ABSTRACT
This chapter deals with the vascular anomalies which have been described in the setting of cirrhosis and their potential functional implications, the current concepts of the mechanisms involved in the development of portal hypertension, and finally the pharmacological approach to the management of portal hypertension. Schaffner and Popper were the first to describe the development of a basement membrane at the margins of the micro vascular channels in long-standing cirrhosis, with sealing of the sieve plates and transformation of sinusoids into capillary-like channels. The findings should be corroborated in an experimental model of cirrhosis before the data can be extrapolated to the development of portal hypertension in human cirrhosis. Attempts to find a portal venous pressure lowering agent suitable for long-term use led Lebrec et al. in 1980 to try oral propranolol in patients with cirrhosis and the portal hypertension.
