門脈高壓
門脈高壓（Portal hypertension）為描述肝門靜脈系統高壓的狀態。目前的定義為肝門靜脈梯度高於或等於6mmHg[1]。門脈高壓最常見的原因就是肝硬化，其他較罕見的原因則稱為非肝硬化性門脈高壓（non-cirrhotic portal hypertension）。當門脈高壓已造成問題，則必須適當紓解門脈壓力。
| 門脈高壓 | |
|---|---|
 | |
| The portal vein and its tributaries | |
| 症状 | 腹水, 黄疸, 脾腫大[*], 微血管擴張 |
| 类型 | hepatic vascular disease[*], hypertension[*] |
| 肇因 | 門靜脈血栓[*], 血吸虫病, 肝硬化, 限制型心肌病[*], 心包炎 |
| 分类和外部资源 | |
| 醫學專科 | Gastroenterology |
| ICD-10 | K76.6 |
| ICD-9-CM | 572.3 |
| DiseasesDB | 10388 |
| eMedicine | radio/570 med/1889 |
| MeSH | D006975 |
症狀和徵象
門脈高壓的症狀和徵象包含：
病因
門脈高壓可藉由病灶發生的位置分為肝前性、肝內性、肝後性等。最常見的因素為肝硬化，其他原因則包含[2][5][6]：
| 非肝硬化性門脈高壓的相關因子 | |
|---|---|
| 肝前性 | 門靜脈或脾靜脈血栓 |
| 動靜脈瘻管 | |
| 脾腫大（增加門脈血流） | |
| 肝內性 | 所有造成肝硬化的原因，包含酗酒、慢性病毒性肝炎、膽道閉鎖等等 |
| Primary biliary cirrhosis | |
| Primary sclerosing cholangitis | |
| Chronic pancreatitis | |
| Hereditary haemorrhagic telangiectasia | |
| 血吸蟲症 | |
| Congenital hepatic fibrosis | |
| Nodular regenerative hyperplasia | |
| Fibrosis of space of Disse | |
| Granulomatous or infiltrative liver diseases (Gaucher, mucopolysaccharidosis, sarcoidosis, lymphoproliferative malignancies, amyloid deposition, …) | |
| 毒素（如砷、銅、氯乙烯、礦物油、維生素A、azathioprine、dacarbazine、methotrexate、amiodarone...） | |
| 病毒性肝炎 | |
| 脂肪肝 | |
| Veno-occlusive disease | |
| 肝後性 | 下腔靜脈阻塞 |
| (Right-sided) heart failure, e.g. from constrictive pericarditis | |
| 布加综合征 | |
| Budd-Chiari syndrome |
病生理
Stellate cell
門脈高壓的直接原因主要是血管的阻力增加，但造成血管阻力增加的原因則相當多樣。一般來說還會合併星狀細胞及肌成纖維細胞活化。內源性血管擴張劑也可能導致靜脈血流增加[2][7]。
參考文獻
- . rarediseases.info.nih.gov. [2016-01-08].
- . Patient. [2016-01-08] （英国英语）.
- . www.karger.com. [2016-01-08].
- Sun, Z; Migaly, J. . Clinics in colon and rectal surgery. March 2016, 29 (1): 22–9. PMID 26929748. doi:10.1055/s-0035-1568144.
- Bloom, S.; Kemp, W.; Lubel, J. . Internal Medicine Journal. 2015-01-01, 45 (1): 16–26. ISSN 1445-5994. doi:10.1111/imj.12590.
- Perkins, [edited by] Vinay Kumar, Abul K. Abbas, Jon C. Aster ; artist, James A. 9th. Philadelphia, PA: Elsevier/Saunders. : 608. ISBN 978-1-4377-1781-5.2013
- .
延伸閱讀
- Garbuzenko D.V., Arefyev N.O., Belov D.V. Mechanisms of adaptation of the hepatic vasculature to the deteriorating conditions of blood circulation in liver cirrhosis. World J. Hepatol. 2016; 8 (16): 665-672.
- Garbuzenko D.V. Current approaches to the management of patients with liver cirrhosis who have acute esophageal variceal bleeding. Curr. Med. Res. Opin. 2016; 32 (3): 467-475.
- Garbuzenko D.V. Contemporary concepts of the medical therapy of portal hypertension under liver cirrhosis. World J. Gastroenterol. 2015; 21 (20): 6117-6126.
- . www.journal-of-hepatology.eu. [2016-01-08].
- Rossi, Plinio. . Springer Science & Business Media. 2012-12-06. ISBN 9783642571169.
- Imanieh, Mohammad Hadi; Dehghani, Seyed Mohsen; Khoshkhui, Maryam; Malekpour, Abdorrasoul. . Middle East Journal of Digestive Diseases. 2012-10-01, 4 (4): 206–210. ISSN 2008-5230. PMC 3990125. PMID 24829658.
外部連結
- Ascites at Merck Manual of Diagnosis and Therapy Home Edition
- Children's Liver Disease Foundation
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