Portal hypertension is having high blood pressure in the veins that are called portal venous system. Portal veins include all those veins that come from stomach, pancreas, spleen and intestine and then travel to the liver.
The pressure is 10mg or more develops either due to increased flow of blood in the portal vein or there is increased resistance in the portal venous system.
The increased pressure opens up venous collaterals that connect the portal venous system to various junctions like gastro- oesophageal junction, anterior abdominal wall, anarectal junction to veins from retroperitomneal viscera. This leads to the development of swollen veins of the abdomen that could cause life threatening complications.
Portal hypertension is usually caused by liver cirrhosis. In cirrhosis, the scar tissues of the liver block the blood from flowing through the liver. Other causes are
- Blood clots in the portal veins
- Blockage or infection of the veins
Although Early symptoms are not known, symptoms in the later stage include
- Gastrointestinal bleeding
- Reduced level of platelets
To get effective treatment of portal hypertension is difficult as it cannot be treated. Rather the treatment concentrates on preventing or curing the complications that are caused by hypertension.
- Diet: patients are advised not to take over the counter medicine or herbal medicines without consulting the doctor; it may worsen the liver condition. Stop having alcohol and drugs and follow diet that has been advised.
- Medications: non selective beta blockers are prescribed either alone or along with endoscopic variceal ligation to reduce the pressure in the veins and reduce the risk of bleeding. The Patients who cannot take beta blockers are prescribed only esophageal variceal ligation.
- Endoscopic therapy: it is the very first treatment that a doctor prescribes that includes banding or sclerotherapy. Banding process consist of banding of the blood vessel using rubber to stop bleeding. Sclerotherapy includes injecting a blood clotting solution in the bleeding varices.
- In case of severe bleeding options like radiology, surgery can be advised by the doctor
- Other treatment
- TIPS(transjugular intrahepatic portosystemic shunt): stent is placed in middle of the liver, it connects the portal vein and the hepatic vein and reroutes the blood flow and relive the pressure in the veins
- DSRS (distal splenorenal shunt): the vein from the spleen and vein of the right kidney are connected to reduce pressure and control bleeding.