Introduction

Hepatic portal hypertension (PHT) is a serious condition that occurs when there is an increase in pressure in the hepatic veins. It can lead to a number of complications, including liver enlargement, varices of the esophagus, lungs or stomach, and even liver failure. Diagnosis of PHT is a key step in treating the condition, enabling early detection and effective management. In this article, we will discuss the most important diagnostic methods used to evaluate portal hypertension of the liver.

Medical history and physical examination

The first step in diagnosing PHT is to take a medical history of the patient and perform a thorough physical examination. The doctor will ask about symptoms such as swelling, jaundice, changes in appetite or weight loss. He or she may also perform an abdominal examination to evaluate liver enlargement or the presence of fluid in the abdominal cavity.

It is also important to examine blood flow in the hepatic veins using Doppler ultrasonography. This non-invasive method allows assessment of pressure in the hepatic veins and diagnosis of the presence of varices. It is a safe and effective diagnostic tool that is often used when PHT is suspected.

The results of the physical examination and ultrasound may be sufficient to make a diagnosis of PHT, but in some cases additional tests are necessary.

Endoscopy

Endoscopy is another important diagnostic method used in cases of suspected PHT. It involves inserting a flexible endoscope through the patient's throat to evaluate the esophagus and stomach. The doctor can see the presence of varices and assess their size and risk of bleeding.

In some cases, it may also be necessary to perform a liver biopsy during the endoscopy to assess the extent of liver damage or identify other causes of the condition.

Computed tomography and magnetic resonance imaging

Computed tomography (CT) and magnetic resonance imaging (MRI) are more advanced imaging techniques used in the diagnosis of PHT. They allow a more accurate assessment of the structure of the liver, varices and other abdominal organs.

CT and RM can be particularly useful in cases that are difficult to diagnose or to evaluate PHT complications such as abdominal fluid, liver tumors or liver failure.

Hemodynamic testing

In some cases, an invasive hemodynamic test, such as measuring portal vein pressure, may be necessary. This is a procedure that requires inserting a catheter through an artery in the legs and reaching the portal vein. This allows for a more precise assessment of hepatic vein pressure and identification of possible causes of PHT.

Hemodynamic testing, however, is more invasive and may carry a risk of complications, so it is not always used as a first-choice method. Rather, it is reserved for cases in which other diagnostic methods have not provided sufficient information.

Summary

Diagnosis of portal hypertension is a key step in the management of this condition. Many patients can be diagnosed and treated based on the results of physical examination and Doppler ultrasonography. However, in some cases, more advanced diagnostic modalities such as endoscopy, CT, MRI or hemodynamic testing are necessary. Early recognition and effective management of PHT are key to improving outcomes and minimizing complications.

If you have any symptoms suggestive of PHT, such as swelling, jaundice or changes in appetite, consult your doctor, who can make an appropriate diagnosis and plan appropriate treatment. Don't ignore these symptoms, as portal hypertension of the liver is a serious condition that requires professional medical care.