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Portal hypertension can be divided into cirrhotic and non-cirrhotic portal hypertension. Portal hypertension indicates an increase in hydrostatic pressure in the portal vein. 

There are several possible causes for this:

1) presinusoidal: for example a portal vein thrombosis or an intrahepatic cholestatic liver disease, due to interaction-inflammatory small bile ducts and small portal venules;

2) sinusoidal: due to cirrhosis, severe alcoholic steohepatitis or tumoral infiltrations;

3) post-sinusoidal: due to a disorder of the venous drainage of the liver, as seen in Budd-Chiari syndrome, pericarditis constructiva or chronic heart failure. This can lead to cardiac cirrhosis.

The increased portal pressure in these cases is caused by an increased intrahepatic vascular resistance. This resistance is caused by a non-manipulable component, namely fibrosis, and by a drug-manipulable component, namely the development of contractile myofibroblasts by activation of stellate cells. These myofibroblasts cause an increased vascular resistance by a deficiency of nitric oxide (NO). On the other hand, there is a decreased extrahepatic systemic vascular resistance, caused by an excess of NO. As a result, there is an increased splanchnic* inflow: an attempt to maintain liver perfusion. This increased inflow then leads to the maintenance of flow in the collaterals. Clinically this phenomenon manifests itself by an increased cardiac output, a systemic underfilling and a low blood pressure with an increased pulse.

[*splanchnic circulation' describes the blood flow to the abdominal gastrointestinal organs including the stomach, liver, spleen, pancreas, small intestine, and large intestine. ]

In the serum thrombocytopenia is found (hypersplenism). Later this also has a decrease in white and red blood cells, with an active bone marrow. The radiological indirect signs of portal hypertension are collaterals, splenomegaly and ascites, found on ultrasound.

Consequences of portal hypertension include: 

1) esophageal varices bleeding; 

2) ascites and complications; 

3) hepatic encephalopathy; 

4) other rare complications of portal hypertension.

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