Department of Medicine-Digestive Diseases, Yale University School of Medicine, 208019, New Haven, CT, 06520-8019, USA

    Roberto J. Groszmann

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  1. Alexander Zipprich
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  1. Keck School of Medicine, Div. GI & Liver Diseases, University of Southern California, Los Angeles, 90033, California, USA

    Laurie D. DeLeve

  2. , Section of Digestive Diseases, Yale University School of Medicine, New Haven, 06520, Connecticut, USA

    Guadalupe Garcia-Tsao

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Zipprich, A., Groszmann, R.J. (2011). Portal Hypertension: Intrahepatic Mechanisms. In: DeLeve, L., Garcia-Tsao, G. (eds) Vascular Liver Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-8327-5_6

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