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Portal Hypertension

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Portal hypertension is a condition that occurs when there is an increase in the blood pressure on veins belonging to the portal venous system. These veins can rupture and lead to fatal consequences.

What is Portal Venous System?

Portal veins are those blood vessels that connect the gastrointestinal tract and spleen to the liver. The blood transported by these veins is nutrient rich. This is because it comes from the stomach and is processed in the liver. This means it is rich in the nutrients from food in the stomach and free from the toxins as the liver filters these nutrients.

The hepatic portal veins conducts blood to the liver, and not to the heart. Thus, it is not a true vein. Any disorder or condition affecting this vein can lead to many complications, including death. Thus, in case of cirrhosis of liver, portal hypertension is a major complication that can turn fatal.

What is Portal Hypertension?

When the pressure gradient of the hepatic vein is >5mmHg, it is called as portal hypertension. When there is a blockage in the blood flow to the liver, it leads to increase in pressure. This causes development of varices, i.e. large veins in the esophagus and stomach. These veins then become very fragile and can burst, leading to internal bleeding.

Symptoms of Portal Hypertension

Signs of portal hypertension include:

  • Gastrointestinal bleeding that causes black, tarry stools. One may even observe blood in stools.
  • Vomiting blood due to rupture of varices
  • Fluid accumulation in abdomen, i.e. ascites
  • Encephalopathy
  • Loss of memory, forgetfulness due to poor blood filtration
  • Decrease in WBC and platelet count
  • Spontaneous bacterial peritonitis
  • Splenomegaly
  • Presence of esophageal varices, gastric varices, anorectalvarices and caput Medusa

What are the Complications of Portal Hypertension?

The increase in pressure on portal veins affects other veins as well. This causes swelling of the spleen. Some develop diarrhea as the veins of the intestines are affected.

In this case, to lower the increase in pressure, the body starts growing new veins that do not pass through the liver. They grow near the esophagus, spleen, stomach as well as the colon. These veins are called as varices that are weaker than normal veins. Thus, they can easily bleed when ruptured.

As these veins do not pass through the liver, they are not filtered of toxins. These toxins then flow all over the body through blood, leading to other secondary complications.

Causes of Portal Hypertension

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The main cause of portal hypertension is blockage of the portal vein. There are three types of blockages that lead to portal hypertension. These include prehepatic, hepatic and posthepatic blockage of the liver.Children mostly suffer from prehepatic blockages. These blockages occur due to blood clots or narrow portal veins. In order to overcome this obstruction, new veins are made that bypass the blockage and the liver. Instead of overcoming the problem, it causes “cavernous transformation of the portal vein.”

Another reason for blockages includes cirrhosis of the liver. It is a disease that leads to progressive scarring of the liver. Cirrhosis is the main cause of portal hypertension in adults. It even affects children, wherein, the soft, healthy liver tissue is replaced with hard tissue, leading to blockage of the portal veins.

Other causes of portal hypertension include:

  • Hepatic vein thrombosis
  • Inferior vena cava thrombosis
  • Portal vein thrombosis
  • Constrictive pericarditis

Diagnostic test for portal hypertension

The only excepted criterion for measurement of portal hypertension is the hepatic venous pressure gradient (HVPG). If the measurement turns out to be >5mmHg, it indicates portal hypertension. Other diagnostic techniques include imaging and endoscopic tests.

Treatment of portal hypertension

There is no treatment for the different causes of portal hypertension. Thus, the treatment aims at management and prevention of various complications.

The treatment includes:

  • Medications like nitrates or beta blockers to control and treat variceal bleeding and reduce the pressure in the varices
  • Portal vein pressure can be reduced with the help medications like propranolol and isosorbide
  • Dietary and lifestyle changes such as quit smoking and drinking, low-sodium diet, etc.
  • Sclerotherapy to stop or control bleeding by injecting a solution into the bleeding varices
  • Banding to block the blood supply to individual varix by using rubber bands
  • Encephalopathy causing mental confusion can be treated with the help of the drug lactulose

If the above treatment does not help in controlling the bleeding, one may have to undergo:

  • A procedure where the doctor will place a stunt in the middle of the liver (Transjugular intrahepatic portosystemic shunt [TIPS])
  • A procedure that helps in connection of the splenic vein with the left kidney vein. This helps in the reduction of pressure in the varices and bleeding (Distal splenorenal shunt [DSRS]).

People suffering from ascites need to manage their condition with a no salt diet, use of diuretics; peritoneovenous shunt as well as TIPS.

Those who suffer from cirrhosis of the liver should be closely monitored for portal hypertension. In case of end-stage liver disease, liver transplantation is the only option. Make sure you undergo regular follow-up with your doctor as portal hypertension, if left unchecked, can turn fatal.

Written by: healthplus24.com team

Date last updated: February 11, 2015

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