Pathology: portal hypertensive gastropathy

Interesting mucosal pattern?  That’s the classic snakeskin, or mosaic appearance of portal hypertensive gastropathy.  As part of the neurohormonal hyperactivation syndrome (NHHS), the combination of splanchnic vasodilation and portal hypertension leads to a plethoric, hyperemic, gastric mucosa.

The islands of the mosaic turn to a pigmented brown or red color as the condition transitions from a mild to moderate state of severity (see image).  In the most advanced states, the mucosa can be friable and lead to both chronic blood loss as well as acute upper GI bleeding.  The effect of pharmacotherapy is limited, and therefore the only curative treatment is liver transplantation.

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