Portal hypertension and its complications.

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Portal hypertension and its complications.

Liver

Current

Opinion in Gastroenterology. 23(3):275-282, May 2007.

Blei, Andres T

Abstract:

Purpose of review: Portal hypertension is responsible for most of the

complications associated with cirrhosis, specifically variceal

hemorrhage, ascites and hepatic encephalopathy. Progress

in understanding the pathophysiology of portal

hypertension and improvements in the diagnosis and management of its

complications that have occurred over the last year are discussed.

Recent findings: Endothelial

dysfunction contributes to the pathogenesis of portal hypertension and may

represent a novel therapeutic target. Hepatic venous

pressure gradient measurements, when properly performed, are useful in the

management of patients with cirrhosis. Hyponatremia in cirrhosis has prognostic value and novel aquaretic and other agents may provide alternative

approaches to the management of chronic liver disease. The

mechanisms for bacterial translocation in cirrhosis that predisposes patients

to infectious complications, such as spontaneous bacterial peritionitis,

are being explored. Adrenal insufficiency is common in

septic patients with advanced cirrhosis and corticosteroids may provide a

survival benefit. Pulmonary disease complicates the

management of patients with advanced liver disease.

Summary:

Significant advances continue to be made in the diagnosis and management of

the complications of portal hypertension in the face of an increasing burden

of chronic liver disease. © 2007 Lippincott & Wilkins, Inc.

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