Portal hypertension classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

Based on the etiology, portal hypertension may be classified as pre-hepatic, intra-hepatic, and post-hepatic. Intra-hepatic portal hypertension classified into pre-sinusoidal, sinusoidal, and post-sinusoidal disorders. Based on the functional impairment in the liver, portal hypertension may be classified as cirrhotic and non-cirrhotic.

Based on the etiology, portal hypertension may be classified as pre-hepatic, intra-hepatic, and post-hepatic.
Intra-hepatic portal hypertension classified into pre-sinusoidal, sinusoidal, and post-sinusoidal disorders.
Based on the functional impairment in the liver, portal hypertension may be classified as cirrhotic and non-cirrhotic.^[1]

Portal Hypertension classification

Functional

Etiology

Cirrhotic

Without any underlying cause

Pre-hepatic portal hypertension

Intra-hepatic portal hypertension

Post-hepatic portal hypertension

Idiopathic portal hypertension

Pre-sinusoidal disorders

Post-sinusoidal disorders

Group		Wedged hepatic venous pressure (WHVP)	Free hepatic vein pressure (FHVP)	Hepatic vein pressure gradient (HVPG)	Cause
Pre-hepatic portal hypertension		Normal	Normal	Normal	Increase in portal veins resistance Inflammatory portal vein closure due to thrombosis^[2]
Intra-hepatic portal hypertension^[3]	Pre-sinusoidal disorders	Normal	Normal	Normal	Portal vein thrombosis Schistosomiasis Primary biliary cirrhosis
	Sinusoidal disorders	Elevated	Elevated	Elevated	Cirrhosis
	Post-sinusoidal disorders	Elevated	Normal	Elevated	Right heart failure Inferior vena cava (IVC) obstruction
Post-hepatic portal hypertension^[4]		Elevated	Elevated	Normal	Increased post-hepatic vessels resistance

Idiopathic portal hypertension (IPH) is due to obstruction and stenosis of intra-hepatic portal vasculature.^[5]
Idiopathic portal hypertension (IPH) has 4 stages:^[5]
1. Stage I: Non-atrophic liver without subcapsular parenchymal atrophy.
2. Stage II: Non-atrophic liver with subcapsular parenchymal atrophy.
3. Stage III: Atrophic liver with subcapsular parenchymal atrophy.
4. Stage IV: Portal venous occlusive thrombosis.

↑ Grammatikopoulos, Tassos; McKiernan, Patrick James; Dhawan, Anil (2017). “Portal hypertension and its management in children”. Archives of Disease in Childhood: archdischild-2015–310022. doi:10.1136/archdischild-2015-310022. ISSN 0003-9888.
↑ Králík J, Neoral C (1992). “[Rational therapy of prehepatic portal hypertension]”. Rozhl Chir (in Czech). 71 (10): 513–22. PMID 1475714.
↑ Bertocchini A, Falappa P, Grimaldi C, Bolla G, Monti L, de Ville de Goyet J (2014). “Intrahepatic portal venous systems in children with noncirrhotic prehepatic portal hypertension: anatomy and clinical relevance”. J. Pediatr. Surg. 49 (8): 1268–75. doi:10.1016/j.jpedsurg.2013.10.029. PMID 25092088.
↑ Abd El-Hamid N, Taylor RM, Marinello D, Mufti GJ, Patel R, Mieli-Vergani G, Davenport M, Dhawan A (2008). “Aetiology and management of extrahepatic portal vein obstruction in children: King’s College Hospital experience”. J. Pediatr. Gastroenterol. Nutr. 47 (5): 630–4. doi:10.1097/MPG.0b013e31817b6eea. PMID 18955865.
↑ ^5.0 ^5.1 Nakanuma, Yasuni; Tsuneyama, Koichi; Makoto, Ohbu; Katayanagi, Kazuyoshi (2001). “Pathology and Pathogenesis of Idiopathic Portal Hypertension with an Emphasis on the Liver”. Pathology – Research and Practice. 197 (2): 65–76. doi:10.1078/0344-0338-5710012. ISSN 0344-0338.