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:
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.
Usually, an individual suffering from portal hypertension does not exhibit any symptoms until complications develop.
Some of these symptoms include:
Some of the common causes of portal hypertension include:
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 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:
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.
Portal hypertension treatment may cause certain complications, including encephalopathy and ascites. Check with your doctor for more information.
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