Portal Hypertension … Ascites and Splenomegaly

There are several complications of Portal Hypertension(PH), including one of the most precarious side effects called Esophageal Varices (covered in a previous post), and of lesser degrees are the conditions of  ascites, and splenomegaly.  

Ascites takes place when excess fluid accumulates between the lining of the abdomen and abdominal organs.  This area is referred to as the  peritoneal cavity.

Low albumin levels in the blood as associated with portal hypertension is also a contributing factor.  Albumin is a protein made by the liver and is measured in the clear liquid portion of the blood by a special blood test.

Beyond portal hypertension there are other causes of ascites and they are cirrhosis, congestive heart failure, hepatitis, and cancers such as pancreatic, ovarian, or liver.  Kidney dialysis can also cause ascites.

Upon examination the obvious signs of ascites are a swollen belly (abdomen).  At that point evaluation tests on the liver may be performed which include urinalysis, and kidney function testing.

Common treatment includes diuretics (water pills), limiting salt in the diet, antibiotics (if infection is present), not to mention the avoidance of alcohol.  If the patient does not respond to the common treatments, then the placement of a tube in the abdomen may be used to drain large amounts of fluid from the area.  Lastly a transjugular intrahepatic portosystemic shunt (TIPS) is a radiology technique that reduces portal pressure and may be the most effective treatment for patients with ascites that are resistant to diuretics. The procedure is performed with the patient under conscious sedation or general anaesthesia.  A radiologist places a stint through the skin from the right jugular vein into the hepatic vein.  A connection is made between the portal and systemic circulations.   This treatment from what I have been reading seems to be the norm in the treatment of ascites for patients resistant to diuretics.

Now on to the topic of splenomegaly or simply put an enlarged spleen.     The spleen is an organ that is part of the lymph system.  The spleen’s role is to filter blood and to maintain healthy red and white blood cells and platelets.  To clarify, your spleen acts like a spongy filter for your blood. As blood circulates through your body, some of the cells (in the form of platelets and red blood cells) get damaged or worn down.  The function of the spleen is to remove these damaged cells from circulation. The spleen also acts as a storage location for extra red blood cells and platelets newly formed by your bone marrow.  There are several other causes to splenomegaly which include diseases of the blood, liver, cancers, and infections but in the case of PH sufferers the cause is clotting to the portal and splenic veins.

From a personal standpoint I have been fortunate enough to not have any pain as related to the enlargement of my spleen, however the possibility does exist from what I have read and been told.  When first diagnosed with portal vein thrombosis(PVT), the first gastroenterologist I had wanted to remove my spleen (splenectomy).  Being only a few months since the discovery of PVT in 2002, I felt uneasy about a possible splenectomy so I consulted with my haematologist who practised at another city hospital.  His exact words at that time were, “anyone can remove your spleen, but ‘he’ is not touching it – come and see me”!  Looking back I realize this was a good decision, and it may have saved me from added or more serious complications.  All being stated, a person can live without their spleen, but from what I have learned recently is that the spleen is very helpful in maintaining one’s immune system especially when the liver and artery function is compromised by a clot.   Without the spleen a person’s vulnerability to infection does increase, so it is important to get regular vaccinations to prevent bacteria such as influenza and pneumonia from taking its toll on one’s health.  I might also add that even though a person still has their spleen, but has portal hypertension, it is important to be inoculated against influenza and pneumonia as either can cause varices (if present) to rupture and bleed with serious consequences.  Like seniors and small children, our immune systems are compromised and health care professionals consider PH sufferers as being “high risk”.

Lastly I want to say that if you or a person you know is experiencing symptoms such as mentioned above, you are more than welcome to comment or post your questions below.  There is so much more one can learn, and each of us has a story… maybe you can shed some light on the subject for the benefit of someone else?

Until next time,


22 thoughts on “Portal Hypertension … Ascites and Splenomegaly

  1. Ela

    Dear Clint,

    Of all the sites I have visited yours is the one with the most information pertinent to my conditions.

