Acute Life-Threatening Complications of Portal Hypertension: a Review of Pathophysiology, Incidence, Management, and Cos
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MEDICINE
Acute Life-Threatening Complications of Portal Hypertension: a Review of Pathophysiology, Incidence, Management, and Cost Robert E. Smith 1 & Alice D. Friedman 2 & James A. Murchison 1 & S. Blake Tanner 3 & P. Alexander Smith 4 & Bradley T. Dollar 1 Accepted: 28 July 2020 / Published online: 6 August 2020 # Springer Nature Switzerland AG 2020
Abstract Portal hypertension represents a dysfunctional hemodynamic alteration within the portal venous system, usually due to cirrhosis. These altered hemodynamics play a direct role in the development of acute, life-threatening variceal hemorrhage and mark an important pathophysiologic step in the development of other sudden and life-threatening complications such as type 1 hepatorenal syndrome and spontaneous bacterial peritonitis. Many life-saving interventions in these patients are aimed at reducing portal venous pressure. The contribution of portal hypertension to the development of variceal hemorrhage, type 1 hepatorenal syndrome (known also by the name HRS-AKI), and spontaneous bacterial peritonitis in cirrhotic patients is discussed. This article reviews the pathophysiology and incidence of life-threatening complications of cirrhotic portal hypertension, with a discussion of management options and treatment costs. Keywords Portal hypertension . Variceal bleeding . Hepatorenal syndrome . Spontaneous bacterial peritonitis . Hemodynamics . Cirrhosis
Introduction Portal hypertension is common, particularly among cirrhotic patients, and its presentation may be both sudden and fatal. A clinical understanding of portal hypertension helps physicians treat and manage these patients, and knowledge of the underlying diseased hemodynamics enables the development of new therapies. The burden of portal hypertension, both economically and in terms of impact on patient lives and those of their families, emphasizes the gravity of portal hypertensive disease and the urgency to address it.
Cirrhotic Portal Hypertension: Epidemiology and Socioeconomic Factors Cirrhosis accounts for approximately 90% of portal hypertension cases in the Western world [1, 2]. The estimated prevalence of cirrhosis in the USA is 0.27% (greater than 600,000) adults, and there is a preponderance of cirrhosis among patients living below the poverty level and those who have not finished the 12th grade [3]. The annual international death toll for complications of cirrhosis is estimated at 1 million patients.
This article is part of the Topical Collection on Medicine * Robert E. Smith [email protected]
Bradley T. Dollar [email protected]
Alice D. Friedman [email protected]
1
Department of Radiology, Baylor Scott & White Medical Center—Temple, 2401 S. 31st St., Temple, TX 76508, USA
James A. Murchison [email protected]
2
Division of Gastroenterology, Austin Diagnostic Clinic, 12221 MoPac Expressway North, Austin, TX 78758, USA
S. Blake Tanner [email protected]
3
Department of Nephrology, Baylor Scott & White Medical Center—Temple, 2401 S. 31st
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