Portal hypertension is high blood pressure which is caused in the portal vein, the blood vessel that connects the intestines and the liver. Generally, the condition develops in people who have liver damage.
The scar tissues that are present in the liver obstruct normal blood flow further causing blood to back up into the portal vein and increasing blood pressure.
Further this backup causes the blood to force its way into small, thin-walled veins at the base of the esophagus and within the stomach. These blood vessels that are known as varices gets stretched, swollen, and twisted and are in danger of breaking and bleeding.
Causes and Risk Factors
People who are having portal hypertension also have a damaged liver. The causes of a damaged liver include:
- Chronic viral hepatitis
- Blood clots
- Various congenital disorders and
- Primary biliary cirrhosis, an autoimmune disease.
Diagnosis of Portal Hypertension
Portal hypertension is suspected if a person with liver disease also has ascites, varices, or encephalopathy.
To confirm the diagnosis of portal hypertension, a doctor may order one or more of the following tests:
- Computed tomography (CT) scan
- Ultrasound or
- Endoscopy (physicians insert a viewing tube called an endoscope through the mouth and down into the beginning of the small intestine).
What are the symptoms of Portal Hypertension?
By itself, portal hypertension has no symptoms. The mentioned below are some complications of portal hypertension, however, cause symptoms: Causes:
- Bloody vomiting, and
- Black, loose stools.
The settlement of fluid in the abdomen (ascites) happens when a liver becomes so damaged that it can no longer make the protein albumin, which holds fluid inside blood vessels.
When the brain comes in contact with toxins like ammonia that a damaged liver cannot clear from the body, a brain disease called encephalopathy results. Some signs of encephalopathy include:
- Neglect of personal appearance
- Difficulty in concentrating
- Confusion and
Treatment for portal hypertension begins when varices bleed majorly. Patients who experience this issue will receive the following:
- Intravenous fluids
- Blood transfusions and
- Emergency endoscopy to confirm the source of the bleeding.
Once the bleeding is located, doctors use one of the following endoscopic techniques to extract the varices:
- Latex banding or
- Balloon tamponade.
Along with these endoscopic therapies, patients receive intravenous blood pressure-lowering medications, like:
- Long-acting nitrates
- Vasoconstrictors or
When endoscopic treatments are unable to cure varices effectively, doctors can place a stent, or a thin mesh-metal tube, to reroute blood and relieve pressure on the portal vein.
To treat ascites, doctors recommend lifestyle changes and over-the-counter treatments, like:
- Avoiding alcohol
- Eating a low-sodium diet and
- Taking diuretics to remove fluid from the body. If the abdomen gets extremely swollen, doctor can advise to have paracentesis (the insertion of a catheter into the abdominal wall to drain excess fluid.)
To treat encephalopathy, a doctor may suggest one or more of the following:
- Substituting vegetable protein for animal protein or
- Lactalose, laxatives and antibiotics (medications that extract toxins from the intestines).
Patients become candidates for a liver transplant when they have portal hypertension with variceal bleeding and end-stage liver disease.