development of portal HTN u. revealed by presence of thrombocytopenia; appearance of an enlarged spleen; or development of ascites, encephalopathy, and/or esophageal varices w/ or w/o bleeding.
In previously undx pxs , any of these features should prompt further evaluation to determine presence of portal HTN and liver disease.
Varices: identified by endoscopy.
Abdominal imaging, either by CT or MRI, helpful in demonstrating a nodular liver and in finding changes of portal HTN w/ intraabdominal collateral circulation.
If necessary, interventional radiologic procedures can be performed to determine wedged and free hepatic vein pressures that will allow for calculation of a wedged-to-free gradient, which is equivalent to portal pressure. average normal wedged-to-free gradient is 5 mmHg, and pxs w/ a gradient >12 mmHg are at risk for variceal hemorrhage.