门脉高压
门脉高压（英语：Portal hypertension）为描述肝门静脉系统高压的状态。目前的定义为肝门静脉梯度高于或等于6mmHg[1]。门脉高压最常见的原因就是肝硬化，其他较罕见的原因则称为非肝硬化性门脉高压（non-cirrhotic portal hypertension）。当门脉高压已造成问题，则必须适当纾解门脉压力[来源请求]。
| 门脉高压 | |
|---|---|
 | |
| The portal vein and its tributaries | |
| 症状 | 腹水、黄疸、脾肿大[*]、微血管扩张 |
| 类型 | hepatic vascular disease[*]、高血压[*]、疾病 |
| 病因 | 门静脉血栓[*]、血吸虫病、肝硬化、限制型心肌病[*]、心包炎 |
| 分类和外部资源 | |
| 医学专科 | Gastroenterology |
| ICD-11 | DB98.7 |
| ICD-9-CM | 572.3 |
| DiseasesDB | 10388 |
| eMedicine | 182098 |
症状和征象
门脉高压的症状和征象包含：
病因
门脉高压可借由病灶发生的位置分为肝前性、肝内性、肝后性等。最常见的因素为肝硬化，其他原因则包含[2][5][6]：
| 非肝硬化性门脉高压的相关因子 | |
|---|---|
| 肝前性 | 门静脉或脾静脉血栓 |
| 动静脉瘘管 | |
| 脾肿大（增加门脉血流） | |
| 肝内性 | 所有造成肝硬化的原因，包含酗酒、慢性病毒性肝炎、胆道闭锁等等 |
| Primary biliary cirrhosis | |
| Primary sclerosing cholangitis | |
| Chronic pancreatitis | |
| Hereditary haemorrhagic telangiectasia | |
| 血吸虫症 | |
| Congenital hepatic fibrosis | |
| Nodular regenerative hyperplasia | |
| Fibrosis of space of Disse | |
| Granulomatous or infiltrative liver diseases (Gaucher, mucopolysaccharidosis, sarcoidosis, lymphoproliferative malignancies, amyloid deposition, …) | |
| 毒素（如砷、铜、氯乙烯、矿物油、维生素A、azathioprine、dacarbazine、methotrexate、amiodarone...） | |
| 病毒性肝炎 | |
| 脂肪肝 | |
| Veno-occlusive disease | |
| 肝后性 | 下腔静脉阻塞 |
| (Right-sided) heart failure, e.g. from constrictive pericarditis | |
| 布加综合征 | |
| Budd-Chiari syndrome |
病生理
门脉高压的直接原因主要是血管的阻力增加，但造成血管阻力增加的原因则相当多样。一般来说还会合并星状细胞及肌成纤维细胞活化。内源性血管扩张剂也可能导致静脉血流增加[2][7]。
参考文献
- ^ Portal hypertension | Disease | Overview | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. rarediseases.info.nih.gov. [2016-01-08]. （原始内容存档于2016-01-27）.
- ^ 2.0 2.1 2.2 2.3 2.4 Portal Hypertension. Learn about Portal Hypertension | Patient. Patient. [2016-01-08]. （原始内容存档于2021-01-19） （英国英语）.
- ^ Spontaneous Bacterial Peritonitis. www.karger.com. [2016-01-08]. （原始内容存档于2020-05-10）.
- ^ Sun, Z; Migaly, J. Review of Hemorrhoid Disease: Presentation and Management.. Clinics in colon and rectal surgery. March 2016, 29 (1): 22–9. PMID 26929748. doi:10.1055/s-0035-1568144.
- ^ Bloom, S.; Kemp, W.; Lubel, J. Portal hypertension: pathophysiology, diagnosis and management. Internal Medicine Journal. 2015-01-01, 45 (1): 16–26 [2017-01-03]. ISSN 1445-5994. doi:10.1111/imj.12590. （原始内容存档于2017-09-14）.
- ^ Perkins, [edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster ; artist, James A. Robbins basic pathology 9th. Philadelphia, PA: Elsevier/Saunders. : 608. ISBN 978-1-4377-1781-5.2013
- ^ Portal Hypertension: Practice Essentials, Background, Anatomy. [2017-01-03]. （原始内容存档于2021-05-06）.
延伸阅读
- Garbuzenko D.V., Arefyev N.O., Belov D.V. Mechanisms of adaptation of the hepatic vasculature to the deteriorating conditions of blood circulation in liver cirrhosis. World J. Hepatol. 2016; 8 (16): 665-672.
- Garbuzenko D.V. Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding. Curr. Med. Res. Opin. 2016; 32 (3): 467-475.
- Garbuzenko D.V. Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis. World J. Gastroenterol. 2015; 21 (20): 6117-6126.
- Functional aspects on the pathophysiology of portal hypertension in cirrhosis – Journal of Hepatology. www.journal-of-hepatology.eu. [2016-01-08]. （原始内容存档于2019-07-10）.
- Rossi, Plinio. Portal Hypertension: Diagnostic Imaging and Imaging-Guided Therapy. Springer Science & Business Media. 2012-12-06 [2017-01-03]. ISBN 9783642571169. （原始内容存档于2020-08-31）.
- Imanieh, Mohammad Hadi; Dehghani, Seyed Mohsen; Khoshkhui, Maryam; Malekpour, Abdorrasoul. Etiology of Portal Hypertension in Children:A Single Center’s Experiences. Middle East Journal of Digestive Diseases. 2012-10-01, 4 (4): 206–210. ISSN 2008-5230. PMC 3990125
. PMID 24829658.
外部链接
- Ascites at Merck Manual of Diagnosis and Therapy Home Edition
- Children's Liver Disease Foundation （页面存档备份，存于互联网档案馆）