Portal prehepatic

Non-parenchymatous portal hypertension 1. Prehepatic portal hypertension 2. Intrahepatic portal hypertension ... 

Prehepatic (non-parenchymatous) portal hypertension develops (i.) as a result of an increase in the portal blood supply in the form of hyperkinetic hypertension or (2.) due to occlusion of the portal vein or its trunks. The frequency is 10—20%. The liver is morphologically normal, but is diminished in size. Its function is not impaired. The reduced afferent portovenous flow is compensated by arterial perfusion of the liver. Ascites occurs only rarely. 

Duodenal varices are rare. Consequently, their frequency is poorly documented. They are present predominantly in patients with prehepatic portal hypertension. Possible therapy options include banding and medication (terli-pressin, octreotide, later on P-blockers, etc.) or placement of a TIPS (provided there is no portal thrombosis). (63, 117)... 

Acquired causes may also be responsible for some of the congenital anomalies described above. Mention should be made of (1.) arterioportal fistulas, (2.) cavernous transformation of the portal vein (in portal vein thrombosis), (3.) fibrous obliteration of the portal vein, and (4.) cicatricial portal vein stenosis. These may also cause prehepatic hypertension, (s. tab. 14.2) (s. p. 246 )... 

Thromboses in the vessels of the portal system constitute the most common cause of prehepatic portal hypertension. Even in the postpartal phase, portal vein thrombosis may occur due to the obliteration of the umbilical vein spreading to the portal vein or due to an infection of the umbilical vein with subsequent pylephlebitis. In the adult, this clinical picture is most commonly observed in liver diseases that cause the portal blood flow to slow down (or even reverse). All diseases which are accompanied by hypercoagulopathies also have a strong tendency to cause portal vein thrombosis. (106, 110, 112, 119, 121) Patients with liver cell carcinoma due to cirrhosis quite often develop thrombosis. Septic processes (such as appendicitis, diverticulitis, colitis) are a further common cause, particularly in immuno-... 

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