Health News
What Causes Portal Hypertension?

Feb 8, 2008, 14:40

The most common cause of portal hypertension is cirrhosis. Cirrhosis results from scarring of a liver injury caused by hepatitis, alcohol abuse or other causes of liver damage. In cirrhosis, scar tissue blocks the flow of blood through the liver.

Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, and a parasitic infection called schistosomiasis. Sometimes the cause is unknown.

What Are the Symptoms of Portal Hypertension?

The onset of portal hypertension may not always be associated with specific symptoms that identify what is happening in the liver. But if you have liver disease that leads to cirrhosis, the chance of developing portal hypertension is high.

The main symptoms and complications of portal hypertension include:

• Gastrointestinal bleeding: Black, tarry stools or blood in the stools; or vomiting of blood due to the spontaneous rupture and hemorrhage from varices.
• Ascites (an accumulation of fluid in the abdomen)
• Encephalopathy or confusion and forgetfulness caused by poor liver function.
• Reduced levels of platelets, blood cells that help form blood clots, or white blood cells, the cells that fight infection.

How Is Portal Hypertension Diagnosed?

Unfortunately, most causes of portal hypertension cannot be treated. Instead, treatment focuses on preventing or managing the complications, especially the bleeding from the varices. Diet, medications, endoscopic therapy, surgery and radiology procedures all have a role in treating or preventing the complications. Other treatment depends on the severity of the symptoms and on how well your liver is functioning.

How Is Portal Hypertension Treated?

Unfortunately, most causes of portal hypertension cannot be treated. Instead, treatment focuses on preventing or managing the complications, especially the bleeding from the varices. Diet, medications, endoscopic therapy, surgery and radiology procedures all have a role in treating or preventing the complications. Other treatment depends on the severity of the symptoms and on how well your liver is functioning.

Endoscopic therapy. This is usually the first line of treatment for variceal bleeding and consists of either banding or sclerotherapy. Banding is a procedure in which a gastroenterologist uses rubber bands to block off the blood vessel. Sclerotherapy is occasionally used when banding cannot be used and is a procedure in which a solution is injected into the bleeding varices to cause them to scar.

Medications. Nonselective beta blockers (nadolol or propranolol) may be prescribed alone or in combination with endoscopic therapy to reduce the pressure in varices and further reduce the risk of re-bleeding. Nonselective beta blockers are also prescribed to prevent a first variceal hemmorrhage in a patient with varices that are felt to be at risk for bleeding. Esophageal variceal banding has also been used for that purpose, especially in those patients who are intolerant to beta blockers. The drug lactulose can help treat confusion and other mental changes associated with encephalopathy.

What Lifestyle Changes Should Be Made?

Maintaining good nutritional habits and keeping a healthy lifestyle will help your liver function properly. Some of the things you can do to improve the function of your liver include the following:

• Do not use alcohol or street drugs.
• Do not take any over-the-counter or prescription drugs without first consulting your doctor or nurse. (Some medications may make liver disease worse.)
• Follow the dietary guidelines given to you by your doctor or nurse, including: eating a low-sodium (salt) diet. You will probably be required to consume no more than 2 grams of sodium per day. Reduced protein intake may be required and only if confusion is a symptom. A dietitian can create a meal plan for you.

Other Treatment Options

If endoscopic therapy, drug therapy and/or dietary changes do not successfully control your variceal bleeding, you may require one of the following procedures to reduce the pressure in these veins. Decompression procedures include:

• Transjugular intrahepatic portosystemic shunt (TIPS): This procedure involves placing a stent (a tubular device) in the middle of the liver. The stent connects the hepatic vein with the portal vein.
• Distal splenorenal shunt (DSRS): This procedure connects the vein from your spleen to the vein from your left kidney in order to reduce pressure in the varices and control bleeding.