Liver and intrahepatic bile ducts-nontumor
Reviewers: Komal Arora, M.D. (see Reviewers page)
Revised: 16 May 2012, last major update May 2012
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● Causes are pre-, intra- and post-hepatic
● Prehepatic: obstructive thrombosis and narrowing of portal vein before it ramifies in the liver, shunting of blood into splenic vein via splenomegaly
● Intrahepatic: usually cirrhosis, due to increased resistance to portal flow at level of sinusoids and compression of central veins by perivenular fibrosis and expansive parenchymal nodules; also connections between arterial and portal systems raise portal venous pressure
● Posthepatic: congestive heart failure, constrictive pericarditis, hepatic vein outflow obstruction; may be due to myeloproliferative disorders with hypercoagulability, peritonitis, chronic exposure to arsenic
● Rare causes: schistosomiasis, massive fatty change, sarcoidosis, miliary tuberculosis, nodular regenerative hyperplasia
● Complications: ascites, portosystemic venous shunts (hemorrhoidal veins, cardioesophageal junction and esophageal varices, retroperitoneum, falciform ligament of liver [dilated periumbilical and abdominal wall collaterals cause caput medusae on abdominal / thorax]), congestive splenomegaly, hepatic encephalopathy
End of Liver and intrahepatic bile ducts-nontumor > Vascular disorders > Portal hypertension
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