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Portal hypertension - Classification
Last reviewed: 04.07.2025
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Portal hypertension is associated with the presence of an obstruction to blood flow. According to the localization of the obstruction to blood flow, the following forms of portal hypertension are distinguished.
- Prehepatic (subhepatic) form - the obstruction is localized in the trunk of the portal vein or its large branches.
- Intrahepatic - an obstruction (block) at the level of the intrahepatic branches of the portal vein, i.e. in the liver itself. Intrahepatic portal hypertension, depending on the relationship of the blockage site to the hepatic sinusoids, is subdivided into postsinusoidal, sinusoidal and presinusoidal.
- Posthepatic (suprahepatic) - a violation of the outflow of blood at the level of the extrahepatic trunks of the hepatic veins or in the inferior vena cava proximal to the place where it enters it.
- Mixed form - the blood flow disorder 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 vascular block, but also the data of hepatic vein catheterization. Hepatic vein catheterization gives an idea of the sinusoidal pressure.
The cardiac catheter is advanced through the antecubital vein, then into the right heart, the inferior vena cava, and finally into one of the hepatic veins until it is wedged in a small intrahepatic vein, transmitting sinusoidal venous pressure 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 hepatic venous wedge pressure and portal venous pressure, intrahepatic portal hypertension is divided into:
- presinusoidal form - wedge hepatic venous (or sinusoidal) pressure is normal or lower than portal pressure;
- sinusoidal shape - in this case, the wedged venous pressure is higher than or equal to the portal pressure;
- postsinusoidal form - the wedged hepatic venous pressure is increased, the portal pressure is slightly increased or normal.
Classification of portal hypertension
Presinusoidal |
|
Extrahepatic |
Portal vein block Increased blood flow through the spleen |
Intrahepatic |
Portal zone infiltration Toxic hepatic portal sclerosis |
Liver |
|
Intrahepatic |
Cirrhosis |
Postsinusoidal |
Other diseases accompanied by the formation of nodes Hepatic vein block |
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