Portal HyperTension and Patient Selection

Portal Hypertension

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Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Normally, the veins come from the stomach, intestine, spleen and pancreas, merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked, it is hard for the blood to flow causing high pressure in the portal system.

Patients with portal hypertenson may undergo EGD to rule out esophageal varices, and perhaps correct them at the same time with banding or sclerotherapy. Acute or severe complications may be treated with intravenous octreotide or terlipressin (an antidiuretic hormone analogue) to decrease the portal pressure. Octreotide inhibits the release of vasodilator hormones such as glucagon, indirectly causing splanchnic vasoconstriction and decreased flow into the portal system.

Liver transplant is the most definitive treatment of portal hypertension and cirrhosis.