Portal hypertension is a serious condition that can lead to esophageal, stomach or rectal varicose veins. If not diagnosed in time, portal hypertension can rupture and result in life-threatening hemorrhages. Another serious complication of portal hypertension can be permanent brain damage. What are the causes and symptoms of portal hypertension? What is the treatment?
Portal hypertensionis a condition in which there is an increase in pressure above 12 mm Hg in the portal vein.
Normally the portal vein carries blood to the liver from the abdominal area (stomach, intestines, spleen, pancreas). In the liver, the blood is cleansed of unwanted elements and then directed towards the heart.
As a result of the increase in pressure in the portal vein, the blood, instead of getting to the liver, regresses and goes to, among others, into the esophageal and gastric veins (the so-called collateral circulation is produced). The reverse outflow of blood causes the widening of these veins, worsening at the same time the function of the valve mechanism and the formation of varicose veins, e.g. stomach and esophagus. In some cases, rupture and life-threatening hemorrhage may occur.
Due to the fact that the blood has not been cleansed of harmful substances by the liver, encephalopathy can also develop, i.e. brain damage due to the action of toxins that appear in the circulatory system.
Portal hypertension - causes
The most common (even 90% of cases) cause of portal vein hypertension is cirrhosis of the liver, caused by hepatitis B or hepatitis C, alcohol or general diseases.
Portal hypertension can also be a complication of portal vein, splenic, mesenteric and hepatic vein thrombosis (Buddha-Chiari syndrome).
Other causes of portal hypertension include heart disease, which obstructs the outflow of blood from the inferior vena cava (e.g. constrictive pericarditis), and neoplastic diseases.
Portal hypertension - symptoms
- abdominal varicose veins. The widening of the veins around the navel (called Medusa's head), characteristic (though rare) of portal hypertension, may occur as a result of blood flowing back through the umbilical vein
- spleen enlargement
- puffiness
- ascites
- jaundice
Varicose haemorrhage and encephalopathy - serious complications of portal hypertension
Haemorrhage from esophageal and gastric varices is the most serious complication of portal hypertension. The hemorrhage can be very massive, rapidly losing blood, which can lead to shock and death.
Encephalopathy is also a serious complication of portal hypertension, which can lead to permanent brain damage.
Portal hypertension - diagnosis
In the case of portal hypertension:
- ultrasound of the abdominal cavity
- Doppler ultrasound
- gastrointestinal endoscopy
Portal hypertension - treatment
The therapy consists in treating the causes of portal hypertension (most often liver cirrhosis), its symptoms, and preventing complications.
The doctor may decide, for example, to transfuse fresh frozen plasma or to perform peritoneal punctures to decompress ascites.
In the prophylaxis of bleeding from esophageal varices, some drugs blocking adrenergic receptors are used.
In the treatment of already existing varicose veins, e.g. of the stomach, ligatures or endo-loops, sclerotherapy, B-RTO or retrograde obliteration of gastric varicose veins are used.