Portal hypertension

Last revised by Calum Worsley on 16 Feb 2023

Portal hypertension is defined as a hepatic venous pressure gradient (HVPG) >5 mmHg. Hepatic venous pressure gradient is a surrogate for the portosystemic pressure gradient. Clinically significant portal hypertension is defined as a gradient >10 mmHg and variceal bleeding may occur at a gradient >12 mmHg. 

Causes can be split by their relation to the hepatic sinusoids 7:

Management ultimately depends on the underlying etiology and the associated complications. Generally, management options include:

  • lifestyle modifications: dietary sodium restriction (e.g. for ascites)

  • medications: propranolol (e.g. for varices), diuretics (e.g. for ascites)

  • interventional procedures

Dilatation of splenic veins at the splenic hilum without splenomegaly may occur in situations such as a state of increased perfusion of splenic tissue associated with an immune response 6.

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