Portal hypertension is abnormally high blood pressure in
branches of the portal vein, the large vein that brings blood
from the intestine to the liver.
The portal vein receives blood from the entire
intestine and from the spleen, pancreas, and gallbladder. After
entering the liver, the vein divides into right and left
branches and then into tiny channels that run through the liver.
When blood leaves the liver, it flows back into the general
(systemic, or body-wide) circulation through the hepatic vein
(see Blood Vessel Disorders of the Liver : Introduction).
Two factors can increase blood pressure in the
portal blood vessels:
In Western countries, the most common cause of
portal hypertension is increased resistance to blood flow caused
by extensive scarring of the liver in cirrhosis, which is most
often due to chronic excessive alcohol intake.
Portal hypertension leads to the development of
new veins (called collateral vessels) that directly connect the
portal blood vessels to the general circulation, bypassing the
liver. Because of this bypass, substances (such as toxins) that
are normally removed from the blood by the liver can pass into
the general circulation. Collateral vessels develop at specific
places. The most important are located at the lower end of the
esophagus and at the upper part of the stomach. Here, the
vessels become engorged and full of twists and turns—that is,
they become varicose veins of the esophagus (esophageal varices)
or stomach (gastric varices). These engorged vessels are fragile
and prone to bleeding, sometimes seriously and occasionally with
fatal results. Other collateral vessels may develop on the
abdominal wall and at the rectum.
Portal hypertension often causes the spleen to
enlarge because the pressure interferes with blood flow from the
spleen into the portal blood vessels. Pressure in the portal
blood vessels may cause protein-containing (ascitic) fluid from
the surface of the liver and intestine to leak into the
abdominal cavity. This condition is called ascites.
Causes Portal Hypertension?
The most common cause of portal hypertension is
cirrhosis. Cirrhosis results from scarring of a liver injury
caused by hepatitis, alcohol abuse or other causes of liver
damage. In cirrhosis, scar tissue blocks the flow of blood
through the liver.
Other causes of portal hypertension include blood
clots in the portal vein, blockages of the veins that carry the
blood from the liver to the heart, and a parasitic infection
called schistosomiasis. Sometimes the cause is unknown.
What Are the Symptoms of Portal Hypertension?
The onset of portal hypertension may not always be associated
with specific symptoms that identify what is happening in the
liver. But if you have liver disease that leads to cirrhosis,
the chance of developing portal hypertension is high.
The main symptoms and complications of portal
Gastrointestinal bleeding: Black, tarry stools or blood in
the stools; or vomiting of blood due to the spontaneous
rupture and hemorrhage from varices.
accumulation of fluid in the abdomen).
Encephalopathy or confusion and forgetfulness caused by poor
levels of platelets, blood cells that help form blood clots,
or white blood cells, the cells that fight infection.
How Is Portal Hypertension Diagnosed?
The presence of significant portal hypertension
is implied by ascites, collaterals, or encephalopathy that
occurs in the presence of known chronic liver disease or
peripheral clinical evidence of chronic liver disease (firm
liver, enlarged spleen, spider angiomas, clubbing of fingers,
An ultrasound test can assess the presence of
collaterals (gastric varices or umbilical vein dilatation), the
width of the portal vein, and portal blood flow with deep
Doppler. Improvement in certain ultrasound techniques, including
the FM ultrasound, may allow assessment of the degree of hepatic
fibrosis. The CT scan can be used to assess the presence but not
the degree of portal hypertension.
demonstration of esophageal varices by endoscopy or barium
swallow implies portal hypertension, as do significant
intraabdominal collaterals at any site.
What Lifestyle Changes Should Be Made?
Maintaining good nutritional
habits and keeping a healthy lifestyle will help your liver
function properly. Some of the things you can do to improve the
function of your liver include the following:
Do not use alcohol or street
Do not take any
over-the-counter or prescription drugs without first
consulting your doctor or nurse. (Some medications may make
liver disease worse.)
Follow the dietary guidelines given to you by
your doctor or nurse, including: eating a low-sodium (salt)
diet. You will probably be required to consume no more than
2 grams of sodium per day. Reduced protein intake may be
required and only if confusion is a symptom. A dietitian can
create a meal plan for you.
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