Clinical Consequences of Portal Hypertension

The portal hypertensive syndrome is responsible for many of the manifestations of advanced, decompensated l iver disease. Some of these complications are a direct consequence of portal hypertension: gastrointestinal bleeding result ing from ruptured gastroesophageal varices, PHG, and colopathy; hyperkinetic syndrome; hypersplenism; and an increased systemic availabil i ty of drugs and endogenous compounds with rapid hepatic uptake (5). In other complications, portal hypertension plays a key role, although it is not the only pathophysiologic factor in their development. These include ascites, abnormalit ies of renal function, hepatorenal syndrome, spontaneous bacterial peritonit is, hepatopulmonary syndrome, and hepatic encephalopathy. This chapter focuses on gastrointestinal bleeding; the other complications are dealt with elsewhere in this book.