What is portal hypertension?
Portal hypertension is high blood pressure in the portal vein. The portal vein is
located in your belly (abdomen). It gets blood from your digestive organs (large and
small intestines, stomach, pancreas, spleen) and carries it to the liver. The liver
cleans and filters waste from the blood. The blood then travels to the heart and into
general circulation for your body to use. With liver disease, blood flow can be blocked
through the liver. This raises the pressure in the portal vein.
When you have portal hypertension, this increased pressure makes it harder for blood
to flow normally through the portal vein. Blood is redirected away from (bypasses)
the liver. The body forms new vessels for the blood to flow through, especially to
the esophagus and stomach. These veins become enlarged and twisted. They swell up
and may burst (rupture) under the added pressure. Treatment is needed to prevent them
from bursting and bleeding. If bleeding occurs, it can be fatal. Other areas of the
body where blood vessels may form and enlarge can include the belly or rectum.
What causes portal hypertension?
These are the most common causes of portal hypertension:
Scarring of the liver (called cirrhosis)
Clotting of the portal vein
Clotting of the veins in the liver
In developing countries, one of the most common reasons is an infection called schistosomiasis.
What are the symptoms of portal hypertension?
At first, you may have no symptoms. They may not develop until there are complications.
Having a higher than normal pressure inside the portal vein can lead to a number of
related symptoms. These include:
Enlarged liver and spleen
Enlarged veins (varices) of the esophagus and stomach. These can cause abnormal bleeding,
such as vomiting blood.
Weight loss from malnutrition
Fluid buildup in the belly (ascites)
Fluid on the lungs
How is portal hypertension diagnosed?
Your healthcare provider will ask you about your health history, symptoms, risk factors,
and family history of disease. The provider will do a physical exam. Unfortunately,
healthcare providers can’t measure high blood pressure in the portal vein with a cuff
like they can for regular high blood pressure. If you are at risk for or already have
cirrhosis, you may need several tests:
Lab tests. You may have various blood tests. A low platelet count is the most common sign of
Imaging tests. These give your provider pictures of the liver or blood flow in the liver. They let
your provider check for enlarged veins around the liver and assess the risk of bleeding.
Common imaging tests done include ultrasound and CT scans.
Endoscopic exam. This is done to see inside the upper digestive tract. During the test, an endoscope
is used. This is a thin, flexible tube with a tiny camera on the end. The provider
puts it through your mouth. He or she guides it down through your esophagus, stomach,
and the first part of your small intestine. This lets the provider check for enlarged
veins and find any bleeding.
How is portal hypertension treated?
Healthcare providers treat portal hypertension in several ways:
Medicines. You may need to take medicines called beta blockers. These improve how your heart
and blood vessels work. These medicines often also lower the risk of bleeding from
swollen veins. If you have internal bleeding because of portal hypertension, your
healthcare provider might inject medicine into the vein to help stop the bleeding.
Or they may place bands around veins to stop the bleeding.
Shunting. If you have a severe case, you may need shunting. This involves putting stents in
the portal vein to open it and improve blood flow. Shunting can be done with or without
surgery. Surgical shunting can cause more complications than the nonsurgical method.
Liver transplant. This treatment may be needed if you have liver failure.
What are possible complications of portal hypertension?
The possible complications of portal hypertension are:
Internal bleeding. Esophageal varices are enlarged veins at the lower end of the esophagus. With portal
hypertension, blood backs up in nearby veins in the esophagus and stomach, causing
varices. Varices are a serious problem. They can burst and cause internal bleeding.
This often happens where the esophagus and stomach meet. This complication can cause
sudden, explosive vomiting of blood. It can be fatal.
Fluid buildup in the stomach. This can cause you to feel full quickly, leading to weight loss and malnutrition.
The discomfort from carrying all that fluid can also reduce how well you can get around.
Sometimes the fluid pushes up on the diaphragm and causes trouble breathing.
Serious kidney problems
When should I call my healthcare provider?
Portal hypertension is a dangerous condition with severe, life-threatening complications.
Call your healthcare provider right away if you notice any of these symptoms:
Key points about portal hypertension
Portal hypertension is high blood pressure of the portal vein. The portal vein is
located in your belly. It collects nutrient-rich blood from your intestines and carries
it to the liver.
Cirrhosis, or scarring of the liver, is one of the most common causes of this health
Some symptoms include an enlarged liver and spleen, varicose veins of the esophagus
and stomach, and weight loss from malnutrition.
Certain medicines may help treat portal hypertension. In severe cases, shunting or
a liver transplant may be needed.
Internal bleeding and fluid buildup in the stomach are possible complications.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.