Portal Hypertension

In medicine Portal hypertension is high blood pressure in the portal vein and its tributaries. Portal hypertension is caused by obstruction of the blood flow into, through or out of the liver.

It is often defined as a portal pressure gradient (the difference in pressure between the portal vein and the hepatic veins) of 10 mmHg or greater.

The portal vein is the large vein through which oxygen-depleted blood from the stomach, the intestines, the spleen the gallbladder and the pancreas flows to the liver. The portal vein is not a true vein, because it conducts blood to capillary beds in the liver and not directly to the heart.

This blood is rich in nutrients that were extracted from food, and the liver processes these nutrients; it also filters toxins that may have been ingested with the food.

The blood leaves the liver and flows to the heart in the hepatic veins.

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Side effects of Portal Hypertension

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Consequences of portal hypertension are caused by blood being forced down alternate channels by the increased resistance to flow through the systemic venous system rather than the portal system. They include:

• Ascites – Ascites is the accumulation of fluid in the abdominal cavity. The abdominal cavity is located below the chest cavity, separated from it by the diaphragm.
• Hepatic encephalopathy – Hepatic encephalopathy is a complex neuropsychiatric disorder that complicates acute and chronic liver failure. HE is a potentially reversible metabolic disorder of the brain in the milieu of hepatic failure. Patients with chronic liver disease develop a more indolent encephalopathy, called portosystemic encephalopathy (PSE).
• Increased risk of spontaneous bacterial peritonitis.
• Increased risk of hepatorenal syndrome.
• Splenomegaly (enlargement of the spleen)
• Esophageal varices, gastric varices, Esophageal and gastric varices pose an ongoing risk of life threatening hemorrhage.
• Anorectal varices (not to be confused with hemorrhoids).

 

What are the symptoms to look out for?

• An enlarged spleen
• Abdominal swelling
• Visible veins under the skin of the abdomen
• Varices or enlarged veins in the lining of the gut, especially the esophagus and stomach
• Bleeding – coughing or vomiting blood, or blood in the stools
• Diarrhea, poor weight gain

 

How is a diagnosis made?
A range of tests can be carried out to make a diagnosis:

• General physical examination
• Blood tests
• Ultrasound scan
• Endoscopy
• Sigmoidoscopy

 

Treatment of Portal Hypertension
Mild symptoms do not require treatment, but bleeding does require treatment. If portal hypertension causes diarrhea or poor weight gain, a dietitian will advise on changes to the child’s diet to ensure they absorb sufficient nutrients and calories.

Treatment for varices
If the varices have inflamed the lining of the esophagus or stomach, a medicine may be given to protect the lining and help it to heal.

Treatment of bleeding
Immediate medical attention is needed if a child is vomiting blood or passing blood in their stools. If possible take a sample of the vomit or stool with you to hospital and inform the doctors about your child’s portal hypertension and the current symptoms.

While in hospital some of the following will be done:

• Monitoring your child’s pulse and blood pressure
• Monitoring vomiting and colour of stools
• Blood test to determine how much blood has been lost
• Intravenous fluids/blood to maintain blood volume
• Intravenous medication to stop the bleeding

 

Once stable, your child may be given an endoscopy to look at the varices that are bleeding. Treatment options will be considered and discussed with you. These may include injecting the varices to prevent the small veins bleeding (sclerotherapy) or placing special rubber bands around them (banding) to remove the varices. Repeated treatments may be necessary to reduce the chance of the varices bleeding again.