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Gastrointestinal
Diagnosis
Peritoneum, Mesentery, and Abdominal Wall
Vascular Disorders
Portal Hypertension and Varices
Portal Hypertension and Varices
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Portal hypertension: Elevated portal pressures due to resistance to portal flow, defined as absolute portal venous pressure of > 10 mm Hg or gradient between portal and systemic veins of > 5 mm Hg
            • Varices: Abnormally dilated and tortuous veins due to rerouting of blood flow away from liver into lower pressure systemic veins through collateral pathways
            • Ascites: Pathologic fluid accumulation in peritoneal cavity

          IMAGING

          • General Features

            • Imaging Recommendations

              DIFFERENTIAL DIAGNOSIS

                PATHOLOGY

                • General Features

                  CLINICAL ISSUES

                  • Presentation

                    • Demographics

                      • Natural History & Prognosis

                        • Treatment

                          DIAGNOSTIC CHECKLIST

                          • Consider

                            Selected References

                            1. Mandorfer M et al: Noninvasive diagnostics for portal hypertension: a comprehensive review. Semin Liver Dis. 40(3):240-55, 2020
                            2. Nicoară-Farcău O et al: Diagnostic challenges in non-cirrhotic portal hypertension - porto sinusoidal vascular disease. World J Gastroenterol. 26(22):3000-11, 2020
                            3. Gerstenmaier JF et al: Ultrasound in chronic liver disease. Insights Imaging. 5(4):441-55, 2014
                            4. Iwakiri Y: Pathophysiology of portal hypertension. Clin Liver Dis. 18(2):281-91, 2014
                            5. Lee JY et al: Clinically severe portal hypertension: role of multi-detector row CT features in diagnosis. Dig Dis Sci. 59(9):2333-43, 2014
                            6. Liu CH et al: Esophageal varices: noninvasive diagnosis with duplex Doppler US in patients with compensated cirrhosis. Radiology. 248(1):132-9, 2008
                            7. Kabeer MA et al: Stomal varices: a rare cause of stomal hemorrhage. A report of three cases. Ostomy Wound Manage. 53(8):20-2, 24, 26 passim, 2007
                            8. Kim SH et al: Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy. Radiology. 242(3):759-68, 2007
                            9. Ishikawa T et al: CT-maximum intensity projection is a clinically useful modality for the detection of gastric varices. World J Gastroenterol. 11(47):7515-9, 2005
                            10. Pickhardt PJ et al: Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. Radiographics. 25(3):719-30, 2005
                            11. Willmann JK et al: Detection of submucosal gastric fundal varices with multi-detector row CT angiography. Gut. 52(6):886-92, 2003
                            12. Ito K et al: CT of acquired abnormalities of the portal venous system. Radiographics. 17(4):897-917, 1997
                            13. Cho KC et al: Varices in portal hypertension: evaluation with CT. Radiographics. 15(3):609-22, 1995
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Pathology

                                  • Clinical Issues

                                    TERMINOLOGY

                                    • Definitions

                                      • Portal hypertension: Elevated portal pressures due to resistance to portal flow, defined as absolute portal venous pressure of > 10 mm Hg or gradient between portal and systemic veins of > 5 mm Hg
                                      • Varices: Abnormally dilated and tortuous veins due to rerouting of blood flow away from liver into lower pressure systemic veins through collateral pathways
                                      • Ascites: Pathologic fluid accumulation in peritoneal cavity

                                    IMAGING

                                    • General Features

                                      • Imaging Recommendations

                                        DIFFERENTIAL DIAGNOSIS

                                          PATHOLOGY

                                          • General Features

                                            CLINICAL ISSUES

                                            • Presentation

                                              • Demographics

                                                • Natural History & Prognosis

                                                  • Treatment

                                                    DIAGNOSTIC CHECKLIST

                                                    • Consider

                                                      Selected References

                                                      1. Mandorfer M et al: Noninvasive diagnostics for portal hypertension: a comprehensive review. Semin Liver Dis. 40(3):240-55, 2020
                                                      2. Nicoară-Farcău O et al: Diagnostic challenges in non-cirrhotic portal hypertension - porto sinusoidal vascular disease. World J Gastroenterol. 26(22):3000-11, 2020
                                                      3. Gerstenmaier JF et al: Ultrasound in chronic liver disease. Insights Imaging. 5(4):441-55, 2014
                                                      4. Iwakiri Y: Pathophysiology of portal hypertension. Clin Liver Dis. 18(2):281-91, 2014
                                                      5. Lee JY et al: Clinically severe portal hypertension: role of multi-detector row CT features in diagnosis. Dig Dis Sci. 59(9):2333-43, 2014
                                                      6. Liu CH et al: Esophageal varices: noninvasive diagnosis with duplex Doppler US in patients with compensated cirrhosis. Radiology. 248(1):132-9, 2008
                                                      7. Kabeer MA et al: Stomal varices: a rare cause of stomal hemorrhage. A report of three cases. Ostomy Wound Manage. 53(8):20-2, 24, 26 passim, 2007
                                                      8. Kim SH et al: Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy. Radiology. 242(3):759-68, 2007
                                                      9. Ishikawa T et al: CT-maximum intensity projection is a clinically useful modality for the detection of gastric varices. World J Gastroenterol. 11(47):7515-9, 2005
                                                      10. Pickhardt PJ et al: Unusual nonneoplastic peritoneal and subperitoneal conditions: CT findings. Radiographics. 25(3):719-30, 2005
                                                      11. Willmann JK et al: Detection of submucosal gastric fundal varices with multi-detector row CT angiography. Gut. 52(6):886-92, 2003
                                                      12. Ito K et al: CT of acquired abnormalities of the portal venous system. Radiographics. 17(4):897-917, 1997
                                                      13. Cho KC et al: Varices in portal hypertension: evaluation with CT. Radiographics. 15(3):609-22, 1995