What is the most common sign of portal hypertension in children?

Splenomegaly is considered the most common sign of portal hypertension in children due to the increased pressure within the portal venous system. When the portal vein experiences elevated pressure, it can lead to a backup of blood in the spleen, resulting in its enlargement. This condition occurs particularly in pediatric populations where conditions such as liver cirrhosis or certain congenital abnormalities may lead to portal hypertension.

In children, the spleen not only enlarges due to congestion of blood but may also become an important clinical marker that prompts further investigation into the underlying cause of portal hypertension. Although ascites, hepatic encephalopathy, and upper gastrointestinal bleeding can also be associated with portal hypertension, they are often more variable and may not occur early in the disease process as prominently as splenomegaly does. Thus, splenomegaly serves as a key indicator in pediatric assessments of portal hypertension.