Portal Hypertension
Basics
Description
- Increased portal venous pressure >5 mm Hg that occurs in association with splanchnic vasodilatation, portosystemic collateral formation, and hyperdynamic circulation
- Most commonly secondary to elevated hepatic venous pressure gradient (HVPG; the gradient between portal and central venous pressures)
- Course is progressive, with risk of acute variceal bleeding, ascites, hepatic encephalopathy, portopulmonary syndrome, and hepatorenal syndrome.
Epidemiology
Prevalence
- Prevalence: <200,000 persons in the United States
- Predominant sex: male > female adults
Etiology and Pathophysiology
- Develops as a consequence of resistance to blood flow in the portal venous system
- Causes generally classified as follows:
- Prehepatic (portal vein thrombosis or obstruction)
- Intrahepatic (most commonly cirrhosis or schistosomiasis)
- Posthepatic (hepatic vein thrombosis, Budd-Chiari syndrome, right-sided heart failure)
- 90% of intrahepatic cases are due to cirrhosis secondary to the following:
- Virus (hepatitis B, hepatitis C, hepatitis D)
- Alcoholism
- Nonalcoholic fatty liver disease
- Schistosomiasis
- Wilson disease
- Hemochromatosis
- Primary biliary cholangitis (PBC)
- Sarcoidosis
- Increased HVPG results in venous collateral formation in the distal esophagus, proximal stomach, rectum, and umbilicus.
- Progression of portal hypertension results in splanchnic vasodilation and angiogenesis.
- Gastroesophageal variceal formation is found in 40% of patients with portal hypertension.
Risk Factors
Pediatric Considerations
Portal vein thrombosis is the most common extrahepatic cause; intrahepatic causes are more likely to be biliary atresia, viral hepatitis, and metabolic liver disease.
Commonly Associated Conditions
- Alcoholism
- Cirrhosis
- Nonalcoholic fatty liver disease
- Schistosomiasis
- Extrahepatic portal vein thrombosis
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Citation
Domino, Frank J., et al., editors. "Portal Hypertension." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688716/all/Portal_Hypertension.
Portal Hypertension. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688716/all/Portal_Hypertension. Accessed December 1, 2024.
Portal Hypertension. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688716/all/Portal_Hypertension
Portal Hypertension [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 01]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688716/all/Portal_Hypertension.
* Article titles in AMA citation format should be in sentence-case
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T1 - Portal Hypertension
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ED - Baldor,Robert A,
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ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
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