Pathophysiology of portal hypertension

The portal vein brings blood from the stomach, bowel, spleen, and pancreas to the liver. Scarring or other blockage within the liver can slow this passage. Pressure then rises upstream, and blood may be redirected through smaller veins around the food pipe and abdomen. These collateral veins can enlarge and become fragile. Fluid may also collect in the abdomen, the spleen may enlarge, and the liver may process medicines and toxins less effectively. Portal hypertension is different from ordinary [Hypertension](/conditions/hypertension/), which affects arteries throughout the body.

Medical care focuses on finding the liver or blood-flow problem and reducing complications. Assessment may include blood tests, imaging, and an examination for fluid retention or enlarged veins. Treatment can involve medicines, procedures, or management of the underlying liver disease. Avoid alcohol unless your clinician says it is safe, check before taking painkillers or supplements, and follow advice about salt, fluids, and nutrition. Keep appointments even when you feel well because early complications may be quiet.

Call emergency services for vomiting blood, black tarry stools, fainting, sudden confusion, severe abdominal swelling with pain, or severe breathlessness. New yellowing of the skin, rapidly worsening swelling, fever with confusion, or inability to keep fluids down needs urgent medical assessment. Do not drive yourself after a suspected internal bleed.

What is causing the resistance to portal blood flow? Do I need screening for enlarged veins? Which medicines, supplements, alcohol, salt, or fluids should I avoid? What is my plan if swelling, confusion, or bleeding appears?