Beyond Varices: Complications of Cirrhotic Portal Hypertension in Pediatrics

Abstract

Complications of cirrhotic portal hypertension (PHTN) in children are broad and include clinical manifestations ranging from variceal hemorrhage, hepatic encephalopathy (HE), ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS) to less common conditions such as hepatopulmonary syndrome, portopulmonary hypertension, and cirrhotic cardiomyopathy. The approaches to the diagnosis and management of these complications have become standard of practice in adults with cirrhosis with many guidance statements available. However, there is limited literature on the diagnosis and management of these complications of PHTN in children with much of the current guidance available focused on variceal hemorrhage. The aim of this review is to summarize the current literature in adults who experience these complications of cirrhotic PHTN beyond variceal hemorrhage and present the available literature in children, with a focus on diagnosis, management, and liver transplant decision making in children with cirrhosis who develop ascites, SBP, HRS, HE, and cardiopulmonary complications.

Pathophysiology, Diagnosis, and Management of Portal Hypertension in the Pediatric Population

“…According to Banc-Husu et al, 14 the clinical definition of pediatric portal hypertension consists of splenomegaly and thrombocytopenia with or without the presence of ascites or varices on endoscopy. However, these clinical findings cannot be used to determine the degree of portal hypertension, as elevations in portal pressures are known to occur before the development of these clinical findings.…”

“…However, these clinical findings cannot be used to determine the degree of portal hypertension, as elevations in portal pressures are known to occur before the development of these clinical findings. 14…”