Portal hypertension differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Differential Diagnosis

• Portal hypertension must be differentiated from other diseases that cause ascites, splenomegaly, hematemesis or melena, bacterial peritonitis, hydrothorax, hypoxemia, and pulmonary hypertension.
• Portal hypertension must be differentiated from various diseases as in the following table.

Differentiating symptom	Diseases	Laboratory Findings							Physical Examination						History and Symptoms				Other Findings
		CBC	ESR	Alb	Iron	Ascites fluid	PBS	Cr	Abdominal tenderness	Pale conjunctiva	Fever	Pitting edema	Apnea/ Baradypnea	Murmur	Weight loss	Weakness	Cough	Dyspnea
	Portal Hypertension	-	-	-	-	Transudate	-	↑	+	-	-	-	-	-	-	-	-	-	Cirrhosis
Ascites	Malignant ascites	-		+
	Nephrogenic ascites	↑			-
	Tuberculosis		↓
Splenomegaly	Thalassemia
	Sickle cell disease
	Hereditary spherocytosis			+
Hematemesis/ Melena	Peptic ulcer disease			+
	Mallory-Weiss tear			+
	Colorectal cancer			+
Bacterial peritonitis	Secondary bacterial peritonitis			+
Hydrothorax	Malignancy			+
	Sarcoidosis			+
	Nephrotic syndrome			+
Hypoxemia	Heart failure			+
	Central nervous system depression			+
	Muscular weakness			+
Pulmonary hypertension	Idiopathic pulmonary arterial hypertension			+
	Valvular heart disease			+
	Connective tissue diseases			+