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Portal Hypertension

more about Portal Hypertension

Portal Vein Hypertension

  • Portal hypertension is a condition in which there is an increase in the pressure within the portal vein.
  • The portal vein is the main vein that feeds blood into the liver.  It is what takes most of the blood away from the intestines and spleen and delivers it to the liver.  The liver then cleans the blood and sends it back to the heart.  In people with Portal Vein Hypertension , the pressure within the vein builds up and causes problems.  Portal hypertension can be due to numerous causes.  In the United States, the most common cause is Cirrhosis due to heavy alcohol abuse.  Treatment and the long-term outlook for this disease depend on the cause of the problem.

  • Most cases are not diagnosed until the condition has been present for some time.
  • Basically, the increased pressure in the portal vein causes a back up of blood and fluid.
  • This can lead to problems such as Ascites (fluid build-up within the stomach), Esophageal Varices (in which the blood vessels around the esophagus get big and may bleed), gastric varices (in which the blood vessels around the stomach get big and may bleed), and splenomegaly (enlarged spleen).
  • Portal Vein Hypertension does not, in itself, cause symptoms.  Most often, symptoms are due to the complications (listed above) that occur because of this condition.  The person may, therefore, have an increase in the size of the abdomen, may vomit blood, may have red or black stools, or may have a fullness or mass in the upper left part of the stomach.

  • Any process that either blocks the flow of blood through the portal vein, through the liver, or blood drainage out of the liver can lead to Portal Vein Hypertension .
  • The most common cause of portal hypertension in the Unites States is alcoholic Cirrhosis.  Basically, the liver is destroyed in people who have abused alcohol for long periods of time.  The destruction of the liver causes problems with blood flow.  This then leads to portal hypertension.
  • Anything that causes Cirrhosis can lead to Portal Vein Hypertension . This includes alcohol, hepatitis, hemochromatosis, Wilson's Disease, alpha one antitrypsin deficiency, primary biliary Cirrhosis, secondary biliary obstruction, Congestive Heart Failure, constrictive Pericarditis, etc.
  • Other causes of his condition include portal vein obstruction (due to a blood clot or tumor), splenic vein obstruction, schistosomiasis (an infection that can go into the liver), noncirrhotic intrahepatic portal sclerosis, or an arterial-portal vein fistula (in which blood from an artery directly goes into the portal vein).
  • The disease can also be due to conditions that block the hepatic vein (which drains blood out of the liver).  There are many causes for this condition including blood clots in the hepatic vein, tumors, heart failure, etc.

  • The diagnosis is usually made when the person has one of the complications of this condition.  When an individual comes in with fluid in the stomach or has bleeding from the stomach, blood tests and other studies will be done.
  • During this process, the person may have a CT scan or Ultrasound that may show an enlarged portal vein, fluid in the stomach, or an enlarged spleen.
  • Angiogram -- dye is injected into the portal vein to see if there is any problem with the blood flow.
  • However, most of the time, the diagnosis is based on the symptoms and complications of these conditions.
  • Once the diagnosis is made, other tests may need to be done to find out why the condition is present.  The specific blood tests necessary will depend on the individual's risk factors and medical history.  For example, if a person has Cirrhosis of the liver, then tests to find out why the condition is present will be needed.
  • If there is a blood clot, then the person will need additional testing to see why the clot developed.
  • In this way, the tests that are needed vary from patient to patient, and depend on the underlying disease that is causing the Portal Vein Hypertension .  The most appropriate tests will need to be discussed with your doctor.

  • There are no specific risk factors for this condition
  • Rather, there are risk factors that may contribute to development of one of the underlying causes.  For example, chronic excessive alcohol intake can lead to Cirrhosis.  Unprotected sex, intravenous drug use, and blood transfusions all increase the risk of developing hepatitis.  This in turn could lead to Cirrhosis and cause portal hypertension.
  • Some of the diseases mentioned above are hereditary.  Therefore, having the gene that causes the disease is a risk factor.
  • Conditions or diseases that increase the chance of developing blood clots also increase the risk of developing portal hypertension.

  • The first thing to consider in the treatment of this condition is the underlying cause of the problem. If it is due to something correctable, then that problem needs to be treated.
  • For example, if there is a tumor then it may need to be removed. If there is an infection, it should be treated. If there is a blockage of the splenic vein, then the spleen may need to be removed. If there is a problem that is causing the formation of blood clots, then the person may need to be on blood thinners.
  • Treatment is aimed at reducing complications. If there is bleeding, then the bleeding can be controlled with medications and other procedures. If there is fluid build-up within the stomach, then the person will need to limit their salt intake and will need to take water pills to help increase urine output.
  • However, many times the condition that is causing the problem cannot be treated or cured. For example, Cirrhosis is usually not curable. In cases where the underlying condition is not treatable, the person may have to have a procedure called portosystemic shunting.
  • Portosystemic shunting is where the blood from the portal vein is diverted around the liver and back into the heart. By doing this, the pressure within the portal vein is reduced and, hopefully, the complications will also be reduced.
  • There are many ways to do this shunting procedure.
    1. One way is through a procedure called TIPS (which stands for transjugular intrahepatic portosystemic shunt).  This procedure is the preferred method now used for forming a shunt, where a small incision is made in the neck.  Through this small cut, a stent (which is a wire mesh-like tubing) is placed in the liver and connects the hepatic and portal vein.  Blood then essentially passes through the liver without any resistance.  However, this procedure also has potential complications including changes in the person's mental capabilities, infections, and narrowing or blockage of the shunt.  However, it is a less invasive surgery compared to traditional methods and, therefore, is much less risky.
    2. The other way to make a shunt is the traditional method in which the person undergoes a regular operation, and a connection is created so that blood bypasses the liver.

  • Complications of this condition have been discussed above and include:
    1. Bleeding from the stomach or esophagus
    2. Fluid build-up within the stomach
    3. Enlarged spleen
    4. Abnormalities showing in the liver tests

  • If you suspect this condition, you will need to go to your doctor for a full examination and evaluation.

  • There is not much that can be done to prevent this condition.  The main thing is to avoid risky behaviors that increase the chances of developing one of the underlying conditions.
  • For example, avoid a heavy intake of alcohol.
  • Also, avoid behaviors such as unprotected sex, intravenous drug use, application of tattoos, etc.  All of these will increase the risk of contracting hepatitis.

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