About portal hypertension
What is portal hypertension?
The liver serves many purposes within the body from making carbohydrates, proteins and fats to synthesizing bile to help digest found. Because of this, the liver requires a significant blood supply. As opposed to other organs in the body, the majority of this blood supply (75%) comes from the venous system through the portal system. Blood vessels from the stomach, small intestine, pancreas, and spleen converge and form the portal vein delivering nutrients and chemical building blocks to the liver. Once in the liver, the portal vein and hepatic artery (which accounts for 25% of the liver's blood supply) come together to form sinusoids, spaces where the blood is filtered. From there, blood makes its way to the Vena cava, the largest vein in the body to return to the heart.
Portal hypertension describes elevated pressure within the portal system, including the portal vein and the tributary veins that drain into it. The pressure within the portal system is not normally measured and is not an issue except if an illness or disease occurs that makes it difficult for blood to flow through the liver tissue. This damming effect increases pressure within the portal venous system and causes potential problems with liver function. It is the onset of symptoms associated with liver disease that might cause the health care professional to look for the presence of portal hypertension.
What are the symptoms for portal hypertension?
Gastrointestinal bleeding symptom was found in the portal hypertension condition
Gastrointestinal bleeding is often the first sign of portal hypertension. Black, tarry stools can be a sign of gastrointestinal bleeding. You may also actually see blood in your stools.
Another symptom is ascites, which is a buildup of fluid in your belly. You may notice that your belly is getting bigger because of ascites. The condition can also cause cramps, Bloating, and shortness of breath.
As well, becoming forgetful or confused could be a result of a circulation problem related to your liver.
What are the causes for portal hypertension?
The main cause of portal hypertension is cirrhosis. This is a scarring of the liver. It can result from several conditions such as hepatitis (an inflammatory disease) or alcohol abuse.
Autoimmune diseases of the liver such as autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cholangitis also are causes of cirrhosis and portal hypertension.
Whenever your liver is harmed, it attempts to heal itself. This causes scar tissue to form. Too much scarring makes it harder for your liver to do its job.
Other cirrhosis causes include:
- nonalcoholic fatty liver disease
- iron buildup in your body
- cystic fibrosis
- poorly developed bile ducts
- liver infections
- reaction to certain medications, such as methotrexate
Cirrhosis can cause the normally smooth inner walls of the portal vein to become irregular. This can increase resistance to blood flow. As a result, blood pressure in the portal vein increases.
A blood clot can also form in the portal vein. This can increase the pressure of blood flow against the walls of the blood vessel.
What are the treatments for portal hypertension?
Treatment for portal hypertension is often directed at preventing complications. This includes treating the underlying cause and avoidance of alcohol. Because of the risk of further liver damage, over-the-counter medications that contain acetaminophen (Tylenol, Panadol, etc.) should also be avoided.
Dietary restrictions include limiting salt to prevent further ascites fluid accumulation. Protein restriction may also be indicated, since increased protein load can overwhelm the liver's ability to synthesize it and may lead to hepatic encephalopathy.
Medications such as beta blockers and nitroglycerin may be appropriate to decrease pressure within the portal system. Lactulose may be prescribed as a treatment for hepatic encephalopathy.
Endoscopy may be required to band or tie off varices in the esophagus to prevent catastrophic and life threatening bleeding.
A TIPS procedure (transjugular intrahepatic portosystemic shunt) may be an option to decrease the pressure within the portal system. An interventional radiologist attempts to place a tube that connects the portal vein with the hepatic vein. This may decrease the pressure within the liver and may also reduce pressure within the veins of the stomach and esophagus, hopefully decreasing the risk of bleeding.
What are the risk factors for portal hypertension?
Intrahepatic causes of portal hypertension
Intrahepatic causes of portal hypertension include cirrhosis and hepatic fibrosis or scarring. A wide variety of illnesses are implicated as the cause of portal hypertension. Examples include the following:
- Alcohol abuse,
- Hepatitis B and C infections,
- Fatty liver (NASH, non-alcoholic steatohepatitis),
- Wilson's disease, an abnormality of copper metabolism,
- Hemochromatosis (iron overload), excess iron buildup
- Cystic fibrosis
- Primary sclerosing cholangitis, a hardening of the bile ducts
- Biliary atresia, poorly formed bile ducts
Pre-hepatic causes of portal hypertension
- Portal vein thrombosis or blood clots within the portal vein
- Congenital portal vein atresia or failure of the portal vein to develop
Is there a cure/medications for portal hypertension?
Portal hypertension is an increase in blood flow within the portal venous system, which is a network of veins.
- The portal vein is formed by veins from the stomach, small bowel, spleen, and pancreas, which then branch into smaller vessels and travel through the liver.
- Blood cannot flow appropriately through the liver if the vessels in the hepatic are blocked due to liver damage.
- As a result, pressure difference develops in the portal system.
- This increased portal vein pressure may result in the formation of large, swollen veins (varices) within the esophagus, stomach, rectum, or umbilical area.
- Unfortunately, the majority of portal hypertension causes are incurable. Instead, treatment focuses on avoiding or managing complications, particularly varices bleeding.
- Diet, medicines, endoscopic therapy, surgical intervention, and radiology procedures are all used to treat or prevent complications.
- Other treatments are dependent on the severity of your symptoms and how well your liver functions.
- Endoscopic therapy, which consists of banding or sclerotherapy, is generally the first treatment option for variceal bleeding.
- Non-specific beta-blockers (nadolol or propranolol) may be recommended alone or in a mixture with endoscopic therapy to reduce varices pressure and thus the risk of bleeding.
Gastrointestinal bleeding,Blood in the stools,Haemorrhage
Liver disease,Cirrhosis,Fluid in the abdomen,Poor liver function