Portal Hypertension Differential Diagnoses

Updated: Nov 30, 2017
  • Author: Jesus Carale, MD; Chief Editor: BS Anand, MD  more...
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Diagnostic Considerations

When evaluating a patient with portal hypertension, also consider the following conditions:

  • Cirrhosis of any etiology (viral hepatitis, autoimmune cirrhosis, alcohol-related cirrhosis, primary biliary cirrhosis, etc)

  • Hepatic infiltrative diseases (eg, Wilson disease, hemochromatosis, sarcoidosis)

  • Hepatoportal arteriovenous fistula

  • Portal vein obstruction

  • Portal vein occlusion (eg, portal vein thrombosis)

  • Primary sclerosing cholangitis

  • Severe congestive heart failure (cardiac cirrhosis)

  • Splenic vein thrombosis

  • Veno-occlusive disease

  • Budd-Chiari syndrome

  • Schistosomiasis

  • Chronic pancreatitis

Patients who present with upper gastrointestinal (GI) bleeding can be approached as whether the bleeding is variceal or nonvariceal. Not all upper GI bleeding in cirrhotic patients are from variceal hemorrhage. It should also be noted that peptic ulcer disease is present more frequently in cirrhotic patients than noncirrhotic patients. [12] The differential diagnosis of variceal hemorrhage includes the following:

  • Acute gastric erosions

  • Duodenal ulcers

  • Gastric cancer

  • Gastric ulcers

  • Mallory-Weiss tear

  • Nasogastric tube trauma

  • Portal hypertensive gastropathy - It is a relatively uncommon cause of significant bleeding

Gastric varices are the source of bleeding in 5-10% of patients with variceal hemorrhage. Higher rates are reported in patients with left-sided portal hypertension due to thrombosis of the splenic vein.

Differential Diagnoses