Portal hypertension and ascites

Portal hypertension is secondary to increased resistance to blood flow and increased blood flow through the portal system. The commonest cause is liver cirrhosis. The most severe and life-threatening presentation of portal hypertension is acute variceal bleeding. Pharmacotherapy with vasoactive agents (terlipressin or somatostatin), endoscopic band ligation and radiological treatment with transjugular intra-hepatic portosystemic shunt (TIPSS) are the commonest treatment options for variceal bleeding. However, where surgical expertise exists, portosystemic shunts can be considered for refractory bleeding in patients without significant liver failure, especially when TIPSS is unavailable or contraindicated. Diuretic therapy with spironolactone and furosemide are the basis for the management of ascites. If ascites becomes refractory, repeat large volume paracentesis and TIPSS are potential treatment options. Liver transplantation offers the definitive treatment for portal hypertension secondary to cirrhosis as it cures the underlying liver disease.