Portal hypertension is an increase in the pressure within the
portal vein (the vein that carries blood from the digestive organs to the
liver). The increase in pressure is caused by a blockage in the blood flow
through the liver.
Increased pressure in the portal vein causes large veins (varices)
to develop across the esophagus and stomach to bypass the blockage. The varices
become fragile and can bleed easily.
What causes portal hypertension?
The most common cause of portal hypertension is cirrhosis, or scarring of
the liver. Cirrhosis results from the healing of a liver injury caused by
hepatitis, alcohol abuse, or other causes of liver damage. In cirrhosis, the
scar tissue blocks the flow of blood through the liver and slows its processing
functions.
Portal hypertension may also be caused by thrombosis, or
clotting in the portal vein.
What are the symptoms of portal hypertension?
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:
- Gastrointestinal bleeding; black, tarry stools or blood in the stools;
or vomiting of blood due to the spontaneous rupture and hemorrhage from
varices.
- Ascites, an accumulation of fluid in the abdomen.
- Encephalopathy, confusion and forgetfulness caused by poor liver
function and the diversion of blood flow away from your liver.
- Reduced levels of platelets or decreased white blood cell count.
How is portal hypertension diagnosed?
Endoscopic examination, X-ray studies, and lab tests can confirm that you
have variceal bleeding. Further treatment is necessary to reduce the risk of
recurrent bleeding.
What are the treatment options for portal hypertension?
The effects of portal hypertension can be managed through diet, medications,
endoscopic therapy, surgery, or radiology. Once the bleeding episode has been
stabilized, treatment options are prescribed based on the severity of the
symptoms and on how well your liver is functioning.
First level of treatment
When you are first diagnosed with variceal bleeding, you may be treated with
endoscopic therapy or medications. Dietary and lifestyle changes are also
important.
Endoscopic therapy consists of either sclerotherapy or banding.
Sclerotherapy is a procedure performed by a gastroenterologist in which a
solution is injected into the bleeding varices to stop or control the risk of
bleeding. Banding is a procedure in which a gastroenterologist uses rubber bands
to block the blood supply to each varix.