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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Adult and Senior Health Portal hypertension

Portal hypertension

Portal hypertension is hypertension in the portal vein and its tributaries. Portal hypertension is defined as portal pressure gradient of 12 mm Hg or greater and is often associated with varices and ascites.


Signs and symptoms

  • Jaundice
  • History of blood transfusion
  • Intravenous drug abuse
  • History of alcohol consumption
  • Pruritus
  • Hematemesis
  • Melena
  • Lethargy
  • Increased irritability
  • Altered sleep patterns
  • Increased abdominal girth due to ascites
  • Hematochezia
  • Abdominal pain
  • Fever


Signs of port systemic collateral formation


  • Dilated veins in the anterior abdominal wall
  • Venous pattern on the flanks
  • Caput medusa
  • Rectal hemorrhoids
  • Ascites
  • Paraumblical hernia


Signs of liver disease


  • Ascites
  • Jaundice
  • Spider nevi
  • Gynecomastia
  • Dupuytren’s contracture
  • Muscle wasting
  • Palmar erythema
  • Asterixis
  • Testicular atrophy
  • Splenomegaly






Intrahepatic presinusoidal and/ or postsinusoidal


  • Hepatic cirrhosis
  • Acute alcoholic hepatitis
  • Primary biliary cirrhosis
  • Congenital hepatic fibrosis
  • Vitamin A toxicity
  • Budd chiari syndrome
  • Pelisosis hepatitis


Intrahepatic, predominantly presinusoidal




Emergency treatment


  • Each episode of variceal bleeding is associated with 30% mortality fever.
  • Initial resuscitation with replacement of blood volume loss by packed or whole red blood cells or plasma expanders.
  • Avoid intravascular volume and variceal overexpansion to prevent re bleeding.
  • Prophylactic antibiotic use to decrease the rate of bacterial infections.




  • Somatostatin- is an endogenous hormone that decreases the portal blood flow by vasoconstriction.
  • Octreotide- it’s an analogue of somatostatin, also effective in reducing the complications of variceal bleeding after emergency sclerotherapy or variceal ligation
  • Vasopressin- Most potent vasoconstrictor has more side effects.
  • Terlipressin- has fewer adverse effects than vasopressin.


Endoscopic therapy


  • Endoscopic therapy has the advantage of allowing specific therapy at the time of diagnosis.
  • >80% of hemostasis can be achieved.
  • Endoscopic injection sclerotherapy involves injecting sclerosant solution like sodium morrhuate, sodium tetradecyl sulfate, and ethanolamine oleate into the bleeding veins.


Endoscopic variceal ligation

Other interventions


  • Balloon tube tamponade
  • Minnesota tube


Primary prophylaxis


  • Beta blockers- Propranolol and Nadolol
  • Vasodilators- Isosorbide mononitrate
  • Combination therapy- Propranolol and Isosorbide mononitrate
  • Prophylactic sclerotherapy
  • Prophylactic endoscopic variceal ligation


Surgical care

Decompressive shunts


  • Total portal systemic shunts
  • Partial portal systemic shunts
  • Selective shunts


Devascularization procedures


  • Splenectomy
  • Liver transplantation