فرط ضغط الدم البابي

فرط ضغط الدم البابي
الوريد البابي وروافده.
التبويب والمصادر الخارجية
التخصص	طب الجهاز الهضمي, جراحة الجهاز الهضمي[*]
ICD-10	K76.6
ICD-9-CM	572.3
DiseasesDB	10388
eMedicine	radio/570 med/1889
Patient UK	فرط ضغط الدم البابي
MeSH	D006975

في الطب فان فرط الضغط البابي يعني ارتفاع ضغط الدم في الوريد البابي وفروعه.وهو غالباما يعرف بمدروج الضغط البابي (الفرق بين الضغط في الوريد البابي والضغط في الوريد الكبدي) بقيمة 5 mmHg أو أكثر. هناك حالات كثيرة تؤدي الى ارتفاع الضغط البابي ففي شمال امريكا واوروبا يكون بسبب التليف الكبدي بينما في المجتمعات الاقل صناعية يكون السبب هو الاصابة بالبلهارسيا schistosomiasis.

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 العلامات والأعراض

Consequences of portal hypertension are caused by blood being forced down alternate channels by the increased resistance to flow through the portal system. They include:

• Ascites (free fluid in the peritoneal cavity)
• Hepatic encephalopathy
• Increased risk of spontaneous bacterial peritonitis
• Increased risk of hepatorenal syndrome
• Splenomegaly (enlargement of the spleen) with consequent sequestration therein of red blood cells, white blood cells, and platelets, together leading to mild pancytopenia
• Portacaval anastomoses (esophageal varices, hemorrhoids, caput medusae), with esophageal varices posing an ongoing risk of life-threatening hemorrhage.

 العلاج

 الإدارة الطبية

Treatment with a non-selective beta blocker is often commenced once portal hypertension has been diagnosed, and almost always if there has already been bleeding from esophageal varices. Typically, this is done with either propranolol or nadolol. The addition of a nitrate, such as isosorbide mononitrate, to the beta blocker is more effective than using beta blockers alone and may be the preferred regimen in those people with portal hypertension who have already experienced variceal bleeding. In acute or severe complications of the hypertension, such as bleeding varices, intravenous octreotide (a somatostatin analogue) or intravenous terlipressin (an antidiuretic hormone analogue) is commenced to decrease the portal pressure.

 التدخل ال Percutaneous

Transjugular intrahepatic portosystemic shunting is the creation of a connection between the portal and the venous system. As the pressure over the venous system is lower than over a hypertensive portal system, this would decrease the pressure over the portal system and a decreased risk of complications.

 التدخل الجراحي

• Distal splenorenal shunt
• Liver transplant

The most definitive treatment of portal hypertension is a liver transplant.

 الوصلات الخارجية

• VIDEO - Portal Hypertension: Shunt Surgery in the Era of Transplant and TIPS, Alysandra Lal, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)
• Ascites at Merck Manual of Diagnosis and Therapy Home Edition
• 00863 at CHORUS
• Overview at Cleveland Clinic
• Children's Liver Disease Foundation