Portal hypertension is the increase in blood pressure in the vascular system called the portal vein system. Normally, blood vessels originating from the stomach, intestines, spleen, and pancreas, merged into the portal vein, which then branch into smaller vessels and travels through the heart. If the vessels in the liver are blocked, it is difficult for blood to flow causing high pressure in the portal system.
When the pressure becomes too high, blood backs and find other ways to flow back to the heart, which is pumped to the lungs, where it gets removes waste products and pick up oxygen. The blood can travel to the deep veins (esophageal varices esophagus), the abdominal skin, and veins of the rectum and anus (hemorrhoids) to get around the blockage in the liver.
What Causes Portal Hypertension?
The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis results from scarring of the liver injury caused by hepatitis, alcohol abuse, or other causes of liver damage. In cirrhosis, scar blocking blood flow through the liver.
Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry blood from heart to heart, and parasitic infection called schistosomiasis. Sometimes the cause is unknown.
What Are the Symptoms of Portal Hypertension?
The occurrence of portal hypertension may not always be associated with specific symptoms that identify what is happening in the liver. However, if you have liver disease leading to cirrhosis, high portal hypertension development opportunities.
The main symptoms and complications of portal hypertension include:
* Gastrointestinal bleeding: a bench to stay black, or blood in stools, or vomiting of blood due to spontaneous rupture and hemorrhage from varices.
* Ascites (accumulation of fluid in the abdomen).
* Encephalopathy or confusion and forgetfulness caused by poor liver function.
* Reducing the level of platelets, blood cells that help form blood clots, or white blood cells, cells that fight infection.
How is Portal Hypertension Diagnosed?
Usually the doctor makes a diagnosis of portal hypertension based on the presence of ascites or dilated or varicose veins as seen on physical examination of the abdomen or the anus. Various laboratory tests, X-ray tests, and endoscopic examinations can also be used
How is Portal Hypertension Treated?
Unfortunately, most causes of portal hypertension can not be treated. Instead, treatment focuses on preventing or managing complications, especially bleeding from varices. Diet, medications, endoscopic therapy, surgery, and radiology procedures all have a role in treating or preventing complications. Other treatment depends on the severity of symptoms and on how well your liver function.
therapy.This Endoscopy is usually the first line of treatment for variceal bleeding, and consists of either an appeal or sclerotherapy. Appeal is a procedure in which the digestion that uses rubber bands to block the blood vessels. Sclerotherapy is sometimes used when the appeal can not be used and the procedure in which a solution is injected into the bleeding varices causing them to scar.
Treatment. Nonselective beta blockers (nadolol or propranolol) may be prescribed alone or in combination with endoscopic therapy to reduce the pressure on varicose veins and reduce the risk of rebleeding. Nonselective beta blockers are also prescribed to prevent varicose veins in patients with first hemmorrhage the perceived risk of bleeding varices. Appeal esophageal varices have also been used for that purpose, especially in patients who are intolerant to beta blockers. The drug lactulose can help treat confusion and other mental changes associated with encephalopathy.
What Life Should Changes Made for Portal Hypertension?
Maintaining good nutritional habits and maintaining a healthy lifestyle will help you avoid portal hypertension. Some things you can do to improve your liver function is as follows:
* Never use alcohol or drugs.
* Do not take any over-the-counter or prescription medications or herbal medications without first consulting your doctor or nurse. (Some medications can make liver disease worse.)
* Follow the dietary guidelines given by your doctor or nurse, including: eating low sodium (salt) diet. You may be asked to consume no more than 2 grams of sodium per day. Reducing protein intake may be necessary and only if the confusion is a symptom. A dietitian can make a meal plan for you.
Other Treatment Options
For those with portal hypertension, if endoscopic therapy, drug therapy, and / or dietary changes failed to control variceal bleeding, you may need one of the following procedures to reduce the pressure in blood vessels. Decompression procedures include:
* Transjugular intrahepatic portosystemic shunt (TIPS): This procedure involves placing a stent (a tubular device) in the center. The stent connects the hepatic vein with the portal vein.
* Distal splenorenal shunt (DSRS): This procedure connects you to the vein from the splenic vein of the left kidney to relieve pressure on the varices and control bleeding.
