(USMLE topics) Pathology of portal hypertension, symptoms, complications and treatment options. This video is available for instant download licensing here: https://www.alilamedicalmedia.com/-/galleries/narrated-videos-by-topics/digestive-diseases/-/medias/e337c5fd-f8b4-49ea-a488-2f12f3873667-portal-hypertension-narrated-animation
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Portal hypertension refers to high blood pressures in the hepatic portal vein – the large vein that carries blood from the digestive tract, spleen and pancreas, to the liver. Within the liver, blood runs through tiny channels where it exchanges contents with the liver cells. This is where nutrients are processed, toxins and pathogens are removed from the blood before it exits the liver, via the hepatic veins, to enter the general circulation.
Portal hypertension usually results from an obstruction, or an increased resistance to blood flow, which may occur before, within, or after the liver. Most commonly, it happens within the liver, due to liver damage, in diseases such as cirrhosis and schistosomiasis. Cirrhosis is by far the most common cause in developed countries, while schistosomiasis, an infection by parasitic flatworms, is more prevalent in children from developing countries. Cirrhosis is the widespread scarring of liver tissues caused by long-term alcohol abuse, chronic viral hepatitis, or fatty liver.

Clinical presentation of portal hypertension may include:
- Abdominal distension, known as ascites - a result of fluid leaking into the abdominal cavity under high blood pressures.
- Enlarged spleen due to congestion of the splenic veins.
- Formation of so-called collateral vessels as alternative routes for blood to bypass the liver. These new blood vessels connect some digestive organs directly to the general circulation. By doing so, they reduce blood flow through the portal vein and relieve portal pressures, but they may also cause serious complications.
- As blood pressures increase, these small vessels can become engorged and form varices, which may rupture and bleed. Variceal bleeding can be massive and life-threatening.
- Because collateral vessels direct blood away from the liver, toxins that are normally removed by the liver can now reach the general circulation and pass into the brain, causing symptoms such as confusion, drowsiness, tremor, or even coma, in a condition known as hepatic encephalopathy.
Treatments aim to prevent and manage digestive tract bleeding, and include ongoing monitoring with endoscopy and a variety of drugs. If these fail, surgery to reroute blood flow may be performed. Liver transplantation may be needed in case of severe liver damage.