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Assessment and Management of Portal Hypertension

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PanVascular Medicine

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Abstract

Cirrhosis is the main cause of portal hypertension. Variceal bleeding is the most serious complication of portal hypertension. All cirrhotic patients should be screened endoscopically for varices which are present in about 50 % of patients at diagnosis. In patients without varices, endoscopy should be repeated every 2 years. Patients with high-risk varices (moderate or large in size, or with red color signs, or in Child-Pugh C patients) should be treated with a nonselective beta-blocker to prevent bleeding. Patients with contraindications to beta-blockers or who cannot tolerate these drugs should receive endoscopic band ligation. Acute variceal hemorrhage calls for intensive care and conservative blood transfusion policy. Treatment is based on the combined use of vasoactive drugs, endoscopic band ligation, and prophylactic antibiotics. Failures are best managed by transjugular intrahepatic portosystemic shunt. Patients surviving variceal bleeding are at high risk of rebleeding; medical therapies, using beta-blockers and endoscopic band ligation, are the recommended treatments.

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Abbreviations

Elastography:

A method to estimate liver stiffness, useful in clinical practice to assess the degree of liver fibrosis and the severity of cirrhosis.

Endoscopic banding ligation:

An interventional endoscopic procedure consisting of the obliteration of esophageal varices by compression with elastic rubber bands. This is done with a special device that suctions the varix into it and deploys the rubber band.

HVPG (hepatic venous pressure gradient):

A measurement of the portal pressure gradient used in clinical practice. It is obtained by measuring wedged hepatic venous pressure (WHVP), by occluding the hepatic vein, and the free hepatic venous pressure. The HVPG is the difference between WHVP and FHVP.

TIPS (transjugular intrahepatic portosystemic shunt):

Nonsurgical portosystemic shunt created by establishing a connection between the portal and hepatic vein through the liver parenchyma. This connection is covered by a stent to maintain a patent tract through the liver parenchyma. The procedure is done transjugularly.

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Acknowledgements

We thank Ms. Rachel Borowsky and Rebecca Thomlinson for expert secretarial support, and Asumpta Garolera for expert assistance with figures.

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Authors and Affiliations

  1. Cirrhosis Care Clinic (CCC), Division of Gastroenterology (Liver Unit), University of Alberta, 1-51 Zeidler Ledcor Building, Edmonton, AB, T6G-2X8, Canada

    Dr. Juan G. Abraldes M.D., M.M.Sc. (Associate Professor of Medicine) & Puneeta Tandon M.D. (Associate Professor of Medicine)

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  1. Dr. Juan G. Abraldes M.D., M.M.Sc.
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  2. Puneeta Tandon M.D.
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Correspondence to Juan G. Abraldes M.D., M.M.Sc. .

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Editors and Affiliations

  1. Akademisches Lehrkrankenhaus MLU, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Abraldes, J.G., Tandon, P. (2014). Assessment and Management of Portal Hypertension. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37393-0_199-1

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  • DOI: https://doi.org/10.1007/978-3-642-37393-0_199-1

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