Portal hypertension – causes, symptoms and treatment

The vein that carries blood from the digestive system, pancreas and the stomach into the liver is called portal vein. This blood in the portal vein is full of toxins and waste materials from digestive organs. It is detoxified and purified by the liver and is given back to the circulation by central vein into the inferior vena cava.

If the vessels that that deals with blood supply are blocked in certain conditions of liver damage, blood flow is interrupted. So the blood pressure arises. An increased blood pressure in this hepatic portal system is called portal hypertension. It is also known as hepatic venous pressure gradient.

Causes of portal hypertension

  • Cirrhosis – the injury to the liver results in the formation of regenerative nodules that are surrounded by fibrous bands.
  • Blood clots in portal vein
  • A parasitic infection called schistosomiasis
  • Blockade of central vein and inferior vena cava
  • Focal nodular hyperplasia

hepatic portal veins and hypertension

Symptoms of portal hypertension

  • Gastrointestinal bleeding – it is usually presented by black, tarry colored stools which means the presence of blood in the stool. This condition is called melena.
  • Ascites – the peritoneal cavity becomes filled with lymph fluids and water. This can be seen as your belly is getting big followed by cirrhosis.
  • People with hepatic encephalopathy usually have all symptoms of liver failure and cirrhosis.
  • Hepatic encephalopathy or mental confusion
  • Coagulation defects

Complications of portal hypertension

Complication of portal hypertension are the complication of liver failure

  • Esophageal varices – it can bleed and may result in life threatening complications.
  • Ascites
  • Hepatic encephalopathy
  • Spontaneous bacterial peritonitis
  • Splenomegaly

Diagnosis

  • Doctors evaluation – evaluate enlarged spleen (splenomegaly), enlarged abdomen, dull sound when tapping the abdomen.
  • Imaging tests like ultrasonography – to evaluate blood flow to the hepatic portal system. Other imaging techniques can also be employed to examine collateral blood vessels.
  • Catheterization – less commonly an incision is made in the neck and a catheter is inserted to measure the pressure in the hepatic portal system.

Treatment

Treatment should be done to control portal hypertension and its symptoms.

  • Control of bleeding – bleeding from varices is an emergency condition. Drugs like

Vasopressin

Octreotide

  • Blood transfusion – is done to replace lost blood
  • Control of blood pressure

Beta blocker

Timolol , propranolol , nadolol, carvedilol

  • Endoscopic therapy – it includes banding using rubber bands to block the blood vessels to stop bleeding. If banding doesn’t works, sclerotherapy is used which injects a blood clotting solution into bleeding varices.
  • Portosystemic shunting – transjugular intrahepatic portosystemic shunt (TIPS) and Distal splenorenal shunt.
  • Liver transplantation

Lifestyle changes

A good healthy lifestyle helps to prevent portal hypertension.

  • Do not consume alcohol
  • Do not take herbal drugs or any other drugs without proper consultation with doctor or clinical pharmacist.
  • Follow the dietary guidelines given by the dietician.
  • Limit the daily salt intake to 2g/day.
  • Limit the protein intake in case of confusion.

Jose J Kochuparambil

I love the quote -' be the change that you wanna see in others'

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