Portal Hypertension Overview

Portal hypertension, a condition caused by liver disease, is an increase of pressure of the portal vein, which leads from the intestines to the liver. It's a complication of hepatitis and liver cirrhosis, and it can cause swelling, bleeding, and more.

Anatomy of liver, antero-visceral view, diagram with labels on a white background

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Blood Flow Through the Liver: How It Works

The liver receives blood from two sources.

  • Fresh blood, coming from the heart, supplies the liver with oxygen and nutrients through the hepatic artery.
  • Because the liver filters toxins and processes nutrients, blood from the intestines and other organs of the digestive system come to the liver via the portal vein.

The blood in the portal vein flows directly into the liver and is filtered by the hepatocytes (liver cells). After this process, the detoxified blood continues through the liver and returns to the heart through a different set of vessels, the hepatic veins.

If the pathway to the liver from the intestines is blocked or slowed because of obstruction or disease, then the pressure increases in the portal venous system. This is portal hypertension, and it leads to many consequences that have widespread effects throughout the body.

Causes of Portal Hypertension

Liver cirrhosis is the most common cause of portal hypertension. Liver cirrhosis is also described as liver fibrosis, a type of scaring. It's caused by liver damage that can occur due to heavy and prolonged alcohol use, hepatitis, other liver infections, inflammatory disorders, blood clots, and toxins.

Other causes of portal hypertension may or may not also cause cirrhosis and include schistosomiasis, sarcoidosis, portal vein thrombosis, toxicity from vinyl chloride or medications, cancer occluding the intrahepatic portal vein, and miliary tuberculosis.

These disease processes may interfere with the passage of blood through the liver. The obstruction can occur within the portal vein, or blood flow through smaller veins in the liver can be blocked, causing a backup into the portal vein.

Problems Caused by Portal Hypertension

Portal hypertension causes several serious problems: ascites, varices, bleeding, and encephalopathy.

Acites

Ascites is the accumulation of excess fluid in the tissues lining the organs and the abdominal wall. This occurs due to pressure and leaking of the lymphatic vessels.

The pressure in the portal vein affects nearby lymphatic vessels, causing them to become permeable, which means that they leak fluid from their vessel walls. The fluid then builds up into surrounding tissues in the abdomen and legs—leading to an appearance of puffiness of these areas.

Varices

Esophageal varices are engorged veins along the esophagus, and varices can develop along the stomach or intestines as well. Varices are directly caused by portal hypertension.

When the blood flow in the liver is obstructed, the blood can become backed up into the intersections of the portal venous system (the system of veins transporting blood between the digestive system and liver) and the systemic venous system (the system of veins that returns blood to the heart). The intersections of these two systems are small, fragile blood vessels called capillaries. These vessels are not able to withstand the increased blood pressure and become engorged or dilated.

These vessels are fragile and at risk for bleeding. This is a dangerous situation that can cause sudden and severe blood loss and accumulation of blood in the body cavities.

Liver Failure

The liver plays a role in detoxifying chemicals in the body, as well as helping in the production of blood clotting factors. Severe portal hypertension can impair these functions.

Hepatic encephalopathy is a condition that causes behavioral problems and memory deficits as a result of liver failure.

And liver failure due to portal hypertension can cause bleeding susceptibility due to the deficiency of adequate clotting factors.

Diagnosis

Portal hypertension is diagnosed based on a combination of medical history, physical examination, and diagnostic tests. Anyone with advanced cirrhosis will be monitored closely for signs of portal hypertension.

Signs and symptoms can include any of the following:

  • Frequent bleeding or bruising
  • Blood in the stool or coughing up blood
  • Jaundice (yellow discoloration of the skin and whites of the eyes)
  • Swollen abdomen or legs
  • Splenomegaly (enlarged spleen)
  • Encephalopathy, with behavioral and cognitive changes and difficulty walking

If you have any of these signs or symptoms, your doctor may order an abdominal X-ray, ultrasound, or computerized tomography (CT) scan. You may also need liver function tests to assess your liver function.

Depending on your signs and symptoms, you may also have a complete blood count (CBC), which can be used to determine whether you've had excess blood loss due to bleeding. Sometimes varices can be seen along the surface of the esophagus or stomach during an endoscopy procedure.

Treatment

The management of portal hypertension can involve emergency treatment, such as for acute variceal bleeding, or ongoing therapy, such as medication to reduce pressure in the portal vein and the varices.

Treatment often depends on the effects that you are experiencing. And interventions to reduce the risk of bleeding and progression of portal hypertension might be needed as well.

Some treatment options include:

  • Blood transfusion
  • Blood clotting factors
  • Medication to reduce blood pressure
  • Surgical repair of varices

Sometimes a liver transplant is considered as a possible treatment.

A Word From Verywell

Portal hypertension is a serious condition, so you need to maintain consistent medical care if you have this condition. While this diagnosis can be anxiety provoking, it's important for you to know that comprehensive medical care can substantially improve your outcome and quality of life. Make sure that you and your loved ones are aware of the lifestyle adjustments that you need to make to ensure that you have the best outcome—this includes avoiding alcohol, following a diet that's guided by your healthcare providers, and avoiding all medications, herbs, or supplements that have the potential to cause further liver damage.

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