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Q. How to differentiate cirrhotic and non-cirrhotic portal hypertension?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 21, 2021 and last reviewed on: May 04, 2022

Hi doctor,

I did a CT scan for my back area due to frequent urination. It showed borderline portal hypertension with a borderline enlarged spleen and mildly enlarged portal vein. I used to be an alcoholic for about 15 years, but now I have not taken alcohol for the past six years. I am planning to see a hepatologist. I am waiting for the insurance. I am worried after looking into portal hypertension and its complications. My blood test for liver function came back normal, and the liver was normal on the CT scan. Kindly give your opinion.

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Hello,

Welcome to icliniq.com.

Thanks for writing in, and I understand your concern. It is confirmed that you have portal hypertension, meaning increased pressure in the portal vein. The portal vein is one of the blood supplies to the liver. Portal hypertension develops with cirrhosis or liver disease, and secondly, without cirrhosis or liver disease, the latter condition is called non-cirrhotic portal hypertension (NCPH). Although it is mentioned in the report (reports removed to protect the patient's identity) that the liver is normal, considering your prior use of alcohol and current overweight, which are two significant causes for the development of cirrhosis or liver disease, I doubt whether it is non-cirrhotic portal hypertension. I suspect there can be some problem with the liver. So, one way to differentiate and confirm among both entities is by doing a fibroscan of the liver, which is like an ultrasound, which would estimate the amount of liver damage in digital values.

I suggest you get a fibroscan of the liver. And have you already tested for hepatitis B and hepatitis C? They are the other common causes of liver disease. All these tests are done to eliminate every possibility of primary liver disease. Once it is sure that there is no liver disease, then this can be labeled as non-cirrhotic portal hypertension. Then proper disease management can be done. I understand your anxiety, but since there is no major anomaly in the CT (computed tomography) scan, except portal hypertension, and as the liver function tests are normal, it is not a serious problem. It is manageable.

Regards.

Hi doctor,

Thanks for the reply.

I have not got tested for hepatitis. I will do that. But I am having trouble getting an appointment with a specialist. Can I take these tests in ER? I also heard a doppler ultrasound might detect a clot if I have any. So, which one is better, a CT scan or a doppler ultrasound scan?

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Hi,

Welcome back to icliniq.com.

I think a fibroscan may not be done in an emergency room. An appointment will be required for the same. Yes, a hepatitis B panel can be done in an emergency room since it is a blood test. I do not think that a doppler ultrasound scan would help, as your CT (computer tomography) scan did not show any clot in hepatic or portal veins. CT scan shows everything.

Regards.

Hi doctor,

Thanks for the reply.

I have a few more queries. You said it is confirmed portal vein hypertension, but why do they put borderline?

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Hi,

Welcome back to icliniq.com.

It is the writing style of the radiologist. Therefore, it will vary depending on the radiologist. As per the given portal vein diameter of 17 (reports removed to protect the patient's identity), spleen enlargements are confirmed with portal hypertension.

Regards.

Hi doctor,

Thank you for the reply.

Earlier you said, it is manageable. Is it manageable enough to live a whole life, or will it get worse later? How can I manage it? Is there something I can do with the diet or weight loss?

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Hi,

Welcome back to icliniq.com.

Yes, you can have a normal life span if you do not have any liver disease. I suggest losing some weight. It can be beneficial. Diet plays a minor role in the overall management of your condition. I strongly feel that you have non-cirrhotic portal hypertension. The survival (life span) is good otherwise, given the fact that it is diagnosed properly and the complication is managed properly.

Hello doctor,

Thank you for the reply.

My doctor had suggested me to take a fasting glucose challenge blood test; the finding in the report reads 15 U/L. This seems pretty normal. Can you give me any feedback about the results?

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Hello,

Welcome back to icliniq.com.

Yes it is within normal range. GGT (Gamma glutamyl transpeptidase) test is a liver enzyme which may or may not rise in liver disease. It is difficult to say whether you have liver disease or not based on single GGT Value. To establish a complete diagnosis we should have evidence in other tests as well.

Regards.

Hello doctor,

Thank you for the reply.

