Portal Hypertension

Portal hypertension refers to elevated blood pressure in the portal venous system, which is a vital vein that connects the liver to 4 organs (stomach, intestine, spleen and pancreas). It is commonly caused by the obstruction in the liver, intrinsic liver disease, or any other structural changes which may lead to an increased hepatic resistance or elevated portal venous flow. This resistance results in amplified pressure, causing dilations or varices of the veins.

Pressure in the portal system predominately depends on:

(i) Blood inflow from the portal vein

(ii) Hepatic resistance to blood outflow

Typically, the pressure of portal vein ranges between 4 mm Hg and 14 mm Hg higher than the hepatic vein-free pressure. Pressures exceeding these limits may result in portal hypertension.

What are The Symptoms and Causes of Portal Hypertension?

Usually, an individual suffering from portal hypertension does not exhibit any symptom until complications develop.

Some of these symptoms include:

  • Ascites (Or Feeling Bloated Due To Excess Fluid)
  • Vomiting
  • Dark-Color Stools
  • Jaundice
  • Coagulopathy
  • Hepatic Encephalopathy (Mental confusion)
  • Low Systolic Blood Pressure (Between 100 Mm Hg –110 Mm Hg)
  • Dilated Abdominal Wall Veins
  • Low Platelet Counts

Some of the common causes of portal hypertension include:

  • Liver Cirrhosis
  • Portal Vein Thrombosis
  • Liver Infection
  • Budd-Chiari Syndrome

What Are The Diagnosis & Treatment Options?

If an individual is experiencing aforementioned symptoms, it is advisable to visit a specialist. Your doctor will ask patients questions pertaining to the medical history and symptoms, including questions related to their family members. Besides, your doctor would also perform a physical examination.

In some cases whereby the diagnosis of the disease is not straightforward, a doctor may recommend performing some invasive examination or testing to gauge the vein pressure or assess liver tissues to have a better understanding of the problem.

Portal Hypertension Treatment

Portal hypertension is generally treated by managing of symptoms of the disease. One of the most common symptoms of portal hypertension is bleeding, which may cause severe complications, if it is not quickly treated.

Three frequently recommended options for treating portal hypertension include:

1. Following a Healthy Diet & Lifestyle:

Dietary changes are very helpful in treating portal hypertension. For instance, by reducing the salt intake, blood pressure can be better controlled. Similarly, minimizing protein intake can minimize the severity of portal hypertension. Furthermore, by giving up on alcohol consumption that causes liver injury, a patient can keep a check on portal hypertension.

2. Radiology & Surgical procedures: These two methods are considered as the first-line treatment to reduce and prevent bleeding resulting from portal hypertension, including sclerotherapy and banding.

What If Sclerotherapy And Banding Fail To Treat Portal Hypertension?

If the aforementioned procedures and medications fail to manage bleeding, other two radiological and surgical procedures are recommended, viz., TIPS and DSRS.

Transjugular Intrahepatic Portosystemic Shunt (TIPS): This method aims at decreasing both portal hypertension and the blood clotting by inserting a stent (or tube-like device) in the liver.

Distal Splenorenal Shunt (DSRS): It is a surgical procedure that controls both bleeding and pressure by creating a channel-like route between the left kidney and the spleen. Thus, DSRS decreases the portal circulation.

Medications: Along with the previously mentioned procedures, your doctor may further prescribe some medications for portal hypertension treatment.

What Are The Complications Associated With Portal Hypertension Treatment?

Portal hypertension treatment may cause certain complications, including encephalopathy and ascites. Check with your doctor to know more information!

As portal hypertension is sometimes associated with cirrhosis of the liver and may also cause bleeding and other symptoms (such as ascites), it is important to get a suitable guidance from a qualified doctor.