When possible, the underlying disorder is treated.
In patients with esophagogastric varices that have not yet bled (ie, for primary prophylaxis), outcomes are similar with beta blocker therapy or endoscopic therapy.
For bleeding due to portal hypertensive gastropathy, beta blockers can be used to decrease portal pressure. A shunt should be considered if drugs are ineffective, but results may be less successful than for esophagogastric variceal bleeding.
Because it rarely causes clinical problems, hypersplenism requires no specific treatment, and splenectomy should be avoided.
Overview The portal vein carries blood from your stomach, pancreas, and other digestive organs to your liver. It differs from other veins, which all carry blood to your heart. The liver plays an important role in your circulation. It filters out toxins and other waste matter that the digestive organs have deposited in your bloodstream. When the blood pressure in the portal vein is too high, you have portal hypertension. Portal hypertension can be quite serious, though it’s treatable if diagnosed in time. It’s not always easy to diagnose, however. Typically, you become alerted to the condition when you start experiencing symptoms. Fast factArteries carry oxygen-rich blood from your heart to your organs, muscles, and other tissue. Veins carry blood back to your heart, except for the portal vein, which carries blood to your liver. Gastrointestinal bleeding is often the first sign of portal hypertension. Black, tarry stools can be a sign of gastrointestinal bleeding. You may also actually see blood in your stools. Another symptom is ascites, which is a buildup of fluid in your belly. You may notice that your belly is getting bigger because of ascites. The condition can also cause cramps, bloating, and shortness of breath. As well, becoming forgetful or confused could be a result of a circulation problem related to your liver. The main cause of portal hypertension is cirrhosis. This is a scarring of the liver. It can result from several conditions such as hepatitis (an inflammatory disease) or alcohol abuse. Autoimmune diseases of the liver such as autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cholangitis also are causes of cirrhosis and portal hypertension. Whenever your liver is harmed, it attempts to heal itself. This causes scar tissue to form. Too much scarring makes it harder for your liver to do its job. Other cirrhosis causes include:
Cirrhosis can cause the normally smooth inner walls of the portal vein to become irregular. This can increase resistance to blood flow. As a result, blood pressure in the portal vein increases. A blood clot can also form in the portal vein. This can increase the pressure of blood flow against the walls of the blood vessel. People at an increased risk for cirrhosis are at an increased risk for portal hypertension. If you have a long history of alcohol abuse, you face a higher risk of cirrhosis. You’re at a higher risk of hepatitis if any of the following apply to you:
Portal hypertension is difficult to diagnose if symptoms aren’t obvious. Screenings such as a doppler ultrasound are helpful. An ultrasound can reveal the condition of the portal vein and how blood is flowing through it. If an ultrasound is inconclusive, a CT scan may be helpful. Another screening method that’s becoming more widely used is a measurement of the elasticity of your liver and surrounding tissue. Elastography measures how tissue responds when it’s pushed or probed. Poor elasticity suggests the presence of disease. If gastrointestinal bleeding has occurred, you’ll likely undergo an endoscopic examination. This involves the use of a thin, flexible device with a camera at one end that allows your doctor to see internal organs. Portal vein blood pressure can be determined by inserting a catheter fitted with a blood pressure monitor into a vein in your liver and taking a measurement. Lifestyle changes such as these can help treat portal hypertension:
Medications such as beta-blockers are also important to help reduce your blood pressure and relax your blood vessels. Other medications, such as propranolol and isosorbide, may help lower the pressure in the portal vein, too. They can also reduce the risk of more internal bleeding. If you’re experiencing ascites, your doctor may prescribe a diuretic to help reduce fluid levels in your body. Sodium must also be severely restricted to help reduce fluid retention. A treatment called sclerotherapy or banding uses a solution that can help stop bleeding in the blood vessels of your liver. Banding involves the placement of rubber bands to block unhealthy blood flow to enlarged veins, known as varices or varicose veins, in your digestive system. Another increasingly popular therapy is called nonsurgical transjugular intrahepatic portal-systemic shunt (TIPSS). This therapy helps control acute bleeding. It creates new pathways for blood to flow from the portal vein into other blood vessels. One of the more common complications associated with portal hypertension is portal hypertensive gastropathy. The condition affects the mucus membrane of your stomach and enlarges blood vessels. The pathways created between blood vessels in TIPSS can become blocked. This can lead to further bleeding. If liver problems continue, you could have further cognitive problems as well. You can’t reverse damage caused by cirrhosis, but you can treat portal hypertension. It may take a combination of a healthy lifestyle, medications, and interventions. Follow-up ultrasounds will be necessary to monitor the health of your liver and the results of a TIPSS procedure. It will be up to you to avoid alcohol and live a healthier life if you have portal hypertension. You’ll also need to follow your doctor’s instructions. This goes for medications and follow-up appointments. Drink alcohol moderately, if at all. And take steps to avoid hepatitis. Talk with your doctor about hepatitis vaccinations and whether you should have them. You may also want to be screened for hepatitis if you’re in an at-risk group. Portal hypertension is caused by declining liver health, but you may be able to avoid this challenging vascular disease through healthy lifestyle choices.
ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS
Portal hypertension is high blood pressure in the portal vein. The portal vein is located in your belly (abdomen). It gets blood from your digestive organs (large and small intestines, stomach, pancreas, spleen) and carries it to the liver. The liver cleans and filters waste from the blood. The blood then travels to the heart and into general circulation for your body to use. With liver disease, blood flow can be blocked through the liver. This raises the pressure in the portal vein. When you have portal hypertension, this increased pressure makes it harder for blood to flow normally through the portal vein. Blood is redirected away from (bypasses) the liver. The body forms new vessels for the blood to flow through, especially to the esophagus and stomach. These veins become enlarged and twisted. They swell up and may burst (rupture) under the added pressure. Treatment is needed to prevent them from bursting and bleeding. If bleeding occurs, it can be fatal. Other areas of the body where blood vessels may form and enlarge can include the belly or rectum.
These are the most common causes of portal hypertension:
In developing countries, one of the most common reasons is an infection called schistosomiasis.
At first, you may have no symptoms. They may not develop until there are complications. Having a higher than normal pressure inside the portal vein can lead to a number of related symptoms. These include:
Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. The provider will do a physical exam. Unfortunately, healthcare providers can’t measure high blood pressure in the portal vein with a cuff like they can for regular high blood pressure. If you are at risk for or already have cirrhosis, you may need several tests:
Healthcare providers treat portal hypertension in several ways:
The possible complications of portal hypertension are:
Portal hypertension is a dangerous condition with severe, life-threatening complications. Call your healthcare provider right away if you notice any of these symptoms:
Key points about portal hypertension
Tips to help you get the most from a visit to your healthcare provider:
Medical Reviewer: Jen Lehrer MD Medical Reviewer: Raymond Turley Jr PA-C Medical Reviewer: L Renee Watson MSN RN © 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. |