I just received results from my fribroscan and more blood work; I have attached pictures and results below. Could these results be a reason for portal vein hypertension? Stiffness of 4.4 kPa and what the F0 reference means? Is mild steatosis fatty liver, right? How bad is mine, and can I fix it? The report says underlying disease findings are multietiology; are they referring to the 4.4 kpa and the mild steatosis? Or does it mean something else? What do the antinuclear antibodies titer and pattern results that were flagged mean, and how should I follow up? Hep A came back as reactive; what should I do? Does this mean I have Hep A? I have a girlfriend and three-year-old daughter; should they get tested? I called my hepatologist, I could not talk to him, but the office lady said they labeled this as "not urgent." I requested to have them call me. All blood work done in fasting state, smooth Muscle (actin) antibody, IGG- negative, Ceruloplasmin- 26 mg/dL, Ferritin- 164 ng/mL, Glycohemoglobin A1C- Hemoglobin A1C 5.2%, Mean Plasma Glucose 108mg/dl, Gamma Glutamyltransferase- 13 U/L , "Flagged"-Hepatitis A abs, Total- "reactive" Flag "abnormal" Hepatitis B Surface AB, Quant- >1,000.

Hepatitis B antigen test details- Hepatitis B surface Ag- non-reactive. Hepatitis C antibody REFLEX HCV RNA PCR details- Hepatitis C Ab non reactive, signal to cut-off 0.01 immunoglobin G- 1,109 mg/dL. Also, on the fibroscan what do the things under “findings” mean? The parallel propagation on the thumbnail? And IQR/median less than 30%? Kindly help.

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Hello.

Welcome back to icliniq.com.

I have seen all your reports. ANA (antinuclear antibody) titer 1:40, which does not seem abnormal but flagged as H, meaning High. And the pattern of ANA is homogenous, which is a common pattern to find.

Regards.

Hi,

Thank you for the reply.

What about everything else?

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Hi,

Welcome back to icliniq.com.

The rest of your blood tests are normal, especially liver function tests. I could not see serum IgG (immunoglobin G) levels in the above tests. Maybe I missed them since they were snapshots. See if you can upload serum IgG levels again. Fibroscan is normal; anything less than six kpa is normal, meaning you do not have liver damage. CAP (controlled attenuation parameter) is raised due to steatosis, meaning fat in the liver. Since your weight is high, this was the expected finding. However, given your normal liver function tests, you do not need any treatment for it except to reduce weight. Hepatitis A total positive suggest that you have had hepatitis A infection once in your life. This is an immunity test that remains positive for life long. You need not do anything further in this regard.

Regards.

Hi doctor,

Thank you for the reply.

I think that was not an attachment, but in the main body of my first message, the IgG (immunoglobulin G) test, right? 1,109 mg/dL was the result.

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Hi,

Welcome back to icliniq.com.

Fine.

Hi doctor,

Thank you for the reply.

So this would not be a reason for portal vein hypertension?

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Hi,

Welcome back to icliniq.com.

I want to know the value of IgG (immunoglobulin G) before commenting.

Regards.

Hello doctor,

Thank you for the reply.

I receive more blood work back, can you give me any information on this? ANA IFA SCREEN W/RFLX TO TITER/PATTERN - details is given below. ANTI-NUCLEAR AB (IFA) is positive, standard range is negative, and flag A.

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Hi,

Welcome back to icliniq.com.

The ETA protein is raised. This suggests the presence of autoimmune disease, namely rheumatoid arthritis or psoriasis. Do you have a skin rash or joint pains?

Regards.

Hi doctor,

Thank you for the reply.

I had a slight rash a while ago, but nothing now, and no joint pain; I had my meniscus trimmed about seven months ago. What should I do? And I am getting little red bumps on my stomach; could this be a symptom?

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Hello,

Welcome back to icliniq.com.

Can you please take a picture of that bump and send it for further evaluation. Why has the meniscus been trimmed?

I suggest you to see a rheumatologist at this moment for non-cirrhotic portal hypertension. I suggest losing some weight. If any rheumatological diagnosis is made, I advise you to get treatment for it. Portal hypertension will not cause a problem if the underlying condition is well treated.

Regards.

Hello doctor,

On my stomach there are little scars some of which are red. I got a rash in the side of my stomach, but it has subsided now. I had a degenerative tear of the meniscus, and it needed to be trimmed, a meniscectomy.

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Hello,

Welcome to icliniq.com.

The skin over the abdomen seems fine except those scars, but I think you need to get it checked with the dermatologist. The pinkish scars are seen in psoriasis.


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