Portal hypertension

Portal Hypertension

Overview

Portal hypertension is increased blood pressure in the portal vein, the main blood vessel that carries blood from the digestive system and spleen to the liver. The increase in pressure is usually due to an obstruction to the blood flow, either due to liver cirrhosis or a blockage in the portal vein. The increased pressure causes varices (high-pressure engorgement of delicate veins surrounding the food pipe and intestines), which are at risk of rupturing.

Signs and symptoms

The main symptoms of portal hypertension are gastrointestinal bleeding which can present as blood in the stools or vomit. The patient usually also experiences fluid build-up in the belly, with associated bloating, cramping and shortness of breath. They may also feel disoriented or confused as a result of encephalopathy. The increased blood pressure can cause distension of the spleen, which may present with left-sided abdominal discomfort.

Causes and risk factors

The most common cause of portal hypertension is cirrhosis. The scarring in the liver causes blockages in the portal vein, leading to increased blood pressure and varices. People with hepatitis, chronic alcoholism and cystic fibrosis are at increased risk for cirrhosis and portal hypertension. Portal hypertension could also be caused by blockage of the portal vein by blood clots, parasitic infections, injury or rare congenital (present at birth) problems.

Diagnosis

Portal hypertension is diagnosed based on patient medical history, physical exam, ultrasound and CT scan, and an endoscopy. Sometimes specialised procedures in the cath-lab may be necessary to investigate portal hypertension.

Treatment

Portal hypertension is treated with medications such as beta-blockers to reduce blood pressure and decrease the chances of internal bleeding. If there is fluid build-up in the belly, salt intake may be restricted, and diuretics may be prescribed. In case of bleeding, the doctor may need to perform endoscopic procedures such as sclerotherapy or banding to control and prevent bleeding. Some patients with severe portal hypertension may require surgery in the form of surgical shunt procedures. Portal hypertension secondary to cirrhosis may need liver transplantation.

Prevention

As cirrhosis is the most common cause of portal hypertension, avoid alcohol and drug abuse, hepatitis and vascular disease to prevent cirrhosis. Eat a balanced diet, and maintain a healthy weight.

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