    Comment and perhaps you or someone else can answer:
    I have portal vein hypertension and enlarged spleen with a distended abdomen, yet they do not find any fluid and am presently not prescribed any medication for the pain I oftentimes experience.

    Any direction you can provide would be appreciated.

    1. Clint Post author

      Dear Ela,

      Thanks for your comments and inquiry regarding portal hypertension.

      It is very common for the spleen to be enlarged (mine is also that way), but a distended abdomen sounds like it might be ascites. But not finding fluid would likely rule out that theory so I am not sure what to say? For pain – it seems to be hard to control, and one of the reasons for that is that vascular pain overall is hard to treat. If you don’t mind me asking – where exactly do you feel the most pain? I always recommend people speak with their doctor’s first of course, but there are some things you can do yourself which may help – if only a little. For some odd reason I have not had the pain issues I normally have so fortunately I have not had to worry too much, but when the pain does happen it is centered in the lower bowel region due to all the arteries being engorged with blood from the clot to the liver. I have tried different pain killers, and right now I am on Gabapentin (Nuerontin) 600mg per day, plus I take Codeine occasionally which only takes the edge off when the pain is prominent. During the day I sometimes will use Tylenol, but I try to avoid that as much as possible because it is very hard on the liver. I will also soak in a warm bath to try to ease the pain, and I have also been known to take some Oil of Peppermint to try to ease the situation. I don’t know exactly how effective the Oil of Peppermint is on it’s own, as I usually apply heat with that when the pain is fierce.

      Hope this helps?

  2. Clint Post author


    Interesting comments from your GI and on that note she is right in many ways. The side effects of PH are not the greatest, but with the meds they have nowadays at least they can stave off bleeding by keeping the blood pressure lower. Do you have esophogeal varices from the PH?

    Stay positive and keep me (us) posted.


  3. Clint Post author

    No problem … come to the site anytime … it is here for people like you who are perplexed by this strange condition.

  4. Ela

    Thank you for your welcoming comments.

    Actually, I am not on any meds and that is why it struck me so.

    No, thank God, no varices have been found, but the pain causes anxiety.


  5. Sylvia Jiminez

    Wow, in reading your comments and insight has indeed opened my eyes. I have been diagnosed with cirrohsis of the liver moderate to severe with varices 3+ (I guess that means 3 stage), enlarged spleen 15.3, colitis, mild gastritis, CREST syndrome Sjorngens, Diabetes type 2, hypertension (I know I have left something out but at this point, it probably is not even important anymore). I have low grade fevers all the time going to 99.9 and as low as 97.1. I have been poked probed, tickled and skewered and all 5 of my doctors are going around scratching their heads. I am very weak and anemic, there has been blood but really not alot just noticeable. At this point my specialist for my liver says that there is not much more they could do for me locally. I am looking for some kind of relief and/or treatment so I can return to work. With this constant discomfort and pain, night sweats and sleepless nights and not able to think and function like a normal humanbeing is not acceptable. I am a litigation assistant and my boss has already expressed that I have a job waiting for me as long as I am not missing for doctors’ appts. and illness; so what am I suppose to do.

    I am going to be looking at Loma Linda University for the Liver/Gastro specialist. Anybody know any names at this hospital. My doctor gave me the referral for the hospital but does not know anyone there. He says that I will probable be looking at surgery (whatever that means). I am reading the reports and there is so much they didn’t tell me. Thanks for any help or assistance you can give.

