To clarify the question of why patients with cirrhosis develop portal hypertension, we need to understand the blood supply to the liver. The portal vein is a large vein at the entrance to the liver. It is responsible for collecting the venous return blood from the esophagus, stomach, intestines, pancreas, gallbladder, and spleen and transporting it to the liver parenchyma. Once the blood reaches the liver, it is “processed” and its nutrients are absorbed. The portal blood flow is abundant, reaching about 1 liter per minute, and flows out of the liver into the inferior vena cava and back into the right atrium. When cirrhosis occurs, the liver lobules become fibrotic, the liver parenchyma hardens, and the intrahepatic resistance increases.