Etiología de la hipertensión porta: segunda parte / Etiology of hypertension carries: part two

De 130 pacientes estudiados, 73 eran del género masculino. La mayoría de los pacientes tenían de 2 a 11 años. Entre las causas de hipertensión porta (HTP)prehepática, la muestra quedó constituida por 62 niños, la causa más frecuente del bloqueo sanguíneo correspondió a la trombosis de la vena porta en 34 de ellos y la degeneración cavernomatosa en 26. Entre las causas de HTP posthepática, se encontró en 10 niños, de los cuales 7 presentaron un síndrome de Budd-Chiari, 3 pacientes con trombosis de la vena cava en su porción poshepática, 1 con estenosis de las venas suprahepáticas y 2 hermanos con trombosis de las venas suprahepáticas.

Of 130 patients studied, 73 were male. Most patients were aged 2 to 11 years. Among the causes of prehepatic portal hypertension (PHT), the sample wascomposed of 62 children, the most common cause of blood clotting corresponded to the portal veinthrombosis in 34 of them and cavernomatosa degeneration in 26. Causes of PHT posthepatic wasfound in 10 children, of whom 7 had a Budd-Chiari syndrome, 3 patients with thrombosis of the vena cava in its portion posthepatic 1 with hepatic vein stenosis with thrombosis and 2 brothers of the hepatic veins.

Hipertensión porta / Portal hypertension

La hipertensión porta en niños es un síndrome que resulta del aumento de la presión dentro del sistema venoso porta por encima de 10 mm Hg. Inicialmente puede ser asintomática, luego se puede manifstar con hematemesis, esplenomegalia, anemia, ascitis y circulación colateral. En la hipertensión porta prehepática las pruebas de función del hígado (aminotransferasasy niveles de albúmina) y las hematológicas están mínimamente alteradas. En hipertensión porta losniños se puede complicar con variasmanifestaciones, pero cuando se presenta el sangrado de vías digestivas altas por ruptura de várices esofágicas, puede ser realmente alarmante porque algunas veces es profuso, este generalmente es más frecuente ante un hígado cirrótico porque se suele acompañar con peor función hepática.

Portal hypertension in children is a syndrome that results from increased pressure within the portalvenous system above 10 mm Hg. May be asymptomatic initially, then may manifest with hematemesis, splenomegaly, anemia, ascites and collateral circulation. In prehepatic portal h y p e r t e n s i o n o f l i v e r f u n c t i o n t e s t s (aminotransferase and albumin levels) and hematologic are minimally altered. Portal hypertension in children is complicated by several events, but when presented with upper GI bleeding from ruptured esophageal varices, can be very alarming because sometimes it is heavy, this usually is more common to a cirrhotic liver because it is usually accompanied with poor liverfunction.

Hipertensión portal / Portal hypertension

Portal hypertension (PH) defined as an increase of hydrostatic pressure in the portal vessels is a relevant clinical condition. Pathogenesis of PH, and classification according to anatomical level of increased resistance, as well as the different etiological conditions are analyzed. Mechanisms involved in the development and rupture of gastro-esophageal varices and the consequent variceal hemorrhage are reviewed. The different choice of treatment available in the prevention of variceal bleed or when hemorrhage occurs are discussed.

La hipertensión portal (HP) definida como un aumento de la presión hidrostática en el sistema venoso portal es una condición clínica muy relevante. La fisiopatología de la HP y la clasificación de acuerdo al nivel de las estructuras anatómicas donde se genera el aumento de resistencia así como las diferentes etiologías relacionadas, son analizados. Se revisan los mecanismos que intervienen en el desarrollo y rupturas de las várices gastroesofágicas y de la consecuente hemorragia variceal. Se discuten los diferentes tratamientos incluyendo la prevención de la hemorragia variceal.

Hipertensão portal / Portal hypertension

A hipertensão portal é uma síndrome clínica freqüente em nosso meio e acompanha-se de manifestações clínicas graves. Aqui são abordados alguns aspectos da hipertensão portal, com particular ênfase na fisiopatologia da síndrome e em suas manifestações clínicas. São listadas causas de hipertensão portal e discute-se a importância de informações obtidas durante a história clínica e no exame físico, que permitem o diagnóstico da síndrome e que auxiliam no esclarecimento da possível etiologia do processo

[Endoscopic and clinical parameters in assessing th degree of portal hypertension: the value of the serum-ascitic fluid albumin gradient]. / Parámetros endoscópicos y clínicos en la evaluación del grado de hipertensión portal: valor de la gradiente de albúmina de suero-líquido ascítico.

A prospective study in thirty one patients with ascites, who were hospitalized at Cayetano Heredia National Hospital (H.N.C.H.), to investigate the association between the high serum-to-ascites albumin concentration gradient (high GRAD-Alb) with the degree and development of oesophageal varices, studied by endoscopy, is here reported. It was also studied its relationship with the degree of impairment of liver function, determined by the Child-Pugh's score. In addition our series found that the degree of high GRAD-Alb could discriminate patients with oesophageal varices finding like a signal of its presence a value of high GRAD-Alb greater than 1.435 +/- 0.015 g/dl. It is here demonstrated that the degree of high GRAD-Alb does not have any relationship with the degree of impairment of liver function (Child-Pugh's score), prothrombine time, serum bilirrubin, degree of encephalopathy neither grade of ascites; however, we found a light association and correlation with serum albumin.

[Portal hypertension]. / Hipertensión portal.

This review covers the most recent advances regarding the anatomy, physiology, etiology, clinical features, laboratory examinations and treatment of portal hypertension. The importance of the increased sensitivity of the S2 receptors for serotonin at the portal circulation level in cases of portal hypertension of cirrotic origin is stressed. An update of non invasive diagnostic methods is made as well as comments on laboratory tests with clinical value. Finally, due emphasis is given to the usage of vasodilators to modify portal pressure.