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Hepatic

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Hepatic causes of portal hypertension arise from disturbance of the liver architecture, either pre-sinusoidal, sinusoidal or post-sinusoidal.

Pre-sinusoidal:

  • alcoholic hepatitis
  • congenital hepatic fibrosis
  • idiopathic non-cirrhotic portal hypertension - more frequent in southern Asia
  • schistosomiasis - important in some parts of the world
  • partial nodular transformation
  • granulomata - for example sarcoidosis
  • myelosclerosis - myelofibrosis

Sinusoidal:

  • cirrhosis - accounting for 85% of cases of portal hypertension in the USA. Specific types include (in decreasing order of frequency):
    • alcoholic
    • viral
    • biliary / cholestatic
    • others - Wilson's disease, haemochromatosis

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