Portal hypertension and its complications

Portasystemic collaterals develop as a result of portal hypertension. The collaterals in the cardioesophageal region is the leading cause of bleeding from esophageal varices. Some of the portal hypertensive patients present with bleeding episodes but the others do not, and some of the bleeders do not respond to endoscopic sclerotherapy procedure, although the underlying pathology is the same. The only difference is the changing pattern of the collateral vasular structures. Since the first step of portasystemic collateralization takes place in the naturally existent vascular channels, the capacity of the natural collateral vessels might be a determining factor of the hemorrhagic events. Treatment options have to bu individualized taking the liver status, clinical symptomatology, frequency of bleeding episodes, investigative prosedures, functional capacity of the natural collateral system, and the treatment strategy of the institution into consideration. (Turk Arch Ped 2010; 45 Suppl: 46-52)