Title: Portal Hypertension in Adults- A Comprehensive Review
Authors: Sweta.V.R, Dr Naufal Rizwan
DOI: http://dx.doi.org/10.18535/jmscr/v4i8.23
AIM: This article aims at providing an overview regarding Portal hypertension in adults. OBJECTIVE: To provide a comprehensive review on portal hypertension in adults. BACKGROUND: Portal hypertension is a clinical condition wherein the pressure inside the portal venous system is increased. Portal venous pressure is usually calculated by measuring the hepatic venous pressure gradient (HVPG), and portal hypertension is said to be present when HVPG is greater than 5mm Hg. The major causes of portal hypertension can be classified as pre-hepatic, hepatic and post hepatic causes. The presence of portal hypertension in an asult can lead to various complications such as ascites, hepato-renal syndrome, hepatic encephalopathy, development of oesophago-gastric varices etc. this article aims at providing an overview about the various causes, symptoms and treatment of portal hypertension. REASON: To provide an updated comprehensive review on portal hypertension in adults. KEY WORDS: hepatic venous pressure gradient, ascites, hepato-renal syndrome, hepatic encephalopathy, oesophago-gastric varices. 1. Ashish Goel, Kadiyala Madhu, Uday Zachariah, K.G. Sajith, Jeyamani Ramachandran, Banumathi Ramakrishna, Sridhar Gibikote, John Jude, George M. Chandy, Elwyn Elias, & C.E. Eapen. A study of aetiology of portal hypertension in adults (including the elderly) at a tertiary centre in southern India. Indian J Med Res 137, May 2013, pp 922-927. 2. Vorobioff J, Bredfeldt JE, Groszmann RJ. Increased blood flow through the portal system in cirrhotic rats. Gastroenterology 1984;87:1120–1126. 3. Dr. GS Sainani Oration; Portal HyPertension Dynamics - Pressure, Portal Flow, Progress & Prognosis; medicine update 2010, vol 20;7 : 11 4. Poddar U, Thapa BR, Rao KL, Singh K. Etiological spectrum of esophageal varices due to portal hypertension in Indian children: is it different from the West? J Gastroenterol Hepatol 2008; 23 : 1354-7. 5. Ray G, Ghoshal UC, Banerjee PK, Pal BB, Dhar K, Pal AK, et al. Aetiological spectrum of chronic liver disease in eastern India. Trop Gastroenterol 2000; 21 : 60-2. 6. Roberto de Franchis, Updating Consensus in Portal Hypertension: Report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension Journal of Hepatology 2000; 33: 846±852 7. Sarin SK, Lahoti D, Saxena SP, Murthi NS, Makwane UK.Prevalence, classification and natural history of gastric varices:long-term follow-up study in 568 patients with portal hypertension. Hepatology 1992; 16: 1343±9. 8. Pizcueta MP, Pique JM, Bosch J, et al. Effects of inhibiting nitric oxide biosynthesis on the systemic and splanchnic circulation of rats with portal hypertension. Br J Pharmacol 1992;105:184–190. 9. Fernandez M, Mejias M, Angermayr B, et al. Inhibition of VEGF receptor-2 decreases the development of hyperdynamic splanchnic circulation and portal-systemic collateral vessels in portal hypertensive rats. J Hepatol 2005;43:98–103. 10. Groszmann RJ, Garcia-Tsao G, Bosch J, et al. Beta-blockers to prevent gastroes-ophageal varices in patients with cirrhosis. N Engl J Med 2005;353:2254–2261. 11. Garcia-Tsao G, Groszmann RJ, Fisher RL, et al. Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 1985;5:419–424. 12. Vianna A, Hayes PC, Moscoso G, et al. Normal venous circulation of the gastroesophageal junction. A route to understanding varices. Gastroenterology 1987;93:876–889. 13. D’amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006;44: 217–231 14. Felipo V, Butterworth RF. Neurobiology of ammonia. Prog Neurobiol 2002;67:259–279. 15. Vaquero J, Polson J, Chung C, et al. Infection and the progression of hepatic encephalopathy in acute liver failure. Gastroenterology 2003;125:755–764. 16. Shawcross DL, Wright G, Olde Damink SW, et al. Role of ammonia and inflammation in minimal hepatic encephalopathy. Metab Brain Dis 2007;22:125–138. 17. de Franchis R, Primignani M. Natural history of portal hypertension in patients with cirrhosis. Clin Liv Dis 2001;5:645–663. 18. Cook D, Laine L. Indications, technique, and complications of balloon tamponade for variceal gastrointestinal bleeding. J Intensive Care Med 1992;7:212–218. 19. Hunt PS, Korman MG, Hansky J, et al. An 8-year prospective experience with balloon tamponade in emergency control of bleeding esophageal varices. Dig Dis Sci 1982;27:413–416. 20. Freedman AM, Sanyal AJ, Tisnado J, et al. Results with percutaneous transjugular intrahepatic portosystemic stent-shunts for control of variceal hemorrhage in patients awaiting livertransplantation.Transplant Proc 1993;25:1087–1089. 21. Bureau C, Garcia-Pagan JC, Otal P, et al. Improved clinical outcome using polytetrafluoroethylene-coated stents for TIPS:results of a randomized study. Gastroenterology 2004;126:469–475. 22. Sanyal AJ, Freedman AM, Luketic VA, et al. Transjugular intrahepatic portosystemic shunts for patients with active variceal hemorrhage unresponsive to sclerotherapy. Gastroenterology 1996;111:138–146 23. Perez-Ayuso RM, Arroyo V, Planas R, et al. Randomized comparative study of efficacy of furosemide versus spironolactone in nonazotemic cirrhosis with ascites. Relationship between the diuretic response and the activity of the renin-aldosterone system. Gastroenterology 1983;84:961–968. 24. Gines P, Arroyo V, Quintero E, et al. Comparison of paracentesis and diuretics in the treatment of cirrhotics with tense ascites. Results of a randomized study. Gastroenterology 1987;93:234–241. 25. Als-Nielsen B, Gluud LL, Gluud C. Benzodiazepine receptor antagonists for hepatic encephalopathy. Cochrane Database Syst Rev 2004;CD002798. 26. [Guideline] Garcia-Tsao G, Sanyal AJ, Grace ND, Carey WD, and the Practice Guidelines Committee of the American Association for the Study of Liver Diseases, the Practice Parameters Committee of the American College of Gastroenterology. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Am J Gastroenterol. 2007 Sep. 102(9):2086-102. [Medline]. 27. [Guideline] Dite P, Labrecque D, Fried M, et al, for the World Gastroenterology Organisation (WGO). World Gastroenterology Organisation practice guideline: esophageal varices. Munich, Germany: World Gastroenterology Organisation; 2008. Abstract
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