Portal hypertension
Clinical features
The major clinical differentiation in patients with portal hypertension is the presence of underlying chronic hepatocellular liver disease and the detection of complications.
Investigations
The presence of chronic liver disease and clinical evidence of portal hypertension should lead to investigations tailored to the identification of the underlying disease, the severity of the disease and identification of potential complications.
Blood tests
Full blood examination
A low haemoglobin or decreased hematocrit may indicate either continued bleeding or anaemia of chronic liver disease. Thrombocytopenia or low white cell count may indicate hypersplenism. A coagulation pro- file is essential for the management and for prognostic contribution to the Child–Pugh system. An elevated prothrombin time or International Normalised Ratio (INR) is a strong indicator of synthetic dysfunction and indicates severe hepatocellular disease. Plasma fibrinogen may also be a useful indicator to the risk of bleeding.
Renal function tests
Electrolyte imbalance, especially low sodium levels, may occur in patients with chronic liver disease. The urea and creatinine levels may not only be an indicator of renal dysfunction but may also be a useful indirect guide to liver function.
Hepatic encephalopathy
This is a complex neuro-psychiatric syndrome with a wide spectrum of clinical manifestations. It may occur due to the loss of hepatocellular function or the formation of porta-systemic shunts which bypass the liver parenchyma. The underlying cause for the encephalopathy dictates the clinical outcomes.