Non-cirrhotic Portal Hypertension

Sarin, Shiv Kumar; Khanna, Rajeev

doi:10.1016/j.cld.2014.01.009

Cited by 86 publications

(116 citation statements)

References 95 publications

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“…52 Clinically, NCPH accounts for 10-30% of all cases of variceal bleed all over world including India. 53 On abdominal ultrasonography, liver is nodular. Portal veins are patent and it mimics cirrhosis on CT scan.…”

Section: Amarapurkar and Amarapurkar Indications Of Liver Biopsy In Tmentioning

confidence: 99%

Indications of Liver Biopsy in the Era of Noninvasive Assessment of Liver Fibrosis

Amarapurkar

Amarapurkar²

2015

Journal of Clinical and Experimental Hepatology

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Background: Liver biopsy (LB) has been used as diagnostic modality in liver diseases (LD). Over last two decades, there has been remarkable improvement in understanding of natural history, molecular diagnostics of viral hepatitis, genetic of LD, and also limitations of LB. There is current trend in avoiding LB in the management of various LDs. Aim: To determine utility of LB in clinical practice. Material and Methods: In a prospective study, 2413 patients of LD were followed up, 219 (9%) were acute, and remaining 2194 (90.9%) were chronic LD. Patients were evaluated by biochemical parameters, virological studies, and imaging endoscopy as and when required. LB was performed in 176 (7.2%) patients when no conclusion could be drawn from the noninvasive workup. Patients with platelet count <50,000/cm 2 , ascites, and overt bleeding were excluded. Patients with international normalization ratio (INR) more than 1.5 were not excluded. No prophylactic use of fresh frozen plasma and platelet transfusion was done. There was no major complication related to the procedure. Indications for LB were as follows: cryptogenic LD 38 cases, hepatitis B infection 35, suspected autoimmune hepatitis 30, mass lesion in the liver and lymphoma 29, evaluation of portal hypertension 15, elevated liver enzymes 11, hepatitis C infection 9, and drug-induced LD 4, and miscellaneous 5 cases which were primary biliary cholangitis, primary sclerosing cholangitis, cholestatic LD, sarcoidosis, and amyloidosis. Results: LB changed the diagnosis in 55 (31.2%). These were cryptogenic LD in 24 cases, portal hypertension 15, elevated liver enzymes 11, and 5 others. In remaining, LB confirmed clinical diagnosis and helped in making management decisions. Conclusion: LB was required in 7.2% of patients with chronic LD. In 31.2% cases, LB changed the diagnosis. LB was a safe procedure even in presence of low platelet count and abnormal INR. ( J CLIN EXP HEPATOL 2015;5:314-319)

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Section: Amarapurkar and Amarapurkar Indications Of Liver Biopsy In Tmentioning

confidence: 99%

Indications of Liver Biopsy in the Era of Noninvasive Assessment of Liver Fibrosis

Amarapurkar

Amarapurkar²

2015

Journal of Clinical and Experimental Hepatology

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“…[1][2][3] Obliterative portal venopathy (OPV) represents an important cause of NCPH that is characterized by sclerosis and obliteration of the medium-sized portal venous branches leading to portal hypertension. [1][2][3][4][5][6][7][8][9][10] Liver biopsy characteristically shows phlebosclerosis and periportal and perisinusoidal fibrosis amid absent cirrhosis ( Figure 1). [1][2][3] Although, the exact aetiology is contentious, infections and prothrombotic states have been implicated in eastern and western patients, respectively.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] Liver biopsy characteristically shows phlebosclerosis and periportal and perisinusoidal fibrosis amid absent cirrhosis ( Figure 1). [1][2][3] Although, the exact aetiology is contentious, infections and prothrombotic states have been implicated in eastern and western patients, respectively. 1,2 Additionally, xenobiotic exposure, autoimmune and genetic factors have also been incriminated.…”

mentioning

confidence: 99%

“…[1][2][3] Although, the exact aetiology is contentious, infections and prothrombotic states have been implicated in eastern and western patients, respectively. 1,2 Additionally, xenobiotic exposure, autoimmune and genetic factors have also been incriminated. [1][2][3][4] Although the disease has a worldwide distribution, it continues to remain poorly understood primarily owing to its relative rarity.…”

mentioning

confidence: 99%

“…[1][2][3][4] Although the disease has a worldwide distribution, it continues to remain poorly understood primarily owing to its relative rarity. [1][2][3][5][6][7][8] Another potential reason is the use of diverse terminologies under which the entity has been described from various parts of the globe, such as non-cirrhotic portal fibrosis in India, idiopathic portal hypertension in Japan and hepatoportal sclerosis in the USA.…”

mentioning

confidence: 99%

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Multimodality imaging of obliterative portal venopathy: what every radiologist should know

Arora¹,

Sarin²

2015

BJR

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Obliterative portal venopathy (OPV) is an important cause of non-cirrhotic portal hypertension, which is often erroneously misdiagnosed as cryptogenic cirrhosis. It has a worldwide distribution with majority of cases hailing from the Asian subcontinent. However, recently the disease has gained global attention particularly because of its association with human immunodeficiency virus infection and use of antiretroviral drug therapy (didanosine). As the name suggests, the disorder is characterized by sclerosis and obliteration of the intrahepatic portal vein branches (with attendant periportal fibrosis) leading to portal hypertension amid intriguingly little liver dysfunction. It primarily affects young adults who present with clinically significant portal hypertension in the form of episodes of variceal bleed; however, contrasting liver cirrhosis, the liver function and liver structure remain normal or near normal until late in the disease process. Radiological findings during advanced disease are often indistinguishable from cirrhosis often warranting a liver biopsy. Nevertheless, recent studies have suggested that certain imaging manifestations, if present, can help us to prospectively suggest the possibility of OPV. At imaging, OPV is characterized by a wide range of intrahepatic and/or extrahepatic portal venous abnormalities with attendant changes in liver and splenic volume and stiffness. We shall, through this pictorial review, appraise the literature and illustrate the germane radiological manifestations of OPV that can be seen using different imaging modalities including ultrasonography, CT, MRI, elastography and hepatic haemodynamic studies.

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Single‐stage hepaticojejunostomy for symptomatic portal biliopathy in a splenectomized patient: A report of two cases

Pandit

Awale

Jaiswal

et al. 2020

Clinical Case Reports

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Non-cirrhotic Portal Hypertension

Cited by 86 publications

References 95 publications

Indications of Liver Biopsy in the Era of Noninvasive Assessment of Liver Fibrosis

Indications of Liver Biopsy in the Era of Noninvasive Assessment of Liver Fibrosis

Multimodality imaging of obliterative portal venopathy: what every radiologist should know

Single‐stage hepaticojejunostomy for symptomatic portal biliopathy in a splenectomized patient: A report of two cases

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