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Portal Hypertension

Portal Hypertension

Portal hypertension is elevated pressure in your portal venous system. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver.

Portal Hypertension Symptoms

If you have liver disease, you have an increased risk of developing portal hypertension. Be aware of unusual symptoms and report them to your doctor right away. Symptoms and signs of portal hypertension include:

  • Gastrointestinal bleeding; you may notice blood in the stools or you may vomit blood as the varices begin to rupture

  • Ascites, when fluid accumulates in your abdomen, causing swelling

  • Encephalopathy, or confusion and forgetfulness

  • Jaundice, the yellowing of the skin and the whites of the eyes

  • Edema (swelling) of the legs

  • Caput medusae, a visible network of dilated veins surrounding your navel

Portal Hypertension Diagnosis at Johns Hopkins

There are a number of ways to diagnose portal hypertension. For patients with end-stage liver disease who present with ascites and varices, the doctor may not need to perform any diagnostic tests and can confirm a diagnosis based on symptoms.

Diagnostic procedures your doctor may order include:

Imaging Studies

An imaging study helps in the diagnosis of portal hypertension. These are noninvasive studies and can give your doctor a detailed image of your portal venous system. A duplex Doppler ultrasound is typically the first imaging test ordered.

A Doppler ultrasound uses sound waves to see how the blood flows through your portal vein. The ultrasound gives your doctor a picture of the blood vessel and its surrounding organs, as well as the speed and direction of the blood flow through the portal vein.

Pressure Measurement Studies

An interventional radiologist may perform a pressure measurement study to evaluate the level of pressure in the hepatic (liver) vein.

Endoscopic Diagnosis

If you suffer from acute gastrointestinal hemorrhage, you will most likely need an endoscopy. In patients with cirrhosis, most often the bleeding is related to esophageal varices, which are enlarged veins in your esophagus.

An endoscopy can provide a definitive diagnosis as well as allow your doctor to treat the bleeding. During a gastrointestinal endoscopy, your doctor can see the mucous lining of the upper gastrointestinal tract, including the esophagus, stomach and duodenum (first part of the small intestine).

During an upper endoscopy:

  1. You receive an anesthetic to help relax your gag reflex.. You may also receive pain medication and a sedative.

  2. You lie on your left side, referred to as the left lateral position.

  3. Your doctor inserts the endoscope (a thin, flexible, lighted tube) through your mouth and pharynx, into the esophagus.

  4. The endoscope transmits an image of the esophagus, stomach and duodenum to a monitor that your physician is watching.

  5. Any bleeding you may have is immediately treated.


If necessary, an enteroscope may be used during the procedure. This is a special type of endoscope that allows your doctor to see even further into your gastrointestinal system.

Complications of Portal Hypertension

Portal Hypertension: Ascites

Ascites is excess fluid in your abdominal cavity. Patients with chronic liver disease often develop ascites, though it may be caused by other factors. Symptoms of ascites include:

  • Early feeling of fullness

  • Increase in size of abdomen

  • Feeling out of breath (if the fluid begins pushing on your lungs)

    Ascites
    Ascites (Click to Enlarge)


You will need to follow a low-sodium diet, as sodium causes fluid retention in your body. In severe cases, you may need to restrict your water intake. A prescription diuretic may help reduce sodium retention in your kidneys.

Sometimes, paracentesis may be necessary if the ascites is difficult to manage. During a paracentesis, your doctor inserts a needle into your abdomen to remove the fluid.

Mechanism of ascites in portal hypertension; S=stomach; C=colon; I=intestine.
Mechanism of ascites in portal hypertension; S=stomach; C=colon; I=intestine. (Click to Enlarge)

Portal Hypertension: Varices

Varices are varicose veins. Your doctor can view them during an endoscopy (internal viewing of your GI tract) or other imaging study. Varices most often occur in the esophagus or stomach as a result of portal hypertension. In patients with cirrhosis, the liver tissue is scarred and blood cannot flow through normally.

As the portal blood is rerouted due to the increased resistance, varices develop. Acute bleeding from varices in patients with portal hypertension requires immediate attention in order to control the bleeding and prevent it from recurring.

Esophageal and gastric varices with corresponding endoscopic views.
Esophageal and gastric varices with corresponding endoscopic views. (Click to Enlarge)

Portal Hypertension Treatment at Johns Hopkins

The goal of treatment for portal hypertension is to prevent further complications and decrease pressure. However, it can be difficult to maintain the proper pressure level. Learn more about portal hypertension treatment at Johns Hopkins.

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