Resumen
Definición
La hipertensión portal se desarrolla progresivamente en el curso natural de la enfermedad hepática crónica y es el factor pronóstico principal de la misma. Sus consecuencias (hemorragia por rotura de varices esofágicas o gástricas, ascitis, síndrome hepatorrenal, peritonitis bacteriana espontánea, encefalopatía hepática y síndrome hepatopulmonar, entre otras) representan la principal causa de muerte y de trasplante hepático en los pacientes cirróticos.
Manifestaciones clínicasLas manifestaciones clínicas de la hipertensión portal pueden aparecer cuando el gradiente de presión portal aumenta por encima del umbral de 10mm Hg, valor que define la hipertensión portal clínicamente significativa.
TratamientoEl tratamiento de elección en la hemorragia aguda por varices es la combinación de tratamiento endoscópico, preferiblemente ligadura endoscópica con bandas y tratamiento farmacológico vasoconstrictor, con somatostatina o terlipresina. La hemorragia por varices esofágicas tiene una alta mortalidad, superior al 20%, por lo que es fundamental establecer tratamientos preventivos, tanto primarios como de recidiva.
Palabras clave
Gradiente de presión venosa hepática (GPVH)
Bloqueadores beta no cardioselectivos
Ligadura endoscópica
Derivación portosistémica percutánea intrahepática
Abstract
Definition
Portal hypertension develops progressively during the natural course of chronic liver disease and is the main prognostic factor for the disease. Its consequences (such as haemorrhaging due to rupture of oesophageal or gastric varices, ascites, hepatorenal syndrome, spontaneous bacterial peritonitis, hepatic encephalopathy and hepatopulmonary syndrome) are the main cause of death and liver transplantation in patients with cirrhosis.
Clinical manifestationsThe clinical manifestations of portal hypertension can appear when the portal pressure gradient rises above the threshold of 10mm Hg, a value that defines clinically significant portal hypertension.
TreatmentThe treatment of choice for acute variceal haemorrhage is the combination of endoscopic treatment, preferably endoscopic band ligation, and vasoconstrictor drug treatment, with somatostatin or terlipressin. Oesophageal variceal haemorrhage has high mortality (greater than 20%). It is therefore essential to establish preventive treatments, both primary and recurrence.
Keywords
Hepatic venous pressure gradient (HVPG)
Noncardioselective beta blockers
Endoscopicband ligation
Percutaneous intrahepatic portosystemic shunt
Identifíquese
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