hepatic and biliary disorders
Portal Hypertension
Key Points
Portal hypertension is caused most often by cirrhosis (in Europe and North America), schistosomiasis (in endemic areas), or hepatic vascular abnormalities. Complications can include acute variceal bleeding (with a high mortality rate), ascites, splenomegaly, and portosystemic encephalopathy. Diagnose portal hypertension based on clinical findings. To help prevent acute variceal bleeding, initiate periodic surveillance and endoscopic banding sessions. To help prevent rebleeding, treat with nonselective beta-blockers with or withoutisosorbide mononitrate, transjugular intrahepatic portosystemic shunting (TIPS), or both. 