Portal Hypertension: What You Need to Know
Portal hypertension is a condition that affects the blood flow to the liver. It occurs when there is increased pressure in the portal vein, which is the main blood vessel that carries blood from the digestive organs to the liver.
Portal hypertension can cause serious complications, such as bleeding varices, ascites, encephalopathy, and jaundice. In this article, we will explain what causes portal hypertension, what are its symptoms, how it is diagnosed, and how it can be treated.
Causes of portal hypertension
The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis is a chronic disease that results from long-term damage to the liver cells.
The damage can be caused by various factors, such as viral infections (hepatitis B or C), alcohol abuse, autoimmune disorders, genetic diseases, or toxins. As the liver cells die, scar tissue replaces them and blocks the normal blood flow through the liver. This increases the resistance and pressure in the portal vein.
Other causes of portal hypertension include:
- Blood clots in the portal vein or its branches.
- Obstruction of the veins that drain blood from the liver to the heart (such as Budd-Chiari syndrome).
- Parasitic infection of the liver (such as schistosomiasis).
- Rare diseases that affect the development or structure of the portal vein (such as congenital hepatic fibrosis or nodular regenerative hyperplasia).
Sometimes, the cause of portal hypertension is unknown. This is called idiopathic portal hypertension.
Symptoms of portal hypertension
Portal hypertension may not cause any symptoms until complications develop. The main complications of portal hypertension are:
- Bleeding varices: These are enlarged and fragile veins that form in the oesophagus, stomach, rectum, or around the belly button due to increased pressure in the portal vein. These veins can rupture and bleed, causing hematemesis (vomiting blood), melena (black, tarry stools), or hematochezia (bright red blood in stools). Bleeding varices are a medical emergency and can be life-threatening if not treated promptly.
- Ascites: This is an accumulation of fluid in the abdomen due to increased pressure in the portal vein and reduced production of albumin by the liver. Albumin is a protein that helps keep fluid in the blood vessels. Ascites can cause abdominal distension, discomfort, shortness of breath, and an increased risk of infection.
- Encephalopathy: This is a condition that affects brain function due to high levels of ammonia and other toxins in the blood. The liver normally filters these toxins out, but when it is damaged, they can reach the brain and cause confusion, forgetfulness, mood changes, sleep disturbances, and coma.
- Jaundice: This is a yellowing of the skin and eyes due to high levels of bilirubin in the blood. Bilirubin is a pigment that is produced when red blood cells break down. The liver normally metabolises and excretes bilirubin, but when it is damaged, it accumulates in the blood and tissues. Jaundice can also cause itching, dark urine, and pale stools.
Diagnosis of portal hypertension
The diagnosis of portal hypertension is based on:
- Medical history: The doctor will ask about your symptoms, medical conditions, medications, and lifestyle habits that may affect your liver function.
- Physical examination: The doctor will examine your abdomen for signs of ascites, enlarged spleen, or varices. They will also check your skin and eyes for jaundice and your mental status for encephalopathy.
- Blood tests: The doctor will order blood tests to measure your liver function, blood count, clotting factors, and electrolytes. These tests can help assess the severity of your liver disease and the risk of bleeding.
- Imaging tests: The doctor may order imaging tests such as ultrasound, CT scan, or MRI to visualise your liver, spleen, portal vein, and other abdominal organs. These tests can help detect cirrhosis, portal vein thrombosis, or other causes of portal hypertension.
- Endoscopy: The doctor may perform an endoscopy to examine your oesophagus, stomach, and duodenum for varices or ulcers. They may also take a biopsy sample from your liver tissue for further analysis.
Treatment of portal hypertension
The treatment of portal hypertension aims to prevent or manage its complications, especially bleeding varices. The treatment options include:
- Medications: The doctor may prescribe medications such as beta-blockers or nitrates to lower the pressure in the portal vein and reduce the risk of bleeding. They may also prescribe medications such as diuretics or antibiotics to treat ascites or prevent infections.
- Endoscopic therapy: The doctor may perform endoscopic procedures such as band ligation or sclerotherapy to stop or prevent bleeding from varices. Band ligation involves placing a rubber band around the varix to cut off its blood supply. Sclerotherapy involves injecting a chemical agent into the varix to seal it off.
- Shunt surgery: The doctor may perform surgery to create a bypass between the portal vein and another vein, such as the hepatic vein or the inferior vena cava. This reduces the pressure in the portal vein and diverts the blood flow away from the liver. There are different types of shunt surgeries, such as portacaval shunt, mesocaval shunt, or transjugular intrahepatic portosystemic shunt (TIPS). Shunt surgery can improve the symptoms of portal hypertension, but it can also worsen encephalopathy and liver function.
- Liver transplantation: The doctor may recommend liver transplantation if your liver disease is advanced and your portal hypertension is severe. A liver transplantation involves replacing your diseased liver with a healthy one from a donor. This can cure your portal hypertension and improve your quality of life, but it also carries risks such as rejection, infection, or complications from surgery.
Sources
Portal Hypertension: Common Symptoms & Treatment - Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4912-portal-hypertension
Portal Hypertension Causes, Symptoms, Treatments, Tests - WebMD. https://www.webmd.com/digestive-disorders/digestive-diseases-portal
Portal Hypertension | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/portal-hypertension