Portal Hypertension

Portal Hypertension is a potentially serious condition marked by elevated blood pressure within the portal venous system, which comprises the veins coming from the stomach, intestine, spleen, and pancreas that merge into the portal vein delivering blood to the liver. This rise in pressure typically occurs due to obstruction or resistance to blood flow through the liver, often resulting from liver cirrhosis.

Left untreated, portal hypertension can cause life-threatening complications such as variceal bleeding, ascites, and hepatic encephalopathy. Understanding this condition is crucial for timely diagnosis and effective management. In this blog, we will cover the causes, risk factors, signs, diagnostic methods, treatments, and preventive measures for portal hypertension.

What Is Portal Hypertension?

The normal pressure in the portal vein ranges between 5 and 10 mmHg. Portal Hypertension is defined as a portal venous pressure greater than 12 mmHg or a hepatic venous pressure gradient (HVPG) of more than 5 mmHg.

As pressure builds up, blood finds alternate pathways, leading to varices (enlarged veins), splenomegaly, and fluid leakage into the abdominal cavity (ascites).

Causes of Portal Hypertension

Portal Hypertension is categorized based on the site of obstruction:

1. Pre-hepatic Causes (before blood enters the liver)

• Portal Vein Thrombosis (PVT)

• Splenic vein thrombosis

• Congenital portal vein anomalies

2. Intra-hepatic Causes (within the liver)

Most common cause overall

• Cirrhosis of the liver (due to hepatitis B/C, alcohol, NAFLD)

• Schistosomiasis

• Congenital hepatic fibrosis

• Nodular regenerative hyperplasia

3. Post-hepatic Causes (after blood exits the liver)

• Budd-Chiari Syndrome (hepatic vein thrombosis)

• Constrictive pericarditis

• Right heart failure

Risk Factors

• Chronic liver disease (especially cirrhosis)

• Alcohol use

• Hepatitis B or C infection

• Obesity and non-alcoholic fatty liver disease (NAFLD)

• Inherited or acquired clotting disorders

• Parasitic infections (in endemic areas)

Symptoms of Portal Hypertension

Portal Hypertension often develops gradually. Early symptoms may be subtle but can progress to serious complications:

Common Signs and Symptoms

• Enlarged spleen (Splenomegaly)

• Abdominal swelling (Ascites)

• Esophageal or gastric varices

• Gastrointestinal bleeding (vomiting blood or black stools)

• Fatigue and weakness

• Low platelet count

• Hepatic encephalopathy (confusion, disorientation)

In children, growth retardation, delayed puberty, and frequent infections may be seen.

Complications of Portal Hypertension

1. Variceal Bleeding
   Life-threatening bleeding from esophageal or gastric varices.

2. Ascites
   Fluid accumulation in the abdominal cavity due to portal pressure and low albumin.

3. Hepatic Encephalopathy
   Toxin buildup due to impaired liver function affecting brain activity.

4. Hypersplenism
   Overactive spleen destroys blood cells, leading to anemia, leukopenia, and thrombocytopenia.

5. Hepatorenal Syndrome
   Kidney failure associated with advanced liver disease and portal hypertension.

6. Spontaneous Bacterial Peritonitis (SBP)
   Infection in ascitic fluid without a clear source.

Diagnosis of Portal Hypertension

1. Clinical Examination

• Signs of ascites, enlarged spleen, or spider angiomas

• History of liver disease or alcohol use

2. Blood Tests

• Liver function tests (LFTs)

• Complete blood count (CBC) – often shows low platelets

• Coagulation profile

• Viral markers for hepatitis B and C

3. Imaging Studies

• Ultrasound with Doppler: Assesses portal vein diameter and flow

• CT Scan or MRI: Detects cirrhosis, varices, thrombosis, and ascites

• Endoscopy: Visualizes and grades esophageal and gastric varices

4. Hepatic Venous Pressure Gradient (HVPG)

• Gold standard test to measure pressure gradient between portal vein and hepatic vein

• HVPG >10 mmHg indicates clinically significant portal hypertension

Treatment of Portal Hypertension

While portal hypertension itself may not be fully reversible, managing the underlying cause and treating complications is crucial.

