Patient selection: portal hypertension (intrahepatic or extrahepatic). The risk for PHB appears to be greater with extrahepatic portal hypertension.
Increased pressure within adjacent blood vessels or compression by collateral blood vessels may compress biliary structures and/or cause ischemic injury.
Abnormalities may affect the entire biliary system:
(1) intrahepatic bile ducts
(2) extrahepatic bile ducts
(3) cystic duct
(4) gallbladder
The patient may be asymptomatic or symptomatic. The patient may present with:
(1) abdominal pain
(2) jaundice
(3) fever
(4) cholangitis
(5) abnormal liver function tests
(6) pruritus
Imaging studies are more sensitive for detection of biliary system abnormalities. Imaging studies may include:
(1) MR cholangiography
(2) endoscopic retrograde cholangiography
If the biliary tract abnormalities are due to PHB, then decompression of the portal hypertension should result in improvement. Some patients may require stenting of larger bile ducts to reduce cholestasis.
