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Other signs of portal hypertension on ultrasound include a portal flow mean velocity of less than 12 cm/s, porto–systemic collateral veins (patent paraumbilical vein, spleno–renal collaterals and dilated left and short gastric veins), splenomegaly and signs of cirrhosis (including nodularity of the liver surface).
Portal venous pressure is the blood pressure in the hepatic portal vein, and is normally between 5 and 10 mmHg. [1] Raised portal venous pressure is termed portal hypertension , [ 2 ] and has numerous sequelae such as ascites and hepatic encephalopathy .
For example, in portal hypertension, there is an abnormal portal venous flow where it flows away from the liver (hepatofugal flow) instead of the normal flow towards liver (hepatopetal flow). In jugular venous pressure waveform of the internal jugular vein , the retrograde "a" waveform is a normal flow due to right atrium contraction.
Hepatorenal syndrome usually affects individuals with cirrhosis and elevated pressures in the portal vein system (termed portal hypertension). While HRS may develop in any type of cirrhosis, it is most common in individuals with alcoholic cirrhosis, particularly if there is concomitant alcoholic hepatitis identifiable on liver biopsies. [9]
Portopulmonary hypertension (PPH) [1] is defined by the coexistence of portal and pulmonary hypertension. PPH is a serious complication of liver disease, present in 0.25 to 4% of all patients with cirrhosis. Once an absolute contraindication to liver transplantation, it is no longer, thanks to rapid advances in the treatment of this condition. [2]
Liver cirrhosis can lead to increased intrahepatic vascular resistance and vasodilation of portal system arteries, both of which increase pressure in the portal vein. [4] Color Doppler Ultrasound is the most useful imaging tool used to identify aneurysms, thrombosis, and branching patterns of the portal venous system, and to determine if ...
A dilated portal vein (diameter of greater than 13 or 15 mm) is a sign of portal hypertension, with a sensitivity estimated at 12.5% or 40%. [8] On Doppler ultrasonography, the main portal vein (MPV) peak systolic velocity normally ranges between 20 cm/s and 40 cm/s. [9]
An enlarged spleen, which normally measures less than 11–12 cm (4.3–4.7 in) in adults, may suggest underlying portal hypertension. [67] Ultrasound may also screen for hepatocellular carcinoma and portal hypertension. [45] This is done by assessing flow in the hepatic vein. [68] An increased portal vein pulsatility may be seen.