Portal hypertension is high blood pressure in the portal vein, the vessel that carries blood from the digestive organs to the liver. It is most often a complication of liver cirrhosis, where scarring blocks the normal flow of blood through the liver and forces pressure to build up behind it.
What Causes Portal Hypertension?
- Liver cirrhosis (the most common cause)
- Blood clots in the portal vein
- Schistosomiasis and certain other infections
- Blockage of the veins draining the liver
Symptoms and Complications
Portal hypertension itself is silent, but its complications are serious:
- Enlarged veins (varices) in the food pipe or stomach that can bleed dangerously
- Fluid build-up in the abdomen (ascites)
- Enlarged spleen and low platelet counts
- Confusion from a build-up of toxins (hepatic encephalopathy)
How Is It Diagnosed?
- Endoscopy to look for varices
- Ultrasound and Doppler study of the portal vein
- CT or MRI of the abdomen
- Blood tests assessing liver function and platelet count
Treatment Options
Treatment focuses on lowering the pressure and preventing complications:
- Medications (beta blockers) to reduce portal pressure
- Endoscopic banding of varices to prevent bleeding
- A TIPS procedure to reroute blood flow in selected cases
- Treating the underlying liver disease
- Liver transplant for advanced cirrhosis with portal hypertension
When to Seek Care
Vomiting blood, black tarry stools, or sudden abdominal swelling are emergencies and need immediate hospital care. If you have known liver disease, regular screening for varices can prevent the first bleed.