Pathogenesis of Portal Hypertension

ABSTRACT To the Editor:— The article, Contrasting Patterns of Ascites Formation in Hepatic Cirrhosis, by Witte et al (208:1661, 1969) shows well how to distinguish between portal hypertension with stagnant portal flow and portal hypertension with high portal flow. An increase in portal blood flow may be the principal cause of portal hypertension, or associated with splenomegaly, and may be treated by splenectomy without the creation of a porta-caval venous shunt.The idea that splenomegaly and increase in portal flow may cause portal hypertension had been postulated on the basis of painstakingly gathered clinical, anatomic, and pathologic observations, but has not yet been generally accepted. Thus the existence of portal hypertension primarily due to increased portal flow has been either ignored or admitted almost furtively.Much more work is needed, but the article shows clearly how to explore this subject with arteriograms, using portal flow and pressure determinations and the