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Diagnósticos

Healthcare professionals often diagnose portal hypertension by asking about your health history and doing a physical exam. A physical exam can show signs such as fluid buildup in the belly or an enlarged spleen. If you have known risk factors for portal hypertension, such as cirrhosis, as well as symptoms, that may be all that's needed to make the diagnosis.

Sometimes, your health professional may order blood tests and imaging tests. If the diagnosis isn't clear, portal vein pressure may be measured directly to find out how high it is. This is not often done because the test is invasive.

Blood and lab tests

Blood tests can show changes linked to portal hypertension.

• Complete blood count (CBC). This test measures the number of different cells in your blood, including platelets. Portal hypertension can enlarge the spleen, which may lower platelet counts. Low platelet levels, called thrombocytopenia, can suggest portal hypertension.
• Liver function tests. These blood tests check how well the liver is working. Results outside the standard range may suggest a liver disease that can cause portal hypertension.
• Other tests. You may have other lab tests, for example, to find out whether fluid in the belly, called ascites, is caused by portal hypertension or something else. A measurement called the serum-ascites albumin gradient (SAAG) can help tell this by comparing the level of a protein called albumin in the blood with the level of albumin in the fluid in the belly. A gradient measurement of 1.1 grams per deciliter (g/dL) or more means the fluid is likely caused by portal hypertension.

Blood and lab test findings help guide the need for more testing, but they do not confirm portal hypertension on their own.

Imaging tests

Imaging helps show the effects of increased pressure in the portal vein system.

• Ultrasound. An ultrasound of the belly, called an abdominal ultrasound, can show an enlarged spleen, fluid in the belly and changes in the size of the portal vein. These findings may suggest portal hypertension. A special type of ultrasound called Doppler ultrasound shows the direction and speed of blood flow in the portal vein and nearby vessels. Slowed or altered blood flow patterns may suggest portal hypertension. However, ultrasound does not directly measure portal pressure.
• Upper endoscopy. This test allows a healthcare professional to look directly at the esophagus and stomach using a flexible tube with a camera. This test can find enlarged veins called varices.
• CT scan. This test shows detailed cross-sectional images, also called slices, of the liver and surrounding blood vessels. An enlarged spleen or new, enlarged or twisting veins, called collateral veins or varices, are possible signs of portal hypertension. CT also may show the underlying cause, such as scarring of the liver called cirrhosis.
• Magnetic resonance imaging (MRI). This test shows detailed images of soft tissues, including the liver and blood vessels. It also can show enlarged veins, changes in blood flow and other features linked to portal hypertension. A test called magnetic resonance elastography also might be done. This test can measure liver tissue stiffness to help show whether portal hypertension is high enough to cause complications. Portal hypertension that can cause complications also is called clinically significant.

Imaging tests show different signs that suggest portal hypertension. But they do not directly measure how high the pressure is.

Measuring portal pressure

If a diagnosis of portal hypertension isn't clear, portal pressure may be measured in one of two ways.

• Indirect method. This is done using a tube called a catheter that's placed into the veins that move blood from the liver to the heart rather than in the portal vein itself. During the test, the pressure is measured both when blood is blocked by a small balloon at the end of the catheter and when blood is not blocked by the balloon. The difference between those two numbers is called the hepatic venous pressure gradient (HVPG). It is an indirect estimate of pressure in the portal vein.

  Portal hypertension is defined as an HVPG greater than 5 millimeters of mercury (mm Hg). When the HVPG reaches 10 mm Hg or more, the risk of complications increases. An HVPG greater than 12 mm Hg is linked to a higher risk of bleeding from enlarged veins.

• Direct method. Though much less common, direct measurement of portal pressure may be done by placing a catheter into the portal vein.

How serious is portal hypertension?

Portal hypertension ranges from mild to severe. How severe it is depends on how high the pressure is and whether complications have happened. Lower pressure levels may not cause symptoms. Higher pressures, especially above 10 to 12 mm Hg, are linked to a greater risk of conditions such as bleeding or fluid buildup.

