- Portal Hypertension Center
- High Blood Pressure Slideshow Pictures
- Take the Salt Quiz!
- Lowering Blood Pressure Exercise Tips Pictures
- Patient Comments: Portal Hypertension - Cause
- Patient Comments: Portal Hypertension - Treatment
- Find a local Gastroenterologist in your town
- What is portal hypertension?
- What causes portal hypertension?
- What are the symptoms of portal hypertension?
- How is the diagnosis of portal hypertension made?
- What is the treatment for portal hypertension?
- What are the complications of portal hypertension?
- Can portal hypertension be prevented?
- What is the prognosis for portal hypertension?
What is portal hypertension?
The liver serves many purposes within the body from making carbohydrates, proteins and fats to synthesizing bile to help digest found. Because of this, the liver requires a significant blood supply. As opposed to other organs in the body, the majority of this blood supply (75%) comes from the venous system through the portal system. Blood vessels from the stomach, small intestine, pancreas, and spleen converge and form the portal vein delivering nutrients and chemical building blocks to the liver. Once in the liver, the portal vein and hepatic artery (which accounts for 25% of the liver's blood supply) come together to form sinusoids, spaces where the blood is filtered. From there, blood makes its way to the Vena cava, the largest vein in the body to return to the heart.
Portal hypertension describes elevated pressure within the portal system, including the portal vein and the tributary veins that drain into it. The pressure within the portal system is not normally measured and is not an issue except if an illness or disease occurs that makes it difficult for blood to flow through the liver tissue. This damming effect increases pressure within the portal venous system and causes potential problems with liver function. It is the onset of symptoms associated with liver disease that might cause the health care professional to look for the presence of portal hypertension.
What causes portal hypertension?
Portal hypertension occurs when there is an obstruction of blood flow through the liver and pressure rises within the portal vein. This obstruction can be intrahepatic (intra=within +hepatic=liver), pre-hepatic (pre=before) or post- hepatic (post=after).
Intrahepatic causes of portal hypertension
Intrahepatic causes of portal hypertension include cirrhosis and hepatic fibrosis or scarring. A wide variety of illnesses are implicated as the cause of portal hypertension. Examples include the following:
- Alcohol abuse,
- Hepatitis B and C infections,
- Fatty liver (NASH, non-alcoholic steatohepatitis),
- Wilson's disease, an abnormality of copper metabolism,
- Hemochromatosis (iron overload), excess iron buildup
- Cystic fibrosis
- Primary sclerosing cholangitis, a hardening of the bile ducts
- Biliary atresia, poorly formed bile ducts
- Parasite infections such as schistosomiasis
Pre-hepatic causes of portal hypertension
- Portal vein thrombosis or blood clots within the portal vein
- Congenital portal vein atresia or failure of the portal vein to develop
Post-hepatic causes of portal hypertension
Post-hepatic causes are due to obstruction of blood flow from the liver to the heart and can include:
- Hepatic vein thrombosis
- Inferior Vena cava thrombosis
- Restrictive pericarditis, where the lining of the heart stiffens and does not allow the heart to relax and expand when blood returns to it. Causes may include tuberculosis, fungal infections, tumors, connective tissue disorders (for example, scleroderma), and complications from radiation therapy.
What are the symptoms of portal hypertension?
When blood cannot easily flow through the liver architecture (from portal vein to sinusoids to hepatic vein to Vena cava), it tries to bypass the portal system, using the systemic venous system to return to the heart. Symptoms of portal hypertension are due to the complications of decreased blood flow through the liver, and from increased pressure within the veins where blood is shunted.
- Varices describe enlarged veins. Blood meant for the portal system, is diverted to and gathers in other veins as it makes its way to the heart. These varices can occur in the esophagus, stomach, around the umbilicus and in the anus and rectum.
- Esophageal and gastric varices are at risk for life threatening bleeding and can have signs and symptoms with vomiting blood and blood in the stool. Melena describes black, tarry stool that is the result of upper gastrointestinal bleeding.
- Ascites describes abnormal fluid collection within the peritoneum (the sac that contains the intestines within the abdominal cavity) and is due to a combination of factors, including increased pressure in the portal system and decrease protein in the body. The liver produces the body's protein and portal hypertension and the underlying liver disease decreases its ability to function.
- Hepatic encephalopathy is another complication of liver disease, causing confusion and lethargy due to the buildup of waste products and the inability of the liver to adequately filter them.
- Splenomegaly or enlargement of the spleen. Because of portal hypertension, blood backs up, and this also can trap the components of blood (red blood cells, white blood cells and platelets) within the spleen causing anemia and thrombocytopenia (low platelet count in the bloodstream).
- Decreased white blood cell counts increase the risk of general infection. Spontaneous bacterial peritonitis is an infection within the peritoneal sac within the abdomen, and is seen as a consequence of long standing portal hypertension.
How is the diagnosis of portal hypertension made?
Portal hypertension usually is diagnosed well after the process has begun in the body, and only after a complication occurs. When a patient develops ascites or has gastrointestinal bleeding, the health care professional will look for potential causes, including portal hypertension.
