Which of the following statements about portal hypertension (PH) is false: PH is an uncommon manifestation of cirrhosis, PH results from impaired blood flow through the liver, PH can lead to splenomegaly, varices, ascites, portosystemic shunting, encephalopathy, or PH may have no initial symptoms?

The FALSE Statement About Portal Hypertension

The statement "PH is an uncommon manifestation of cirrhosis" is FALSE—portal hypertension is actually the initial and main consequence of cirrhosis, not an uncommon one. 1

Why This Statement is Incorrect

Portal hypertension is definitively not uncommon in cirrhosis:

• Portal hypertension is the initial and main consequence of cirrhosis and is responsible for the majority of its complications. 1

• Clinically significant portal hypertension (HVPG ≥10 mmHg) is present in approximately 50-60% of patients with compensated cirrhosis without varices. 1

• In Western countries, cirrhosis is by far the most common cause of portal hypertension and has been the most widely investigated. 1

• Portal hypertension develops in the vast majority of cirrhotic patients as the disease progresses, making it a common—not uncommon—manifestation. 2, 3

Why the Other Statements Are TRUE

Portal Hypertension Results from Impaired Blood Flow

• Portal hypertension arises from increased resistance to portal blood flow, including both fixed structural changes (fibrosis, angiogenesis, nodule formation, vascular occlusion) and dynamic changes (increased vascular tone). 1

• The condition can be classified by anatomic location: prehepatic, intrahepatic (parenchymal liver diseases), and posthepatic (hepatic venous outflow obstruction). 1

Portal Hypertension Leads to Multiple Complications

• Portal hypertension directly causes splenomegaly, varices, ascites, portosystemic shunting, and encephalopathy. 1, 2, 4

• Ascites is the most common complication, occurring in nearly 60% of patients within a decade of compensated cirrhosis diagnosis, and reduces 5-year survival from 80% to 50%. 1, 2

• Gastroesophageal varices are present in 30-40% of patients with compensated cirrhosis and up to 85% with decompensated cirrhosis. 1

• Hepatic encephalopathy occurs in 30-40% of cirrhotic patients at some point during their clinical course. 1

Portal Hypertension May Have No Initial Symptoms

• The compensated stage of cirrhosis with portal hypertension is the longest stage and is asymptomatic. 1

• Patients with mild portal hypertension or even clinically significant portal hypertension may have no overt clinical symptoms initially. 1

• Portal hypertension can occur before a formal anatomical diagnosis of cirrhosis is established, emphasizing its early and often silent development. 1