How is portal hypertension diagnosed?
The diagnosis of portal hypertension may be suspected by the patient's signs and symptoms and may easily be confirmed by ultrasound examination of the abdomen. The presence of significant portal hypertension is implied by ascites, collaterals, or encephalopathy that occurs in the presence of known chronic liver disease or peripheral clinical evidence of chronic liver disease (firm liver, enlarged spleen, spider angiomas, clubbing of fingers, palmar erythema). An ultrasound test can assess the presence of collaterals (gastric varices or umbilical vein dilatation), the width of the portal vein, and portal blood flow with deep Doppler. Improvement in certain ultrasound techniques, including the FM ultrasound, may allow assessment of the degree of hepatic fibrosis. The CT scan can be used to assess the presence but not the degree of portal hypertension. The demonstration of esophageal varices by endoscopy or barium swallow implies portal hypertension, as do significant intraabdominal collaterals at any site. |