1. Lifestyle & Dietary Modifications

• Avoid alcohol

• Low-sodium diet to reduce ascites

• Adequate protein intake (may need adjustment in hepatic encephalopathy)

2. Medications

Non-selective Beta-Blockers

• Propranolol, Nadolol

• Reduce portal pressure and prevent variceal bleeding

Diuretics

• Spironolactone and furosemide to manage ascites

Lactulose or Rifaximin

• For treating hepatic encephalopathy

Antibiotics

• To prevent SBP in high-risk ascites

3. Endoscopic Procedures

Endoscopic Variceal Ligation (EVL)

• Rubber band applied to varices to prevent bleeding

Sclerotherapy

• Injection of a sclerosing agent into varices to stop bleeding

4. Interventional Radiology

TIPS (Transjugular Intrahepatic Portosystemic Shunt)

• Minimally invasive procedure creating a channel within the liver to bypass high-pressure portal vein and reduce portal pressure

• Effective for recurrent variceal bleeding or refractory ascites

5. Liver Transplantation

• Only curative option in cases of end-stage liver disease or decompensated cirrhosis

Portal Hypertension in Children

In children, non-cirrhotic portal hypertension is more common than in adults and is often caused by extrahepatic portal vein obstruction (EHPVO) or congenital liver fibrosis.

Symptoms in Children

• Splenomegaly

• Growth retardation

• Upper GI bleeding

Treatment in children typically includes:

• Endoscopic therapy

• Beta-blockers

• Shunt surgeries in selected cases

Prevention Strategies

While portal hypertension itself is often secondary to other conditions, prevention focuses on avoiding liver damage and managing risk factors:

• Avoid alcohol

• Vaccinate against hepatitis B

• Maintain healthy weight

• Manage chronic viral hepatitis

• Routine liver check-ups if at risk

• Avoid hepatotoxic drugs

At Sparsh Diagnostic Centre, we offer comprehensive services to diagnose and monitor portal hypertension effectively:

🩺 Imaging

• Ultrasound with Doppler.

💉 Blood Investigations

• Liver profile, viral markers, clotting tests, and platelet counts

📍 Endoscopy Referrals

• For direct visualization of varices and bleeding risk

👩‍⚕️ Expert Consultations

• Gastroenterology, hepatology, and interventional radiology available on referral

🏠 Home Sample Collection

• Convenient and safe diagnostic services across Kolkata

With modern diagnostics and compassionate care, we help detect complications early and guide effective treatment plans.

Frequently Asked Questions (FAQs)

Q1: Is portal hypertension curable?

Not entirely, but its complications can be managed effectively. In some cases, liver transplant is the only curative option.

Q2: Can someone live with portal hypertension?

Yes, many patients live with the condition if they manage their liver health, avoid alcohol, and follow their doctor’s guidance.

Q3: What foods should be avoided in portal hypertension?

Salt, red meat, raw seafood, and alcohol. A liver-friendly diet and low-sodium intake are essential.

Q4: Is variceal bleeding life-threatening?

Yes. It is a medical emergency. Immediate endoscopic treatment and blood transfusion may be required.

Portal Hypertension is a serious yet manageable condition. While cirrhosis is its most common cause, early detection and comprehensive management can significantly improve the quality of life.

Understanding its signs, undergoing regular check-ups, and seeking prompt care are key to preventing complications.

If you or a loved one has liver disease, unexplained abdominal swelling, or gastrointestinal bleeding—don’t ignore the signs. Let Sparsh Diagnostic Centre help you with accurate diagnosis and compassionate care.

Visit Sparsh Diagnostic Centre

Mon–Sat: 7 AM – 9 PM | Sunday: 7 AM – 3 PM
📞 Call: 9830117733 / 8335049501
🌐 Website: www.sparshdiagnostica.com

Early diagnosis saves lives.