In a patient with cirrhosis and portal hypertension, which finding is most indicative of portal hypertension?

• A. Ascites and Hematemesis
• B. Hypertension
• C. Kidney failure
• D. Anemia

Answer: (C)

Portal hypertension elevates pressure in the portal venous system, which most clearly translates into fluid buildup and bleeding from enlarged intestinal and esophageal veins. Ascites stems from the increased hydrostatic pressure and splanchnic vasodilation that push fluid into the peritoneal cavity, while hematemesis arises from ruptured varices caused by the same high portal pressures. These two findings together are the most characteristic sign of portal hypertension in cirrhosis. General hypertension isn’t specific to the portal system, kidney failure can occur later as a consequence of severe liver disease but isn’t a direct indicator of portal hypertension, and anemia is nonspecific and not diagnostic for portal hypertension.