Portal Hypertension

By Myers, Wyatt 
March 22, 2017

Portal Hypertension

Portal hypertension is high blood pressure of the portal vein. The portal vein is located in your abdomen. It collects nutrient-rich blood from your intestines and carries it to the liver. The liver cleans the blood for your body to use.

When you have portal hypertension, the increased pressure means it is harder for the blood from the liver to flow through the portal vein to travel back to the heart. This means it has to use smaller veins in the esophagus, stomach, and intestines. The body also forms new vessels for the blood to flow through. These smaller and newly formed veins may be much weaker than the portal vein and may swell up and burst under the added pressure.


Having a higher than normal pressure inside the portal vein can lead to a number of related symptoms and complications. These include:

  • Enlarged liver and spleen

  • Varicose veins of the esophagus and stomach, which can cause abnormal bleeding, such as vomiting of blood 

  • Internal hemorrhoids

  • Weight loss from malnutrition

  • Ascites, or fluid buildup in the abdomen

  • Kidney malfunction

  • Low platelets

  • Fluid on the lungs


These are the most common cause of portal hypertension:

  • Cirrhosis, or scarring of the liver. This blocks the blood flow in the liver and leads to portal hypertension.

  • Clotting of the portal vein

  • Clotting of the veins in the liver

  • In developing countries, one of the most common reasons is an infection called schistosomiasis 


Unfortunately, healthcare providers can’t measure high blood pressure in the portal vein with a cuff as they can regular high blood pressure. If you are at risk for or already have cirrhosis, your healthcare provider will likely do various lab tests, X-rays, and endoscopic exams to see if you have portal hypertension.


Healthcare providers treat portal hypertension in several ways. You might need to take beta blockers, or medicines that improve how your heart and blood vessels work. These medicines often also reduce the risk of bleeding from swollen veins. If you have internal bleeding because of portal hypertension, your healthcare provider might inject medicine into the vein to help stop the bleeding. Or he or she may place bands around veins to stop the bleeding.

In more severe situations, your healthcare provider may treat portal hypertension with shunting. This involves putting stents in the portal vein to open it and improve blood flow. Shunting can be done with or without surgery. Surgical shunting can cause more complications than the nonsurgical method.

A liver transplant may be needed.


The small veins overloaded because of portal hypertension can burst and cause internal bleeding. This usually happens where the esophagus and stomach meet. This complication can cause sudden, explosive vomiting of blood. It can be fatal.

Fluid buildup in the stomach can cause you to feel full quickly, leading to weight loss and malnutrition. The discomfort from carrying all that fluid can also reduce how well you can get around. The changes in blood flow sometimes lead to serious kidney problems.

Lung problems can also result.

When to call the healthcare provider

Portal hypertension is a dangerous condition with severe, life-threatening complications.  Call your healthcare provider immediately if you notice any of these symptoms:

  • Yellowing of the skin

  • Unusually swollen abdomen

  • Unexpected weight loss


March 22, 2017


Portal hypertension in adults. UpToDate, Portal hypertension: pathophysiology, diagnosis and management. Bloom S. Internal Medicine Journal. 2015;45:16-26.

Reviewed By:  

Freeborn, Donna, PhD, CNM, FNP,Lehrer, Jenifer, MD