Tests Are Required Before TIPS and DSRS procedures
Before accepting one of the procedures for portal hypertension, the following test may be performed to determine the extent and severity of your condition:
* Evaluate your medical history
* Physical examination
Blood tests
* Angiogram (X-ray test that takes pictures of blood flow in certain arteries)
* Ultrasound
* Endoscopy
Before either TIPS or DSRS procedure, your doctor may ask you to have other preoperative tests, which may include an electrocardiogram (ECG) (a test that records the electrical activity of your heart), chest X-ray, or additional blood tests. If your doctor thinks you will need additional blood products (eg plasma), they will be ordered at this time.
What Happens at the TIPS procedure?
During the TIPS procedure, the radiologist makes a tunnel through the heart with a needle, connecting the portal vein to one of the hepatic veins (veins connected to the liver). A metal stent that is covered with a thin plastic material, placed in this tunnel to keep the tunnel open.
The procedure reroutes blood flow in the liver and reduces pressure in all abnormal veins, not only in the stomach and esophagus, but also in the intestine and liver.
This is not surgery. The radiologist who performed the procedure in the space under the guidance of X-rays. This process lasts for one to three hours, but you have to stay in hospital overnight after the procedure.
How successful TIPS procedure is?
TIPS procedure to control bleeding quickly more than 90% of patients with portal hypertension. However, in about 20% of patients, the shunt may narrow, causing varices bleed again later.
Complications What Is the Association of TIPS?
narrowing or blockage of the shunt may occur within the first year after TIPS procedure. Follow-up ultrasound examinations are often performed after the TIPS procedure to detect complications. Signs of blockage include increased ascites (accumulation of fluid in the abdomen) and re-bleeding. This condition can be handled by a radiologist who returned extend parallel with a balloon or repeats the procedure for placing a new stent.
Encephalopathy, or abnormal brain function, can occur with severe liver disease. Hepatic encephalopathy may be worse when blood flow to the liver is reduced by TIPS, which can result in toxic substances reaching the brain without first metabolized by the liver. This condition can be treated with medication, diet, or by creating a shunt which can not be accessed.
What Happened on the DSRS procedure?
DSRS is a surgical procedure where the vein from the spleen (called the splenic vein) is removed from the portal vein and attached to the left renal vein (renal). This surgery selectively reduces the pressure on the varices and control bleeding related to portal hypertension. This is usually done only in patients with good liver function.
A general anesthetic is given before surgery, which lasted about four hours. You have to stay in the hospital from seven to 10 days.
How this DSRS Surgery Success?
DSRS control bleeding in more than 90% of patients, with the highest risk of rebleeding whatever happens within the first month. DSRS procedure provides long-term control of bleeding is good in patients with portal hypertension.
What Is the Association of Surgical Complications DSRS?
Ascites, an accumulation of fluid in the abdomen, can occur with surgery DSRS. It can be treated with diuretics and restricted sodium intake
Follow-Up Care Procedures Following TIPS or DSRS
Follow-up care for the TIPS and DSRS may differ depending on where the procedure performed. Below find basic guidelines.
* Ten days after hospital discharge, meet with your surgeon or hepatologist (liver specialist) to evaluate your progress. Lab work will be done at this time.
* Six weeks after the TIPS procedure (and again three months after the procedure), had an ultrasound so your doctor can check that the shunt is functioning properly. You will have an angiogram (an x-ray of blood vessels) only if the ultrasound shows that there is a problem. You also will have lab work done at the moment.
* Six weeks after DSRS procedure (and again three months after the procedure), met with the surgeon to evaluate your progress. Lab work will be done at this time.
* Six months after either the TIPS or DSRS procedure, have an ultrasound to make sure the shunt is working properly. Also, visit the surgeon or hepatologist.
* Twelve months after either procedure, to have another ultrasound shunt. Also, you may have an angiogram so your doctor can check the pressure inside your blood vessels in the shunt.
* If the shunt is working properly, every six months after the first year of follow-up appointments, have an ultrasound, lab work, and visit with your doctor.
* More frequent follow-up visits may be needed, depending on your condition.
* Attend follow-up as scheduled to ensure that the shunt is functioning properly. Be sure to follow the dietary recommendations that you provide your health care provider.
Another treatment for Portal Hypertension
* Liver transplantation. This is done in cases of end-stage liver disease.
* Devascularization. A surgical procedure to remove varicose veins bleed. This procedure is done when a TIPS or shunt surgery is not possible or not successful in controlling bleeding.
