Laboratory Evaluation

Laboratory measurements that should raise concern for portal hypertension include abnormal liver chemistries and other serum markers of chronic liver disease. Elevated aminotransferases signal hepatocellular injury, but there is no correlation between the degree of transaminase elevation and the severity of histologic injury. Cholestatic liver chemistries (increased alkaline phosphatase, GGT) may reflect chronic biliary obstruction from PBC or PSC. Hypoalbuminemia and elevated prothrombin time suggest possible decreased hepatic synthetic function. Thrombocytopenia is commonly found in patients with portal hypertension, splenomegaly, and platelet sequestration. An abdominal ultrasound examination that demonstrates a large-diameter portal vein in combination with a platelet count of 140,000/mm3 or less is a sensitive predictor of portal hypertension (5).

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