Portal hypertension and its complications.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Blei
Andres T
AT
Division of Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. a-blei@northwestern.edu
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001201:Ascites / Q000209:etiology*; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007010:Hyponatremia / Q000209:etiology*; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D011379:Prognosis; D015911:Sclerotherapy / Q000379:methods
D000959:Antihypertensive Agents