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Acute Life-Threatening Complications of Portal Hypertension: a Review of Pathophysiology, Incidence, Management, and Cost

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Abstract

Portal hypertension represents a dysfunctional hemodynamic alteration within the portal venous system, usually due to cirrhosis. These altered hemodynamics play a direct role in the development of acute, life-threatening variceal hemorrhage and mark an important pathophysiologic step in the development of other sudden and life-threatening complications such as type 1 hepatorenal syndrome and spontaneous bacterial peritonitis. Many life-saving interventions in these patients are aimed at reducing portal venous pressure. The contribution of portal hypertension to the development of variceal hemorrhage, type 1 hepatorenal syndrome (known also by the name HRS-AKI), and spontaneous bacterial peritonitis in cirrhotic patients is discussed. This article reviews the pathophysiology and incidence of life-threatening complications of cirrhotic portal hypertension, with a discussion of management options and treatment costs.

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Authors and Affiliations

  1. Department of Radiology, Baylor Scott & White Medical Center—Temple, 2401 S. 31st St., Temple, TX, 76508, USA

    Robert E. Smith, James A. Murchison & Bradley T. Dollar

  2. Division of Gastroenterology, Austin Diagnostic Clinic, 12221 MoPac Expressway North, Austin, TX, 78758, USA

    Alice D. Friedman

  3. Department of Nephrology, Baylor Scott & White Medical Center—Temple, 2401 S. 31st St., Temple, TX, 76508, USA

    S. Blake Tanner

  4. TMC Innovation Institute, Texas Medical Center, 2450 Holcombe Blvd Ste X, Houston, TX, 77021, USA

    P. Alexander Smith

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Correspondence to Robert E. Smith.

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Smith, R.E., Friedman, A.D., Murchison, J.A. et al. Acute Life-Threatening Complications of Portal Hypertension: a Review of Pathophysiology, Incidence, Management, and Cost. SN Compr. Clin. Med. 2, 1628–1645 (2020). https://doi.org/10.1007/s42399-020-00435-5

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