Tratamientos

Treating portal hypertension includes managing the underlying causes. It also includes ongoing treatment to prevent and manage complications, such as bleeding in the digestive system and fluid in the belly. This treatment is done with medicines, endoscopy procedures or both.

When medicines and endoscopy aren't enough to manage symptoms and complications, treatments may include other procedures or surgery. This may include a procedure to place a shunt that redirects blood flow in the liver or transplant surgery to replace the diseased liver with a donated liver.

Can portal hypertension be cured?

If the underlying cause of portal hypertension is reversible, the liver may heal and reverse or cure the portal hypertension. For example, if viral hepatitis is the cause, treating it may resolve both conditions. If a liver transplant is done for advanced liver disease, the donated liver also could cure the underlying cause. Medicines and other procedures do not cure portal hypertension. But they can help protect the body from further damage and complications and improve some symptoms.

Medicines

• Medicines to lower blood pressure. Beta blocker medicines can be used to reduce the risk of bleeding varices. They work to lower blood pressure in the portal vein by slowing the heart rate and widening blood vessels. They may not be safe to use if you have ascites or an infection of ascites called spontaneous bacterial peritonitis. Beta blocker medicines include propranolol (Inderal LA, Innopran XL), carvedilol (Coreg) and nadolol.
• Medicines to slow blood flow into the portal vein. Vasoconstrictor medicines such as octreotide (Sandostatin) and vasopressin (Vasostrict) taken for several days may help treat sudden, also called acute, bleeding varices. They can help by tightening widened blood vessels.
• Medicines to remove sodium and water from the body. These medicines, called diuretics, may prevent or reduce extra fluid buildup in the body called ascites. Diuretics can be given as pills or through a tube placed in a vein (IV). Your healthcare professional also may suggest limiting sodium in your diet to help prevent fluid buildup.
• Medicines to fight infection. To treat or prevent infection of ascites, called peritonitis, you may be given antibiotic medicines either in pill form or by IV.
• Medicines to treat changes in thinking and alertness. If portal hypertension causes a buildup of toxins in the brain, called hepatic encephalopathy, it can affect personality, thinking and alertness. Medicines such as lactulose and rifaximin can help prevent or reduce ammonia and other toxins from building up.

Procedures and surgery

• Endoscopy. Endoscopy involves inserting a flexible tube with a tiny camera, called an endoscope, through the mouth and down the throat. It allows a view of the esophagus, stomach and beginning of the small intestine. Endoscopy looks for enlarged veins called varices. If found, varices are measured and checked for red streaks and red spots, which usually suggest a high risk of bleeding. When bleeding risk is high or bleeding is already happening, a procedure called band ligation can help prevent and treat it.
• Endoscopic band ligation. Using an endoscope, a healthcare professional uses suction to pull the varices into a chamber at the end of the scope and wraps them with an elastic band. This essentially "strangles" the veins so they can't bleed. Endoscopic band ligation carries a small risk of complications, such as bleeding and scarring.

• Transjugular intrahepatic portosystemic shunt (TIPS). You may have a TIPS procedure to stop bleeding if it isn't stopped by medicine or endoscopy. This procedure is not a traditional surgery. Instead, it uses imaging technology and tools guided through blood vessels. The procedure reroutes — also called shunts — blood from the portal vein to a hepatic vein. Hepatic veins carry blood from the liver to the heart. This is done by placing a small hollow tube called a stent. It decreases pressure in the varices and often stops bleeding.

  TIPS can cause serious complications, including liver failure and mental confusion. These symptoms can happen when toxins that the liver typically would filter are passed through the shunt directly into the bloodstream. TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant.

• Surgical shunts. Sometimes, though rarely, a shunt may be placed through traditional surgery instead of the TIPS procedure. This might be done, for example, in someone who has portal hypertension not caused by cirrhosis with bleeding that's hard to manage. It also might be done in someone who can't have a TIPS procedure due to technical reasons.
• Liver transplant. Liver transplant may be an option for some people, for example, those with severe liver disease or who have bleeding of varices again and again. Although liver transplantation is often successful, the number of people awaiting transplants far outnumbers available organs.

