Liver Doppler: Portal Hypertension

Liver Dopplers can be very difficult to complete depending on the level of the diseased liver. A liver becomes diseased from hepatitis, cirrhosis, alcohol abuse, or other factors.

Portal Hypertension means there is elevated pressure in the portal venous system within the liver. Cirrhosis, obstruction, and liver diseases can cause portal hypertension (HTN, the medical abbreviation for hypertension). Viral Hepatitis C is the most common cause of cirrhosis in the United States. And cirrhosis is the most common cause of portal HTN that causes the portal venous system to have increased resistance to blood flow. This leads to increased pressure that causes varices and dilation of veins. Many varices can be seen near the pancreas and splenic hilum. They will appear as large tortuous anechoic vessels on grayscale ultrasound images. Patients with portal hypertension could have these other symptoms:

Patent umbilical vein (seen at the level of the LPV and exiting the liver anteriorly)

GI bleed (hemorrhage) related to bleeding esophageal varices

Ascites (free fluid in the abdomen/peritoneum)


Hepatic Encephalopathy

Splenomegaly (enlarged spleen); low platelet count

Dilated abdominal wall veins

Portal vein thrombosis and cavernous transformation

Ultrasound is used to diagnosis portal hypertension and it is important for sonographers to confirm this diagnosis by evaluating for the following: the direction and velocity of portal vein flow within the liver, GB wall thickness, liver echogenicity and  surface nodularity, spleen size, patency of the umbilical vein, PV thrombosis and ascites.

TIPS (Transjugular Intrahepatic Portal-Systemic Shunt) can be placed within the liver to help with bleeding of varices

Liver Transplant may be another alternative for severe liver disease.