What is portal hypertension?

Portal hypertension occurs when the portal vein that carries blood from the digestive organs to the liver is blocked, causing increased pressure. This increased pressure then causes varices to appear in the esophagus and abdomen to move around the obstructed veins.

While there are other causes of portal hypertension, the predominant associating factor is cirrhosis of the liver. The likelihood of developing portal hypertension after cirrhosis is much greater, since the scar tissue in the liver can block the flow of blood in the portal vein. Thrombosis of the portal or hepatic veins also can cause portal hypertension.

In addition to varices in the esophagus and abdomen, the symptoms of portal hypertension include dark-colored or bloody stool, gastrointestinal bleeding or bleeding from vomiting, reduced white blood cell count, build up of fluid in the abdomen, and confusion or forgetfulness. Other times, however, people with portal hypertension do not show any symptoms that indicate they have liver issues.

Portal hypertension is difficult to diagnose, and is usually found through a combination of lab tests, endoscopic examinations, and by studying imaging after diagnosing whole body hypertension. Treatment for early stage portal hypertension can include beta blockers, nitrates, propranolol or isosorbide to decrease the risk for bleeding. A hepatologist also may use endoscopic sclerotherapy or banding to seal the varices and prevent bleeding.

More severe forms of portal hypertension can be treated using a transjugular intrahepatic portosystemic shunt (TIPS) or a distal splenorenal shunt (DSRS) to bypass the liver and relieve pressure in the varices. TIPS is a shunt placed in the middle of the liver to bypass the portal vein, while DSRS relieves pressure by connecting the left kidney vein and splenic vain. Fluid in the abdomen can be removed using paracentesis. Advanced forms of portal hypertension may require a liver transplant or the removal of the varices through surgery if TIPS or DSRS are not possible.

A hepatologist may require people with portal hypertension to meet with a dietitian to create a diet plan specific to their needs. In general, a physician will recommend avoiding abusing alcohol, reducing or eliminating the use of certain prescription medications, and following a low-sodium diet.

References:

http://my.clevelandclinic.org/disorders/portal_hypertension/hic_portal_hypertension.aspx

http://www.ncbi.nlm.nih.gov/books/NBK6973/

http://vasculardisease.org/flyers/portal-hypertension-flyer.pdf