Portal hypertension

Cirrhosis represents the end stage of any chronic liver disease. Two major syndromes result from cirrhosis: portal hypertension and hepatic insufficie ncy, Additionally, vasodilatation and the hyperdynamic circulation are hemo dynamic abnormalities typical of cirrhosis and portal hypertension, Complic ations of cirrhosis occur as a consequence of a combination of these factor s. Gastroesophageal varices result almost solely from portal hypertension. although the hyperdynamic circulation contributes to variceal growth and he morrhage. Ascites results from sinusoidal hypertension and sodium retention , which is, in turn, secondary to vasodilatation and activation of neurohum oral systems. Hyponatremia and the hepatorenal syndrome result from water r etention and renal vasoconstriction, respectively, both of which are also c onsequences of peripheral vasodilatation. Vasodilatation that occurs in the pulmonary circulation leads to the hepatopulmonary syndrome. Another compl ication of cirrhosis, portosystemic encephalopathy, is a consequence of bot h portal hypertension (shunting of blood through portosystemic collaterals) and hepatic insufficiency. This paper reviews the recent advances in the p athophysiology and management of the complications of cirrhosis and portal hypertension. (C) 1999 Lippincott Williams & Wilkins, Inc.