Portal Hypertension: Integrated Internal Medicine Management with Laboratory Evaluation, Radiologic Assessment, and Family Medicine–Based Longitudinal Care
Abstract
Background: Portal hypertension is a major hemodynamic consequence of chronic liver disease and other hepatic or extrahepatic disorders. It drives complications such as variceal bleeding, ascites, and encephalopathy, significantly impacting morbidity and mortality.
Aim: To provide an integrated review of portal hypertension, emphasizing pathophysiology, diagnostic strategies, and multidisciplinary management.
Methods: A comprehensive synthesis of current evidence and guidelines was performed, covering hemodynamic principles, etiologic classification, laboratory and imaging evaluation, and therapeutic approaches including pharmacologic, endoscopic, and interventional strategies.
Results: Portal hypertension arises from increased intrahepatic resistance and augmented splanchnic inflow, leading to collateral formation and systemic circulatory changes. Clinically significant portal hypertension (HVPG ≥10 mm Hg) predicts decompensation, while ≥12 mm Hg correlates with variceal bleeding risk. Noninvasive tools such as elastography and Doppler ultrasound complement invasive HVPG measurement. Management integrates etiologic therapy, nonselective beta-blockers (preferably carvedilol), endoscopic prophylaxis, and escalation to TIPS or transplantation for refractory complications. Preventive strategies—alcohol abstinence, metabolic optimization, and early antiviral therapy—remain pivotal.
Conclusion: Portal hypertension is a multifactorial syndrome requiring early detection, risk stratification, and coordinated care across specialties. Evidence-based interventions targeting both underlying disease and portal pressure reduction improve survival and quality of life.
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Copyright (c) 2025 Moneef Mansour Aldosari, Ghada Zaal Alrowaili, Othman Mohammed Almousa, Abada Awaji Hakami, Essa Hassan Essa Abu Alzwaid, Amin Ibrahim Ahmed Otaif, Amal Ali Soliman Gahtani, Hussen Bahws Saeed Alhsnani, Mohd Husain Mobarki, Salem Ali Aldhafeeri, Salman Mkazi Sulaiman Alshammri
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