Portal Hypertension; Causes, Symptoms, Diagnosis, & Treatment

Diagnosis of portal hypertension

The diagnosis of portal hypertension is a clinical one. Patients present with classical signs and symptoms such as bloody vomiting and early satiety, otherwise no specific tests are done in clinical practice to measure the blood pressure within the portal system the same way the normal blood pressure is measured. Some investigations may be done to assess the degree of complications of portal hypertension including endoscopy. In endoscopy, your doctor will insert a small tube into your esophagus (food tube) to see if there are any varices or dilated blood vessels and to see the source of bleeding in case of bloody vomiting.

With that said, it is important to understand the identification of the cause of portal hypertension is far more important than the diagnosis of portal hypertension itself. For example. Liver cirrhosis needs a group of investigations including:

1. Liver function tests: Liver function tests are impaired in cirrhosis with elevated liver enzymes and prolonged prothrombin time (prothrombin time is a measure of coagulation)
   1Bilirubin levels: Bilirubin is metabolized and excreted by liver cells, and this can be affected in liver diseases like cirrhosis. This resulted in the elevation of bilirubin levels.
2. Alpha-fetoprotein: Alpha-fetoprotein is an important tumor marker that can be elevated in hepatocellular carcinoma (liver cancer). Liver cancer is, unfortunately, one of the complications of liver cirrhosis, and screening for its occurrence, especially in the presence of rapid deterioration of the patient’s condition.
3. Liver ultrasound: Liver ultrasound is used for the diagnosis of cirrhosis and to detect if there is a focal lesion suggestive of cancer. It can also be used to see the gall bladder.
4. Computed tomography of the abdomen (CT): Computed tomography is an advanced imaging study that detects changes within the liver, which includes both benign and malignant tumors.

On the other hand, conditions like splenic venous thrombosis can be diagnosed using ultrasonography and CT scan of the abdomen as well as Budd Chiari syndrome.

It is also important to do some routine investigations including:

• A complete blood count
• Kidney function tests
• Coagulation profile