Which sign is most indicative of portal hypertension in cirrhosis?

• A. Headache
• B. Nausea
• C. Ascites
• D. Confusion

Answer: (C)

Portal hypertension in cirrhosis causes fluid to push into the abdominal cavity. The scarred liver raises resistance to blood flow, increasing pressure in the portal venous system. This elevated pressure, along with hormonal changes that promote sodium and water retention, leads to the accumulation of fluid in the peritoneal cavity—ascites. Ascites directly reflects the hemodynamic changes from portal hypertension and is a quintessential sign of this condition. Headache and nausea are nonspecific symptoms that don’t specifically indicate portal pressure, and confusion points to hepatic encephalopathy from liver failure rather than portal hypertension itself. So ascites is the sign most indicative of portal hypertension in cirrhosis.