Portal Hypertension
Portal hypertension (PHT) is a condition characterized by an elevated blood pressure in the portal vein, which is the vein responsible for carrying blood from the intestines, spleen, and pancreas to the liver.
The normal pressure in the portal vein is around 5-10 mmHg, but in individuals with portal hypertension, the pressure can be significantly higher, often reaching 20 mmHg or more.
Main Causes of Portal Hypertension
The main causes of PHT are cirrhosis of the liver and blockages in the portal vein.
Cirrhosis is a condition in which liver tissue is replaced by scar tissue, leading to poor blood flow and increased resistance to blood flow through the liver. Blockages in the portal vein can be caused by blood clots, tumors or other conditions that impede the flow of blood through the vein.
Complications due to Portal Hypertension
The increased pressure in the portal vein can lead to a number of complications, including the development of varices (enlarged veins) in the esophagus or stomach, bleeding from these varices, and the formation of fluid in the abdomen (ascites).
Varices are dilated veins that form as a result of increased pressure in the portal vein (obstruction to flow). The increased pressure causes these to veins to rupture and leads to severe and even life-threatening bleeding into the stomach- which presents as vomiting of blood.
Ascites, the other common sequelae of PHT, is the accumulation of fluid in the abdominal cavity caused by the increased pressure in the portal vein. Other complications of PHT include hepatic encephalopathy (a brain disorder caused by liver failure) and increased susceptibility to infections.
How to diagnose Portal Hypertension?
The diagnosis of PHT is based on the presence of characteristic symptoms and signs and confirmed by results of various diagnostic tests. These include- blood tests, imaging studies (ultrasound, CT scan, or MRI), and endoscopy.
Treatment for Portal Hypertension
PHT is a serious condition that can lead to life-threatening complications if left untreated.
Individuals with known risk factors for portal hypertension, such as cirrhosis of the liver or a family history of the condition, should be evaluated by a healthcare provider on a regular basis to detect the condition early and start treatment before complications develop
Treatment options for PHT include medications, endoscopic procedures to control bleeding and surgery. Medications include beta-blockers and nitrates, which are used to reduce the pressure in the portal vein, and diuretics, which are used to remove excess fluid from the body.
Endoscopic procedures, such as band ligation and sclerotherapy, are used to treat varices and prevent bleeding. In these procedures, a small elastic band is placed around the base of the varix to cut off its blood supply, or a solution is injected into the varix to shrink it.
Medication and endoscopic procedures are aimed at providing relief to and preventing complications of PHT, they do not cure or control the elevated pressure. Cirrhosis in the background progresses and worsens the PHT.
Surgery becomes the primary option for people with severe PHT who do not respond to other treatments. The most common surgical procedure used to treat PHT is a procedure called a transjugular intrahepatic portosystemic shunt (TIPS), in which a small channel is created within the liver to divert blood flow away from the blocked portal vein, reducing pressure in the vein.
Though this decreases portal pressure, it does not tackle the cause for development of PHT and brings forth a new set of complications, does not prolong survival.
Liver Transplant procedure for PHT
Liver Transplantation is the curative procedure and is required in later stages (severe) PHT or when complications of PHT threaten survival.
Here, the scarred liver which is impeding flow of blood through it is replaced with a healthy one to allow for smooth passage of blood flow. This corrects the PHT as well as the deficiency of liver function due to scaring in the liver and is the only treatment that restores life expectancy.
Typically the doctor will recommend a transplant when there is intractable jaundice, coagulopathy or ascites.