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Portal Hypertension
Good Day all,

I have recently been told by my Gastro Specialist that they suspect I have early liver Cirrhosis. Ultrasound shows normal sized spleen and liver but liver has 'Slightly Coarse Echotexture' . As i have read a fair bit on the scary complications of Cirrhosis I am rather concerned about the possibility of Portal Hypertension. My doc says that this is unlikely with normal spleen size. Does anyone know if it is possible to have Portal Hypertension and Varices if spleen is a normal size or is this unlikely?
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Hello and hope you are doing well.

When there is increased pressure in the portal vein, it causes a backflow of blood and in places where the portal and systemic veins anastomosis is there they engorge or swell up. The sites where this happens is the lower end of esophagus, around the umbilicus and in the rectum. Thia back flow also causes the enlargement of spleen. So, an effect of portal hypertension are the varices and splenomegaly.

Hope this helped and do keep us posted.
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To try and answer your question - yes, it is possible to have Portal Hypertension and Varices if spleen is a normal size.

I have read articles on this subject and I recall that almost all of the patients with bleeding varices but without splenomegaly had a history of alcoholism.

Though I don't have documentation in support of this I believe that it is much more likely for splenomegaly to be present in cirrhotic patients with portal hypertension and varices. I suffered 2 major bleeds back in 1995 and my spleen was quite enlarged. The people I have known who suffered bleeding varices all had significantly enlarged spleens. All of those patients were infected with Hepatitis C.

If you're worried you could undergo endoscopic examination to see if the vessels in your esophagus and below are normal and not distended. It's a relatively easy procedure and it eliminates the stress of not knowing. And if there is something going on you can get ahead of it. Varices can be managed with banding and sclero-therapy. I lost 4 units of blood on two occasions months apart and once a competent doctor treated me I never bled out again before I received a liver transplant in 2000. And I pretty much did what I wanted to do during that 5 year period. So, in the worst case scenario there are options.

Good luck,
Mike
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Thanks for the Info. I was a little surprised that my Gastro doc did not reckoment Endoscopy to be on the safe side. As they think my condition is 'Early' they want to monitor for now. My Cirrhosis is alcohol induced so i'm hoping that continued abstinance will slow down progression and serious hypertension. I will however be requesting endoscopy to be safe!
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I'd advise you to try and see a hepatologist. There are good GI's but with liver issues I always prefer a hepatologist. Unfortunately in some areas they just aren't any available. You can usually find a hepatologist at large teaching hospitals/universities/medical centers.

I agree with your doctor that it's unlikely that you have significant portal hypertension that would put you at risk of bleeding. Nevertheless I always like to play it safe with issues like this and an endoscopic examination isn't a big deal.

Again I wish you good luck,

Mike
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