CMAJ • May 9, 2006; 174 (10). doi:10.1503/cmaj.051700.
© 2006 CMA Media Inc. or its licensors
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Right arrow Liver (including hepatitis and cirrhosis)

Review

Current management of the complications of portal hypertension: variceal bleeding and ascites

Nina Dib, Frédéric Oberti and Paul Calès

From the Department of Hepato-Gastroenterology, University Hospital, and HIFIH Laboratory, Université d'Angers, Angers, France (all authors).

Correspondence to: Dr. Paul Calès, Centre hospitalier universitaire, 49933 Angers Cedex 09, France; fax (33) 2 41 35 41 19; paul.cales{at}univ-angers.fr

Abstract

Portal hypertension is one of the main consequences of cirrhosis. It results from a combination of increased intrahepatic vascular resistance and increased blood flow through the portal venous system. The condition leads to the formation of portosystemic collateral veins. Esophagogastric varices have the greatest clinical impact, with a risk of bleeding as high as 30% within 2 years of medium or large varices developing. Ascites, another important complication of advanced cirrhosis and severe portal hypertension, is sometimes refractory to treatment and is complicated by spontaneous bacterial peritonitis and hepatorenal syndrome. We describe the pathophysiology of portal hypertension and the current management of its complications, with emphasis on the prophylaxis and treatment of variceal bleeding and ascites.




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