Feline Portal Hypertension: Vet Guide 2025 🐱🩺💥

Welcome concerned cat parents! I’m Dr Duncan Houston BVSc 🩺. Portal hypertension occurs when blood pressure in the portal vein rises—either from increased flow or resistance—leading to serious complications like ascites, varices, portosystemic shunts, and hepatic encephalopathy. This guide covers causes, symptoms, diagnosis, treatments, and compassionate home support 😊.

🔍 What Is Portal Hypertension?

When pressure in the portal vein exceeds ~10 mm Hg (or >13 cm H₂O), portal hypertension is present :contentReference[oaicite:3]{index=3}. This can result from:

• Prehepatic: blockage or thrombosis before the liver.
• Intrahepatic: cirrhosis, fibrosis, or inflammation inside the liver.
• Posthepatic: impaired flow after the liver (e.g. vena cava obstruction) :contentReference[oaicite:4]{index=4}.

⚠️ Why It Matters: Complications

• Ascites: fluid buildup in the abdomen causing distension :contentReference[oaicite:5]{index=5}.
• Portosystemic shunts (PSS): blood bypasses the liver—allows toxins into circulation causing encephalopathy :contentReference[oaicite:6]{index=6}.
• Varices: swollen veins (e.g., around stomach) may rupture, causing bleeding :contentReference[oaicite:7]{index=7}.

👂 Clinical Signs to Spot

• Abdominal enlargement, discomfort, panting, lethargy.
• vomiting blood (hematemesis), black stool (melena), anemia.
• Neurologic signs: confusion, tremors, seizures (hepatic encephalopathy).
• Poor growth or weight loss, especially in kittens with congenital shunts.

🔬 Diagnosing the Condition

1. Ultrasonography & Doppler

Doppler ultrasound reveals:

• Dilated portal vein >13 mm :contentReference[oaicite:8]{index=8}.
• Lack of respiratory variation in splenic/mesenteric veins :contentReference[oaicite:9]{index=9}.
• Portal-to-systemic flow reversal (hepatofugal flow) is diagnostic :contentReference[oaicite:10]{index=10}.
• Collateral vessels: splenorenal, gastric, paraumbilical veins (“caput medusae”) :contentReference[oaicite:11]{index=11}.
• Detection of small volumes of ascites :contentReference[oaicite:12]{index=12}.

2. Bloodwork & Urinalysis

• Elevated liver enzymes, low albumin, ammonia rise in encephalopathy.
• Proteinuria may reflect kidney stress.

3. Imaging & Advanced Testing

• CT scan to detect shunts and evaluate portal flow.
• Exploratory surgery or biopsy to confirm cirrhosis or thrombosis.

🏥 Treatment Strategies

1. Treat the Underlying Cause

• Medical management of cirrhosis and cholangitis with antibiotics and diet :contentReference[oaicite:13]{index=13}.
• Treat thrombosis or vessel obstruction as appropriate.

2. Manage Ascites

• Salt-restricted diets, diuretics like spironolactone or furosemide.
• Periodic fluid drainage if breathing becomes labored.

3. Portosystemic Shunt Therapy

• Congenital shunts: surgical attenuation with ameroid rings or cellophane banding is ideal :contentReference[oaicite:14]{index=14}.
• Acquired shunts: result from cirrhosis; managed medically (lactulose, low-protein diet) :contentReference[oaicite:15]{index=15}.

4. Control Encephalopathy

• Lactulose, antibiotics (metronidazole) to reduce ammonia.
• Manage seizures or neurologic flare-ups.

5. Monitor & Support Liver**

• Hepatoprotectants like SAMe or ursodeoxycholic acid as directed.
• Regular ultrasound and blood testing for early changes.

📈 Prognosis Outlook

• Ascites or acquired shunts: guarded to poor—requires ongoing medical care.
• Congenital shunts: good to excellent—successful surgery often resolves signs :contentReference[oaicite:16]{index=16}.
• Complications: recurring fluid build-up, bleeding, encephalopathy, progressive cirrhosis.

🏡 Home Care & Monitoring

• Use **Ask A Vet app** 📱 to track abdominal size, appetite, vomiting, behavior changes.
• Provide low-sodium diet, small frequent meals, and consistent medication routines.
• Avoid stress and dehydration; ensure easy access to water and litter box.
• Recognize emergency signs: labored breathing, collapse, seizures, bleeding—seek vet care.
• Schedule regular check-ups for ultrasound and blood tests.

📝 Key Takeaways

• Portal hypertension means high pressure in the portal vein (>10 mm Hg) causing fluid buildup and shunts.
• Diagnosis relies heavily on ultrasound and Doppler blood flow observations.
• We treat complications—ascites, encephalopathy, shunts—plus the root cause, whether cirrhosis or thrombus.
• Congenital shunt surgery offers best outcomes; acquired cases need lifelong management.
• Home care is vital—diet, medication adherence, and monitoring tools matter.

📞 When to Contact Ask A Vet

If your cat shows abdominal swelling, vomiting blood, confusion, seizures, or collapse—use the **Ask A Vet app** 💬 immediately for rapid advice and vet referral.

✨ Final Thoughts

Portal hypertension in cats demands vigilant care but can be managed. With accurate diagnosis, targeted treatments, surgical correction when possible, and attentive home support, cats can lead more comfortable lives. You’re an important partner in that journey—thank you for caring ❤️🐾.