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Portal hypertension is asymptomatic in its early phases, but always should be suspected in chronic liver disease. The diagnostic work-up should include radiologic studies of the hepatic vascular pattern, measurement of portal pressure, and estimation of total hepatic and portal blood flow. Portal hypertension is not spontaneously progressive, and an appropriate medical regimen is often effective n patients with mesenchymal cell proliferation or hyperplasia of endoplasmic reticulum. When the disease is refractory to medical measures, surgical therapy should preserve portal blood flow if at all possible.