* Paracentesis. This is a procedure in which the accumulation of fluid in the abdomen (ascites) directly removed
SOURCE:
Cleveland Clinic Department of Gastroenterology, Merck Manual
When the pressure becomes too high, blood backs and find other ways to flow back to the heart, which is pumped to the lungs, where it gets removes waste products and pick up oxygen. The blood can travel to the deep veins (esophageal varices esophagus), the abdominal skin, and veins of the rectum and anus (hemorrhoids) to get around the blockage in the liver.
What Causes Portal Hypertension?
The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis results from scarring of the liver injury caused by hepatitis, alcohol abuse, or other causes of liver damage. In cirrhosis, scar blocking blood flow through the liver.
Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry blood from heart to heart, and parasitic infection called schistosomiasis. Sometimes the cause is unknown.
What Are the Symptoms of Portal Hypertension?
The occurrence of portal hypertension may not always be associated with specific symptoms that identify what is happening in the liver. However, if you have liver disease leading to cirrhosis, high portal hypertension development opportunities.
The main symptoms and complications of portal hypertension include:
* Gastrointestinal bleeding: a bench to stay black, or blood in stools, or vomiting of blood due to spontaneous rupture and hemorrhage from varices.
* Ascites (accumulation of fluid in the abdomen).
* Encephalopathy or confusion and forgetfulness caused by poor liver function.
* Reducing the level of platelets, blood cells that help form blood clots, or white blood cells, cells that fight infection.
How is Portal Hypertension Diagnosed?
Usually the doctor makes a diagnosis of portal hypertension based on the presence of ascites or dilated or varicose veins as seen on physical examination of the abdomen or the anus. Various laboratory tests, X-ray tests, and endoscopic examinations can also be used
How is Portal Hypertension Treated?
Unfortunately, most causes of portal hypertension can not be treated. Instead, treatment focuses on preventing or managing complications, especially bleeding from varices. Diet, medications, endoscopic therapy, surgery, and radiology procedures all have a role in treating or preventing complications. Other treatment depends on the severity of symptoms and on how well your liver function.
therapy.This Endoscopy is usually the first line of treatment for variceal bleeding, and consists of either an appeal or sclerotherapy. Appeal is a procedure in which the digestion that uses rubber bands to block the blood vessels. Sclerotherapy is sometimes used when the appeal can not be used and the procedure in which a solution is injected into the bleeding varices causing them to scar.
Treatment. Nonselective beta blockers (nadolol or propranolol) may be prescribed alone or in combination with endoscopic therapy to reduce the pressure on varicose veins and reduce the risk of rebleeding. Nonselective beta blockers are also prescribed to prevent varicose veins in patients with first hemmorrhage the perceived risk of bleeding varices. Appeal esophageal varices have also been used for that purpose, especially in patients who are intolerant to beta blockers. The drug lactulose can help treat confusion and other mental changes associated with encephalopathy.
What Life Should Changes Made for Portal Hypertension?
Maintaining good nutritional habits and maintaining a healthy lifestyle will help you avoid portal hypertension. Some things you can do to improve your liver function is as follows:
* Never use alcohol or drugs.
* Do not take any over-the-counter or prescription medications or herbal medications without first consulting your doctor or nurse. (Some medications can make liver disease worse.)
* Follow the dietary guidelines given by your doctor or nurse, including: eating low sodium (salt) diet. You may be asked to consume no more than 2 grams of sodium per day. Reducing protein intake may be necessary and only if the confusion is a symptom. A dietitian can make a meal plan for you.
Other Treatment Options
For those with portal hypertension, if endoscopic therapy, drug therapy, and / or dietary changes failed to control variceal bleeding, you may need one of the following procedures to reduce the pressure in blood vessels. Decompression procedures include:
* Transjugular intrahepatic portosystemic shunt (TIPS): This procedure involves placing a stent (a tubular device) in the center. The stent connects the hepatic vein with the portal vein.
* Distal splenorenal shunt (DSRS): This procedure connects you to the vein from the splenic vein of the left kidney to relieve pressure on the varices and control bleeding.
Tests Are Required Before TIPS and DSRS procedures
Before accepting one of the procedures for portal hypertension, the following test may be performed to determine the extent and severity of your condition:
* Evaluate your medical history
* Physical examination
Blood tests
* Angiogram (X-ray test that takes pictures of blood flow in certain arteries)
* Ultrasound
* Endoscopy
Before either TIPS or DSRS procedure, your doctor may ask you to have other preoperative tests, which may include an electrocardiogram (ECG) (a test that records the electrical activity of your heart), chest X-ray, or additional blood tests. If your doctor thinks you will need additional blood products (eg plasma), they will be ordered at this time.
