What are portal hypertension, ascites and varices?
Last content review 2026-09-23
The short answer
Portal hypertension is raised blood pressure in the portal vein system that carries blood from the gut to the liver, most often because cirrhosis makes the liver stiff. It can lead to ascites (fluid in the abdomen) and varices — enlarged veins in the food pipe (oesophagus) or stomach that can bleed. These are complications that need specialist care.
What is happening?
When scarred liver tissue resists blood flow, pressure builds up behind it and blood diverts into smaller veins, which can swell into varices.
Fluid can leak into the abdomen (ascites), and the spleen may enlarge, lowering the platelet count.
Why does this matter?
Vomiting blood, black stools, rapidly increasing abdominal swelling or new confusion in someone with liver disease are emergencies.
People with cirrhosis are assessed for varices so that preventive treatment can be offered when indicated.
What does the evidence say?
AASLD practice guidance (2016, published 2017) sets out risk stratification, diagnosis and management of portal hypertensive bleeding in cirrhosis.
The Baveno VII consensus (2022) describes the use of liver stiffness and platelet count to identify people who are unlikely or likely to have clinically significant portal hypertension.
Key takeaway
Ascites and varices are signs that liver scarring is affecting blood flow; they are managed by specialists, and warning symptoms need urgent care.
Sources & references
American Association for the Study of Liver Diseases
Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the AASLD (2017) · Clinical guideline
View original sourceBaveno VII Faculty (Journal of Hepatology)
Baveno VII – Renewing consensus in portal hypertension (2022) · Consensus statement
View original sourceUS National Institute of Diabetes and Digestive and Kidney Diseases
Cirrhosis · Official health information
View original source
This page is general health education. It is not a diagnosis, and it cannot replace advice from your treating doctor. Never start or stop a prescribed medicine based on what you read here.
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