Portal Hypertensive Gastropathy (PHG)

Etiology

  • Same processes (portal hypertension) that leads to esophageal varices
  • Post-hepatic: budd-chiari (hepatic vein thrombosis); Constrictive pericardial disease; Advanced left/right sided heart failure
  • Hepatic: cholestatic or inflammatory/fibrotic liver disease that leads to cirrhosis (alcohol, hep b/c, fatty liver, other); Can be chronic, acute, or acute on chronic
  • Pre-hepatic: portal vein thrombosis (associate w/hypercoaguable states); parasitic blockage of portal vein (e.g. clonorchis, schistosomiasis)
  • Splenic vein thrombosis: from pancreatitis, hypercoaguable states; unusual problem, typically w/o ascites

Risk Factors

  • Anything that leads to cirrhosis: ETOH (most common), Hep C, Hep B, NASH, other

Symptoms

  • Melena
  • Nausea, vomiting blood
  • Confusionif co-existing encephalopathy
  • Abdominal discomfort
  • Bleeding can also occur more slowly, presenting w/fatigue and weakness

Physical Exam Findings

  • Signs of severe illness w/tachycardia and hypotension (blood loss can be rapid and profound)
  • Jaundice, ascites, edema--> underlying liver disease
  • Confusion from encephalopathy
  • Coffee-ground emesis or frank blood; melena, guaiac + stool on rectal exam

Tests