Portal Hypertension

Portal hypertension is abnormally high pressure in the portal vein system, the network of vessels that carries blood and nutrients from the intestine to the liver, clinically defined as a hepatic venous pressure gradient above 5 mmHg against a normal range of 1 to 4 mmHg, with complications becoming likely above 10 mmHg. Cirrhosis of the liver is by far the most common cause; less common causes, grouped as non-cirrhotic portal hypertension, include blood clots, narrowing of the portal vein, and other vascular problems. It typically causes abdominal swelling from fluid buildup called ascites, vomiting of blood, and abnormal blood tests including raised liver enzymes and low platelet counts, and its complications include spontaneous infection of the abdominal fluid, bleeding from swollen veins in the esophagus or stomach, confusion from liver-related toxin buildup called hepatic encephalopathy, kidney failure, and heart problems. Treatment aims either to lower the portal pressure directly or to manage its acute and chronic complications.