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
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