    1. Clint Post author

      Hi Sylvia, Thanks for your comments. I am sorry to hear of your health misfortunes and I pray that you find just what you need at Loma Linda. I don’t know of anyone in particular I can direct you too, but someone may show up on here to make a recommendation. As you have read it is a complicated condition and when a person has other conditions added to the mix like you do I know it must be difficult to deal with all of that. Hang in there though, and maybe you will get some more direction at Loma Linda – I know they have some of the best doctors in the US. I or others on here may not have the answers, but we have a great understanding of what you are up against so that is very valuable as you go forward. Have your current doctors put you on Nadolol (beta blockers) to prevent varical bleeding? On a scale of 1 to 10 how intense is your pain? Not to discourage you, but if your pain is vascular in nature then is gets difficult to treat. Keep plugging your way through. Best, Clint

  6. Charlie

    Wow,what good imformation.My wife had lots of pain in 2004 and finally in 2007 they took our her spleen.What a mistake.She has constant diherria since.Using a box of depends a week.She has a herina in stomach.The surgent found liquid bewteen stomach and skin..They haven,t said how its getting there but they said portal hydpertension and ascities could be the problem.Also said her white blood cells count is up .She has to have the liquid taken off every 10-12 days… one or two bottles each time..Now the pain shot isn,t deadening the area for the needle. They have started the water pills and anti bioace pills for stomach pain. She is almost bed fast and has lost 70 lbs because her stomach is alway full or heavy with the weight of the fluid..At least we known a little more about this situation .She will be 73 years old in march. Thanks

    1. Clint Post author

      Thanks Charlie, Welcome to the blog! Sorry to hear of your wife’s health issues. I trust you find some mutual support from the many who have posted here, and hopefully some understanding of this condition from a laymans point of view on the articles I have written.

      All the best for both of you in the New Year!


  7. sheila denton

    Hello, Clint……after 25 years of stable MS (most of the lesions are at T5) and 22 years of MF (a rare, chronic leukemia) with the main presenting symptom being a massive spleen (30cmx14cmx10cm as of last month!) with no pain, a nurse practitioner has startled my hem/onc by suggesting ascites might be the cause of my recent increase in size. Sorry for the run-on sentence! I had just been dealing with being skinny with a huge tummy, being hungry all the time because my stomach is so pressured……when it seemed that all the areas around the spleen, hips, etc., just became like a water balloon. Sitting upright on my scooter is now impossible (vascular doctor wants me in bed, with compression hose, 20+ hours a day) because there is concern about Superior Vena Cava Syndrome, and maybe hepatic vein squashing. So, here I am, some problems with eating, breathlessness, and moving…..and it has been difficult to find info on massive splenomegaly and ascites. No pain, blood numbers and liver and heart fine. Oooooooph. Any suggestions? And, no, they absolutely cannot remove the spleen…..it makes my blood because my bone marrow no longer works. Thanks for reading….Sheila

    1. Clint Post author

      Thanks for sharing your story. I was absolutely blown away by the fact that you have to deal with so much, and on that note I pray for you that somehow your pain and the symptoms will diminish over time. To be honest I don’t have any suggestions for what may be going on, because much of what you are telling me is new. You have complications that I am unsure of how they react with Vena Cava Syndrome, and besides that I can not venture to far to say anything because I am not a physician. I do have a good understanding of Portal Hypertension and its related symptoms, however there is much more to learn.

      Like you I cannot have my spleen removed as it would complicate matters for me significantly. A gastroenterologist wanted to remove it when I was first diagnosed over 10 years ago, but my hematologist at the time said that “no one was going to take out anything” and so I have been relieved about that ever since. As you may have already read I am at serious risk to bleed from any procedure, so most of my doctors have to diagnose and treat from the outside. rather than the inside.

      Being a person who trusts God (despite the complications of this condition), I think I qualify to show some empathy, and definitely can pray for others so I do that as much as I can. When I hear of something that I have learned through my research, or others have shared, I am more that willing to share that information with others in hopes they can benefit and try to live a relatively normal life.

      Please – if you hear of anything or you need to share more information it is so valuable to others as they at least can be assured that they are not the only ones who may be suffering, and that others have been there regarding the pain they feel, or the fear they have regarding the future.

      Bless you for sharing!


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