Prognosis

Portal hypertension is a serious condition. The outlook, also called prognosis, and how it affects life expectancy mainly depends on the underlying cause and how bad the liver damage is. For example, idiopathic portal hypertension that's not caused by cirrhosis has a good prognosis when complications are managed well.

However, portal hypertension usually is a result of cirrhosis or other liver disease. Because of this, the prognosis for most portal hypertension is closely tied to how the underlying liver disease progresses and is managed.

The risk of death from sudden, also called acute, bleeding varices ranges from 15% to about 40% within six weeks of the acute bleed. Treatment helps reduce the risk of further bleeding. But more than 60% of people do not survive five years beyond the first bleed. Ultimately, those with progressive liver disease and many varices need a liver transplant.

Estudios clínicos

Explora los estudios de Mayo Clinic que ensayan nuevos tratamientos, intervenciones y pruebas para prevenir, detectar, tratar o controlar esta afección.

Modo de vida y remedios caseros

If you have portal hypertension, lifestyle changes may help protect the liver and reduce the risk of portal hypertension complications:

• Don't drink alcohol. Even a single glass of alcohol can damage your liver further. This is true for all types of alcoholic drinks.
• Eat a low-sodium diet. Extra salt can cause your body to hold on to fluids. This can worsen swelling in your belly and legs. Use herbs rather than salt to season your food. Choose prepared foods that are low in sodium.
• Protect yourself from infections. If you have cirrhosis, your body can have trouble fighting off infections. Protect yourself by avoiding people who are sick and washing your hands often. Get vaccinated, for example, for hepatitis A and B, influenza, and pneumonia.
• Use nonprescription medicines carefully. Liver damage makes it harder for your liver to process medicines. For this reason, ask a healthcare professional before taking any medicines, including those you can get without a prescription. Do not take ibuprofen (Advil, Motrin IB, others), aspirin or aspirin-containing products unless your care team tells you. A health professional may recommend that you take acetaminophen (Tylenol, others) in low doses for pain relief.
• Follow your healthcare team's instructions. Follow any diet recommendations, take medicines as prescribed, and get your blood tests and medical exams at the recommended times. Also watch for signs of complications and take action as advised by your care team.

Preparación para la consulta

If you have portal hypertension, you may be referred to a doctor who specializes in the digestive system, called a gastroenterologist, or a doctor who is an expert on the liver, called a hepatologist.

Here's some information to help you get ready for your appointment and what to expect.

What you can do

• Be aware of anything you need to do ahead of time, such as diet restrictions on the day before your appointment.
• Write down your symptoms, including when they started and how they may have changed or worsened over time.
• Take a list of all your medicines, as well as any vitamins or supplements, including the doses.
• Write down your key medical information, including other diagnosed conditions.
• Bring results of medical tests done so far, including digital copies of ultrasound, CT or MRI images and biopsy slides if you've had a liver biopsy.
• Write down key personal information, including any recent changes or stressors in your life.
• Take along a family member or friend to help you remember things.
• Write down questions to ask your healthcare professional.

Questions to ask your doctor

Preparing a list of questions can help you make the most of your time. Some basic questions to ask include:

• What's likely causing my symptoms?
• What tests do I need?
• What is most likely causing my portal hypertension?
• Is there a way to slow or stop my liver damage?
• What are my treatment options?
• What are the side effects of treatments?
• Are my symptoms likely to get worse, and what can I do to help prevent that?
• What signs and symptoms of complications should I watch for?
• I have other health conditions. How can I best manage them together?
• Are there medicines or supplements that can hurt my liver?
• What foods should I eat or avoid?
• What's the right level of physical activity for me?
• Should I see a specialist?
• How often should I schedule appointments to check on my health?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Be prepared to answer questions, including:

• When did you first begin having symptoms?
• Do your symptoms happen all the time or do they come and go?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• What, if anything, seems to worsen your symptoms?
• How often do you drink alcohol?
• Have you been exposed to or taken toxic drugs?
• Do you have a family history of liver disease, hemochromatosis or obesity?
• Have you ever had viral hepatitis?
• Have you ever had jaundice?
• Have you ever had a blood transfusion or used injected drugs?
• Do you have any tattoos?