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Portal Hypertension

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Portal Hypertension
Portal Hypertension

Portal hypertension refers to elevated blood pressure in the portal venous system — a vital vein that connects four organs (stomach, intestine, spleen, and pancreas) to the liver. It is commonly caused by an obstruction in the liver, intrinsic liver disease, or any other structural changes which may lead to an increased hepatic resistance or elevated portal venous flow. This resistance results in amplified pressure, causing dilations or varices of the veins.

Pressure in the portal system predominately depends on:

  • Blood inflow from the portal vein
  • Hepatic resistance to blood outflow

Typically, the pressure of the portal vein ranges between 5 mm Hg and 10 mm Hg higher than the hepatic vein-free pressure. Pressures exceeding these limits may result in portal hypertension.

What Are the Symptoms and Causes of Portal Hypertension?

Usually, an individual suffering from portal hypertension does not exhibit any symptoms until complications develop.

Some of these symptoms include:

  • Ascites (or feeling bloated due to excess fluid)
  • Vomiting
  • Dark-Colour Stools
  • Jaundice
  • Coagulopathy
  • Hepatic Encephalopathy (Mental confusion)
  • Low Systolic Blood Pressure (Between 100–110 Mm Hg)
  • Dilated Abdominal Wall Veins
  • Low Platelet Counts

Some of the common causes of portal hypertension include:

  • Portal Vein Thrombosis
  • Liver Infection
  • Budd-Chiari Syndrome
If you are experiencing any of the aforementioned symptoms, book an appointment with our specialists for a detailed assessment today.
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What Are the Diagnostic & Treatment Options?

The doctor will ask the patient about their medical history and symptoms, including questions related to their family members. The doctor will also perform a physical examination.

In cases where the disease diagnosis is not straightforward, a doctor may recommend performing some invasive examination or testing to gauge the vein pressure or assess liver tissues to have a better understanding of the problem.

Portal Hypertension Treatment

Portal hypertension is generally treated by managing the symptoms of the disease. One of the most common symptoms of portal hypertension is bleeding, which may cause severe complications if it is not quickly treated.

Three frequently recommended options for treating portal hypertension include:

  • Following a Healthy Diet & Lifestyle:
    Blood pressure can be better controlled by reducing salt intake. Similarly, minimising protein intake can minimise the severity of portal hypertension. Avoiding alcohol, which damages the liver, also helps manage portal hypertension.
  • Medical Therapy:
    Medications may be required to manage the underlying liver illness, symptoms arising from the higher pressure (for example the use of diuretics to reduce water retention in the abdomen), and reduce the pressure of the portal venous system.
  • Radiology & Surgical procedures:
    These two methods are considered the first-line treatment to reduce and prevent bleeding resulting from portal hypertension, including sclerotherapy and banding.

What if Sclerotherapy and Banding Fail to Treat Portal Hypertension?

If the aforementioned procedures and medications fail to manage bleeding, other radiological and surgical procedures are recommended, viz. TIPS, BRTO and DSRS.

Transjugular Intrahepatic Portosystemic Shunt (TIPS): This method aims at decreasing portal hypertension and blood clotting by inserting a stent (or tube-like device) in the liver.

Ballon retrograde transvenous obliteration (BRTO): This method involves cannulating an outflow vein, traversing it untill the target varix is identified and using sclerosants, gel foam or coils to occlude the offending vessels.

Distal Splenorenal Shunt (DSRS): This surgical procedure controls bleeding and pressure by creating a channel-like route between the left kidney and the spleen. Thus, DSRS decreases the portal circulating pressure.

Medications: Along with the previously mentioned procedures, your doctor may further prescribe some medications for portal hypertension treatment.

What Are the Complications Associated With Portal Hypertension Treatment?

Portal hypertension treatment may cause certain complications, including encephalopathy and ascites. Check with your doctor for more information.

As portal hypertension is sometimes associated with cirrhosis of the liver and may also cause bleeding and other symptoms (such as ascites), it is important to get suitable guidance from a qualified doctor.
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