Every year in western countries
millions of people are diagnosed with portal hypertension (PHT) which rapidly
complicates hepatic cirrhosis and causes esophageal varices, ascites and
encephalopathy. This determines higher risk of morbidity and mortality and
contributes to elevate costs for the Health Care System.
PHT is defined as the elevation
of the portal vein pressure gradient over 5-10 mmHg. Common causes are:
Pre-hepatic such as portal vein thrombosis or congenital atresia; intra-hepatic
as liver cirrhosis, hepatic
fibrosis and less commonly non-cirrhotic causes such as schistosomiasis,
massive fatty change and granulomatous diseases; post-hepatic including
obstruction that occurs at any level between liver and right heart (i.e., Budd
Chiari syndrome and veno-occlusive disease VOD).
The pathophysiology of portal
hypertension is explained by the increasing of vascular resistance into the
blood flow of the liver; as consequence the hepatic micro vasculature is
compressed by regenerative nodules and fibrotic scars of the cirrhosis.
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