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Portal hypertension: classification
Last reviewed: 23.04.2024
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Portal hypertension is associated with the presence of an obstruction to outflow of blood. In accordance with the localization of the obstruction, the current of the blood is divided into the following forms of portal hypertension.
- Prehepatic (subhepatic) form - the obstruction is localized in the trunk of the portal vein or its large branches.
- Intrahepatic - an obstacle (block) at the level of intrahepatic branching of the portal vein, i.e. In the liver itself. Intrahepatic portal hypertension, depending on the ratio of the blocking site to the hepatic sinusoids, is divided into postsinusoidal, sinusoidal and presynusoidal.
- Posthepatic (superhepatic) - a violation of the outflow of blood at the level of extrahepatic trunks of the hepatic veins or in the inferior vena cava proximal to the point of confluence into it.
- Mixed form - a violation of blood flow is localized both in the liver itself and in the extrahepatic parts of the portal or hepatic veins.
Gamado (1981), Sherlok (1985) suggested taking into account not only the area of the vascular block, but also the hepatic vein catheterization data. Catheterization of the hepatic vein gives an idea of sinusoidal pressure.
The cardiac catheter is guided through the ulnar vein, then into the right heart, the lower vena cava, and finally into one of the hepatic veins until it seizes in a small intrahepatic vein, while sinusoidal venous pressure is transferred to the tip of the catheter.
Portal venous pressure is determined by catheterization or puncture of the main trunk of the portal vein.
Based on the gradient between wedged hepatic venous pressure and portal venous pressure, intrahepatic portal hypertension is divided into:
- Presinusoidal form - wedged hepatic venous (or sinusoidal) pressure normal or below portal pressure;
- Sinusoidal form - with the jammed venous pressure higher or equal to the portal one;
- postsinusoidal form - wedged venous hepatic pressure increased, portal pressure increased slightly or normal.
Classification of portal hypertension
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Presynusoidal | |
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Extrahepatic |
Blockade of the portal vein Increased blood flow through the spleen |
|
Intrahepatic |
Infiltration of the portal zone Toxic Hepatic-portal sclerosis |
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Hepatic | |
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Intrahepatic |
Cirrhosis |
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Post-sinusoidal |
Other diseases accompanied by the formation of nodes Blockade of the hepatic vein |
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