What Happens at the TIPS procedure?
During the TIPS procedure, the radiologist makes a tunnel through the heart with a needle, connecting the portal vein to one of the hepatic veins (veins connected to the liver). A metal stent that is covered with a thin plastic material, placed in this tunnel to keep the tunnel open.
The procedure reroutes blood flow in the liver and reduces pressure in all abnormal veins, not only in the stomach and esophagus, but also in the intestine and liver.
This is not surgery. The radiologist who performed the procedure in the space under the guidance of X-rays. This process lasts for one to three hours, but you have to stay in hospital overnight after the procedure.
How successful TIPS procedure is?
TIPS procedure to control bleeding quickly more than 90% of patients with portal hypertension. However, in about 20% of patients, the shunt may narrow, causing varices bleed again later.
Complications What Is the Association of TIPS?
narrowing or blockage of the shunt may occur within the first year after TIPS procedure. Follow-up ultrasound examinations are often performed after the TIPS procedure to detect complications. Signs of blockage include increased ascites (accumulation of fluid in the abdomen) and re-bleeding. This condition can be handled by a radiologist who returned extend parallel with a balloon or repeats the procedure for placing a new stent.
Encephalopathy, or abnormal brain function, can occur with severe liver disease. Hepatic encephalopathy may be worse when blood flow to the liver is reduced by TIPS, which can result in toxic substances reaching the brain without first metabolized by the liver. This condition can be treated with medication, diet, or by creating a shunt which can not be accessed.
What Happened on the DSRS procedure?
DSRS is a surgical procedure where the vein from the spleen (called the splenic vein) is removed from the portal vein and attached to the left renal vein (renal). This surgery selectively reduces the pressure on the varices and control bleeding related to portal hypertension. This is usually done only in patients with good liver function.
A general anesthetic is given before surgery, which lasted about four hours. You have to stay in the hospital from seven to 10 days.
How this DSRS Surgery Success?
DSRS control bleeding in more than 90% of patients, with the highest risk of rebleeding whatever happens within the first month. DSRS procedure provides long-term control of bleeding is good in patients with portal hypertension.
What Is the Association of Surgical Complications DSRS?
Ascites, an accumulation of fluid in the abdomen, can occur with surgery DSRS. It can be treated with diuretics and restricted sodium intake
Follow-Up Care Procedures Following TIPS or DSRS
Follow-up care for the TIPS and DSRS may differ depending on where the procedure performed. Below find basic guidelines.
* Ten days after hospital discharge, meet with your surgeon or hepatologist (liver specialist) to evaluate your progress. Lab work will be done at this time.
* Six weeks after the TIPS procedure (and again three months after the procedure), had an ultrasound so your doctor can check that the shunt is functioning properly. You will have an angiogram (an x-ray of blood vessels) only if the ultrasound shows that there is a problem. You also will have lab work done at the moment.
* Six weeks after DSRS procedure (and again three months after the procedure), met with the surgeon to evaluate your progress. Lab work will be done at this time.
* Six months after either the TIPS or DSRS procedure, have an ultrasound to make sure the shunt is working properly. Also, visit the surgeon or hepatologist.
* Twelve months after either procedure, to have another ultrasound shunt. Also, you may have an angiogram so your doctor can check the pressure inside your blood vessels in the shunt.
* If the shunt is working properly, every six months after the first year of follow-up appointments, have an ultrasound, lab work, and visit with your doctor.
* More frequent follow-up visits may be needed, depending on your condition.
* Attend follow-up as scheduled to ensure that the shunt is functioning properly. Be sure to follow the dietary recommendations that you provide your health care provider.
Another treatment for Portal Hypertension
* Liver transplantation. This is done in cases of end-stage liver disease.
* Devascularization. A surgical procedure to remove varicose veins bleed. This procedure is done when a TIPS or shunt surgery is not possible or not successful in controlling bleeding.
* Paracentesis. This is a procedure in which the accumulation of fluid in the abdomen (ascites) directly removed
SOURCE:
Cleveland Clinic Department of Gastroenterology, Merck Manual
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