Cirrhotic Portal Hypertension: A Case Report

Background: Portal hypertension (PH) is defined as an abnormal increase of the blood pressure in the hepatic portal vein system. PH can result from pre-hepatic, intra-hepatic, and post-hepatic causes with 90% of cases in the United States being due to the intrahepatic cause of cirrhosis. Prognosis of PH is made through calculation of the Hepatic Venous Pressure Gradient (HVPG) via hepatic vein catheterization. Once PH is identified, bleeding and fluid status must be appropriately managed using pharmacological and surgical therapy to avoid complications such as ascites and splenomegaly. In this report, we offer a summary of the diagnosis and management of PH, and present the case of a 59-year-old male diagnosed with the cirrhotic form of PH. Case Information: This case was selected and assembled using electronic medical records and imaging results. A 59-year old male presented to a family medicine clinic with a chief complaint of abdominal pain for 2 months. Past medical history was significant for chronic hepatitis C, alcohol abuse, and cirrhosis of the liver. An abdominal ultrasound was ordered and revealed morphologic changes of cirrhosis present with evidence of portal venous hypertension with moderate splenomegaly present. Laboratory blood works showed ALT to be 56 U/L (9-46 normal), AST 57 U/L (10-35 normal), GGT 151 U/L (3-85 normal). Otherwise, blood cell counts were within normal limits. Conclusions: Portal Hypertension (PH) is a serious chronic hepatic illness that can occur due to a variety of pre-hepatic, intrahepatic, and post-hepatic causes. The patient’s PH etiology comes from the most common cause of PH, cirrhosis, which causes around 90% of PH in the United States. In this case, the patient’s cirrhosis was due to hepatic remodeling due to alcohol abuse and hepatitis C. While the definitive way of diagnosing PH remains HVPG, the patient’s symptoms coupled with abdominal ultrasound evidence were enough to make the diagnosis. The patient risks complications involving ascites, further problems with existing splenomegaly, and development of varices. To effectively prevent these complications, careful interdisciplinary medical management must be followed.