Portal hypertension refers to the increase in the pressure within the portal vein, which carries blood from your digestive organs to your liver. It is commonly caused due to scarring of the liver, also called, liver cirrhosis. Other causes may include a blood clot (thrombus) which blocks the blood flow across the liver.
What are the Symptoms of Portal Hypertension?
The common signs and symptoms of portal hypertension may include:
- Blood in the stools or tarry stools
- Vomiting of blood
- Encephalopathy: confusion and forgetfulness due to abnormal functioning of the brain
- Ascites: fluid accumulation in the abdomen
- Reduced levels of platelets or white blood cells
What are the Causes of Portal Hypertension?
Portal hypertension may be caused due to:
- Liver cirrhosis
- Chronic alcohol consumption
- Thrombosis, or a blood clot that develops in the portal vein
What are the Complications of Portal Hypertension?
Portal hypertension causes enlargement of the veins supplying the digestive organs, namely the stomach and the esophagus. The enlarged veins, also called varices, become weak and can be ruptured easily. This causes internal bleeding, also called variceal bleeding.
How is Portal Hypertension Diagnosed?
Your doctor will review your medical history and clinical symptoms. Portal hypertension can be diagnosed with the help of:
- Physical examination
- Imaging studies such as X-ray and ultrasound
- Laboratory tests that include your blood test and stool sample analysis
What are the Treatments Available for Portal Hypertension?
Portal hypertension can be controlled through proper diet, blood pressure-lowering medications, and making healthy lifestyle changes. For severe symptoms caused due to variceal bleeding, you may be recommended:
- Endoscopic therapy
- Interventional radiology treatment
Endoscopic therapy is usually performed by a trained gastroenterologist. It includes the following:
Sclerotherapy: This procedure involves injecting a special solution into the bleeding varices to control or stop bleeding.
Banding: In this procedure, rubber bands are used to block the blood supply to the enlarged vein.
Surgery is recommended if you do not obtain relief following endoscopic therapy. Surgical procedures are aimed at reducing the elevated pressure in the enlarged veins.
Distal splenorenal shunt (DSRS): In this procedure, the splenic vein is connected to your left kidney vein to reduce pressure in your varices and control bleeding.
Transjugular intrahepatic portosystemic shunt (TIPS): An interventional radiology procedure in which a tiny tube called a stent is placed in the middle of the liver.
Other Treatment Procedures for Portal Hypertension
- Devascularization, a surgical procedure in which the bleeding varices are removed. It is recommended when TIPS or a surgical shunt is unsuitable or was unsuccessful in controlling the bleeding.
- Paracentesis: The direct removal of the fluid with a needle that has accumulated in the abdomen called ascites.
- Liver transplant is recommended for end-stage liver disease.
Post-Operative Care after Portal Hypertension Surgery
After your surgery, your surgeon will schedule your regular checkups.
- Ten days after your hospital discharge date, you will be required to meet with your surgeon or hepatologist and undergo lab tests to evaluate your progress.
- Again, at the end of 6 weeks, 3 months, 6 months, and 12 months after your surgery, you will be required to visit your healthcare provider to undergo lab tests, angiogram and ultrasound to monitor your progress and detect any abnormality.
What are the Risks and Complications of Portal Hypertension Surgery?
The risks associated with portal hypertension surgery include:
- Shunt narrowing or occlusion (blockage)
- Fluid accumulation (increased ascites)
- Recurrent bleeding