Portal Hypertension - Differential Diagnosis
Portal ...
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Description

Portal Hypertension - Differential Diagnosis

Portal Pressure = the pressure difference between the pressure in the portal vein and IVC, (HVPC) estimated by gradient between wedged (sinusoidal) and free hepatic vein pressure. 

    >5 mmHg - portal HTN

    >10 mmHg - clinically significant portal HTN

Signs of portal HTN: ascites (SAAG>I.I), esophageal varices, hypersplenism and related thrombocytopenia, hepatic encephalopathy, and hepatorenal syndrome

Clues to non-cirrhotic portal HTN:

 • Ascites protein 22.5 g/dl (suggest hepatic outflow obstruction)

 • Lack of signs of increased estrogen such as spider angiomas, gynecomastia, and palmar erythema

 • Preserved hepatic synthetic function: INR, bilirubin, albumin

Post-Hepatic:

 • Cardiac causes including R heart failure and constrictive pericarditis

 • Budd Chiari syndrome (hepatic vein clot)

Intrahepatic:

 • Cirrhosis/acute hepatitis

 • Infiltrative diseases (amyloidosis/ sarcoidosis)

 • Liver metastasis

 • Fatty liver of pregnancy

 • Primary biliary cirrhosis

 • Schistosomiasis

 • Veno-occlusive disease

Pre-Hepatic

 • Portal vein thrombosis

 • Splenic AV malformation



Dr. Ann Marie Kumfer @AnnKumfer



#Portal #Hypertension #Differential #Diagnosis #causes #hepatology 
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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