Once the diagnosis is a possibility, it can be confirmed by blood tests, X-rays, CT or MRI and endoscopy. Pressures within the portal vein are not routinely measured except in specific situations (see TIPS procedure)
What is the treatment for portal hypertension?
Treatment for portal hypertension is often directed at preventing complications. This includes treating the underlying cause and avoidance of alcohol. Because of the risk of further liver damage, over-the-counter medications that contain acetaminophen (Tylenol, Panadol, etc.) should also be avoided.
Dietary restrictions include limiting salt to prevent further ascites fluid accumulation. Protein restriction may also be indicated, since increased protein load can overwhelm the liver's ability to synthesize it and may lead to hepatic encephalopathy.
Endoscopy may be required to band or tie off varices in the esophagus to prevent catastrophic and life threatening bleeding.
A TIPS procedure (transjugular intrahepatic portosystemic shunt) may be an option to decrease the pressure within the portal system. An interventional radiologist attempts to place a tube that connects the portal vein with the hepatic vein. This may decrease the pressure within the liver and may also reduce pressure within the veins of the stomach and esophagus, hopefully decreasing the risk of bleeding.
If portal hypertension and liver dysfunction become bad enough, liver transplantation may be necessary.
What are the complications of portal hypertension?
The complications of portal hypertension are the complications of liver failure. These include gastrointestinal bleeding from varices, ascites and hepatic encephalopathy. Splenomegaly can also cause anemia , low white blood cell counts, and low platelet counts.
Can portal hypertension be prevented?
Some liver diseases due to inborn errors of metabolism like copper and iron cannot be prevented. The same can be said with congenital anatomy problems. However, when liver disease is due to alcohol and drug abuse, prevention is a real possibility. Chronic alcoholism can lead to cirrhosis and portal hypertension. IV drug abuse can be the cause of hepatitis B and C, resulting in cirrhosis.
What is the prognosis for portal hypertension?
Portal hypertension is a complication of an underlying liver disease. It is a disease that can be controlled but requires patients to be compliant with dietary restrictions and to abstain from alcohol and drugs. Survival rates can be quite high as long as some liver function is maintained. The worse the liver function, the worse the prognosis
Health Solutions From Our Sponsors
Garcia-Tsao G, Lim JK; Management and treatment of patients with cirrhosis and portal hypertension: Am J Gastroenterol. 2009 Jul;104(7):1802-29.
Ponziani FR, Zocco MA, Campanale C, et al; Portal vein thrombosis: insight into physiopathology, diagnosis, and treatment. World J Gastroenterol. 2010 Jan 14;16(2):143-55.
Portal Hypertension - Cause
What was the cause of your portal hypertension?Post View 2 Comments
Portal Hypertension - Symptoms
What were the symptoms of your portal hypertension?Post
Portal Hypertension - Treatment
What was the treatment of your portal hypertension?Post View 1 Comment
Portal Hypertension - Complications
What complications have you experienced with portal hypertension?Post
Top Portal Hypertension Related Articles
AscitesAscites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
Blood ClotsBlood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for causes of blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history.
Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
CirrhosisCirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.
Symptoms include yellowing of the skin (jaundice), itching, and fatigue.
The prognosis is good for some people with cirrhosis of the liver, and the survival can be up to 12 years; however the life expectancy is about 6 months to 2 years for people with severe cirrhosis with major complications.
Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
Enlarged SpleenAn enlarged spleen or splenomegaly, is generally caused by other diseases or conditions such as infections, cancers, blood disorders, or decreased blood flow. Symptoms of an enlarged spleen are often unnoticed. A feeling of fullness after eating a small amount of food and not being able to eat large meals may be a symptom of an enlarged spleen. Treatment for an enlarged spleen depends upon the cause.
Hemorrhoids (piles) are swollen veins in the rectum and anus. Causes include pregnancy, obesity, diarrhea, low-fiber diet, and prolonged sitting on the toilet. Treatment varies depending upon the severity of the hemorrhoids. Some treatment options include over-the-counter creams and suppositories, stool softeners, warm sitz baths, and hemorrhoidectomies.
Internal BleedingInternal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases, for example, gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause and may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Liver Disease QuizWhat is liver disease? Take the Liver Disease Quiz and test your knowledge about this organ and its function.
Liver PictureFront View of the Liver. The liver is a large, meaty organ that sits on the right side of the belly. See a picture of the Liver and learn more about the health topic.
Transjugular Intrahepatic Portosystemic ShuntTransjugular intrahepatic portosystemic shunt or (TIPS) is a procedure in which a shunt is placed between the portal vein and the hepatic vein. TIPS is primarily used in individuals who have cirrhosis of the liver. Complications of cirrhosis may result in portal hypertension. There are several types of portosystemic shunts. Two complications of the TIPS procedure include hepatic encephalopathy and/or heart failure.
UltrasoundUltrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as:
- heart valve irregularities,
- carotid artery disease,
- heart disease,
- kidney stones,
- liver disease,
- diseases of the female reproductive, and
- diseases of the male reproductive organs.