Liver & intrahepatic bile ducts

Vascular disorders

Portal hypertension

Topic Completed: 8 January 2021

Minor changes: 11 January 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Portal hypertension[TI] liver[TI] free full text[sb]pathology

Raul S. Gonzalez, M.D.
Page views in 2020: 1,445
Page views in 2021 to date: 1,629
Cite this page: Gonzalez R. Portal hypertension. website. Accessed November 29th, 2021.
Definition / general
  • Increased blood pressure within portal venous system
Essential features
  • Causes are numerous and can be divided into prehepatic, intrahepatic and posthepatic
  • Cirrhosis is most common cause
  • Patients without cirrhosis typically are labeled with "noncirrhotic portal hypertension"
Clinical features
  • Clinical complications include ascites, portosystemic venous shunts (hemorrhoidal veins, esophageal varices, etc.), congestive splenomegaly, hepatic encephalopathy
  • Gold standard is measurement of hepatic venous pressure gradient via portal vein catheterization
  • Ultrasound is noninvasive and can detect signs of portal hypertension
Microscopic (histologic) description
Microscopic (histologic) images

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Idiopathic noncirrhotic portal hypertension

Sample pathology report
  • Liver, biopsy:
    • Liver with prominent nodular regenerative hyperplasia (see comment)
    • Comment: The finding likely explains the patient’s reported portal hypertension. A reticulin stain confirms nodular regenerative hyperplasia. Trichrome and iron stains are unremarkable.
Board review style question #1
    A patient is found to have portal hypertension in the absence of cirrhosis. Considering the most common overall cause of noncirrhotic portal hypertension, which of the following is most likely to be seen on liver biopsy?

  1. Herniated portal veins
  2. Mastocytosis
  3. Nodular hepatocyte parenchyma
  4. Parasite eggs
  5. Sinusoidal fibrosis
Board review style answer #1
D. Parasite eggs: schistosomiasis is the most common cause of noncirrhotic portal hypertension in the world

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Reference: Portal hypertension
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