Portal hypertension is elevated blood pressure in the portal vein, which carries blood to the liver. It is caused by a blockage in blood flow to the liver, usually as a result of cirrhosis. This can lead to internal bleeding and other complications. Show
Key Facts
CausesThe most common cause of portal hypertension is cirrhosis. Cirrhosis is when scar tissue builds up in the liver after repeated damage, such as from alcohol abuse or hepatitis. This scar tissue causes the smooth inner lining of the portal vein to become irregular, which can slow blood flow and increase pressure. A blood clot in the portal vein can also cause portal hypertension, although this is less common. SymptomsThe following are some of the most common symptoms of portal hypertension:
DiagnosisThe following are some of the most common ways to diagnose portal hypertension:
TreatmentThe main cause of portal hypertension is cirrhosis, which cannot be reversed. Because of this, the primary goal of treatment is to reduce and manage the effects of portal hypertension, such as internal bleeding. The following are the most common ways to do this:
OutlookWhile cirrhosis cannot be cured, portal hypertension can be managed. After treatment, patients should schedule regular ultrasounds to monitor the health of their liver. In addition, they should make healthy lifestyle changes, such as limiting alcohol, eating a well-rounded diet, and getting regular exercise. Next StepsIf you think you may be experiencing any symptoms of portal hypertension, it is important to get diagnosed immediately. We can quickly assess your health and will work with you to develop an appropriate treatment plan that fits your needs. Call us at (877) LIVER MD/ (877) 548-3763 or use our online form to schedule an appointment. Related
Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins coming from the stomach,
intestine, spleen, and pancreas merge into the portal vein, which then branches into smaller vessels and travels through the
liver. If the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. As a result, high pressure in the portal
system develops. This increased pressure in the portal vein may lead to the development of large, swollen veins (varices) within the esophagus, stomach, rectum, or umbilical area (belly button). Varices can rupture and bleed, resulting in potentially life-threatening complications. The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis
is scarring which accompanies the healing of liver injury caused by hepatitis, alcohol, or other less common causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver. Other causes of portal hypertension include
blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, a parasitic infection called schistosomiasis, and focal nodular hyperplasia, a disease seen in people infected with HIV, the virus that may lead to AIDS. Sometimes the cause is unknown. The onset of portal hypertension may not always be associated with specific symptoms that identify what is happening in the liver. But if you have liver disease that leads to cirrhosis, the chance of developing portal hypertension is
high. The main symptoms and complications of portal hypertension include:
How Is Portal Hypertension Diagnosed?Usually, doctors make the diagnosis of portal hypertension based on the presence of ascites or of dilated veins or varices as seen during a physical exam of the abdomen or the anus. Various lab tests, X-ray tests, and endoscopic exams may also be used. Unfortunately, most causes of portal hypertension cannot be treated. Instead, treatment focuses on
preventing or managing the complications, especially the bleeding from the varices. Diet, medications, endoscopic therapy, surgery, and radiology procedures all have a role in treating or preventing the complications. Other treatment depends on the severity of the symptoms and on how well your liver is functioning. Treatment may include: Maintaining good nutritional habits and keeping a healthy lifestyle may help you avoid portal hypertension. Some of the things you can do to improve the function of your liver include the following: If endoscopic therapy, drug therapy, and/or dietary changes don't successfully control variceal bleeding or ascites (a buildup of fluid in your belly), you may require one of the following procedures to reduce the pressure in these veins. Decompression procedures include: Before receiving either of these procedures for portal hypertension, the following tests may be performed to determine the extent and severity of your condition:
Before either the TIPS or DSRS procedure, your doctor may ask you to have other tests, which may include an electrocardiogram (EKG) (a test that records the electrical activity of your heart), chest X-ray, or additional blood tests. If your doctor thinks you will need additional blood products (such as plasma), they will be ordered at this time. What Happens During the TIPS Procedure?During the TIPS procedure, a radiologist makes a tunnel through the liver with a needle, connecting the portal vein to one of the hepatic veins (veins connected to the liver). A metal stent is placed in this tunnel to keep it open. The procedure reroutes blood flow in the liver and reduces pressure in abnormal veins, not only in the stomach and esophagus, but also in the bowel and the liver. This is not surgery. The radiologist performs the procedure within the vessels under X-ray guidance. The process lasts one to three hours, but you should expect to stay in the hospital overnight after the procedure. The TIPS procedure controls bleeding immediately in more than 90% of patients with portal hypertension. However, in about 20% of patients, the shunt may narrow, causing varices to re-bleed at a later time. Shunt narrowing or blockage can occur within the first year after the TIPS procedure. Follow-up ultrasound exams are performed frequently after the TIPS procedure to detect these complications. The signs of a blockage include increased ascites (accumulation of fluid in the abdomen) and re-bleeding. This condition can be treated by a radiologist who re-expands the shunt with a
balloon or repeats the procedure to place a new stent. Encephalopathy, or abnormal functioning of the brain, can occur with severe liver disease. Hepatic encephalopathy can become worse when blood flow to the liver is reduced by TIPS, which may result in toxic substances reaching the
brain without being metabolized first by the liver. This condition can be treated with medications, diet, or by making the shunt inaccessible. What Happens in the DSRS Procedure?The DSRS is a surgical procedure during which the vein from the spleen (called the splenic vein) is detached from the portal vein and attached to the left kidney (renal) vein. This surgery selectively reduces the pressure in the varices and controls the bleeding associated with portal hypertension. It is usually performed only in patients with good liver function. A general anesthetic is given before the surgery, which lasts about four hours. You should expect to stay in the hospital from seven to 10 days following surgery. How Successful Is the DSRS Surgery?The DSRS procedure provides good long-term control of bleeding in many people with portal hypertension. DSRS controls bleeding in more than 90% of patients, with the highest risk of any re-bleeding occurring in the first month. What Complications Are Associated With DSRS Surgery?Ascites, an accumulation of fluid in the abdomen, can occur with DSRS surgery. This can be treated with diuretics and by restricting sodium in the diet. Follow-up care for TIPS and DSRS can differ depending on where the procedures are performed. Here are basic guidelines: Attend all follow-up appointments as scheduled to ensure that the shunt is functioning properly. Be sure to follow the dietary recommendations that your health care providers give you. Attend
all follow-up appointments as scheduled to ensure that the shunt is functioning properly. Be sure to follow the dietary recommendations that your health care providers give you. Does cirrhosis and hepatitis cause intrahepatic portal hypertension?Hepatic Causes
Cirrhosis is the most common cause of portal hypertension, and chronic viral hepatitis C is the most common cause of cirrhosis in the United States. Alcohol-induced liver disease and cholestatic liver diseases are other common causes of cirrhosis.
What is portal hypertension with cirrhosis?Portal hypertension is elevated pressure in your portal venous system. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver.
Does hepatitis cause portal hypertension?p < 0.01). We conclude that portal hypertension in the course of acute hepatitis is related to the severity of liver damage and is a major factor in the development of ascites. Portal hypertension is mainly determined by intrahe- patic vascular space being reduced by the collapse of sinusoids.
What are the 3 categories of portal hypertension?With regard to the liver itself, causes of portal hypertension usually are classified as prehepatic, intrahepatic, and posthepatic.
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