The liver performs many functions within the body from making proteins fats and carbohydrates to producing bile to help digest food. To perform all the functions, the liver needs a significant blood supply. Unlike other organs, the portal vein carries the majority of the blood to the liver from your stomach, pancreas, and other organs. The liver plays a significant role in blood circulation as it filters the toxins and other wastes from your bloodstream.
What Is Portal Hypertension?
Portal hypertension is a condition of increased blood pressure within the portal venous system. Veins that comes from the stomach, spleen & pancreas merge into the portal system which branches out into smaller vessels and travels through the liver.
If these vessels blocked due to liver damage, the blood flow gets disturbed and develops high pressure in the portal system. The pressure increased in the portal vein system might develop varices within the oesophagus, intestine, or umbilical area. Varices can cause potentially life-threatening complications.
Symptoms Of Portal Hypertension
In case of improper blood flow through the liver, it tries to bypass the portal vein system to return to the heart. Symptoms of portal hypertension are developed due to decreased flow of blood through the liver and increased pressure in the veins. The symptoms include:
- Gastrointestinal bleeding
- Varices (enlarged veins)
- Oesophagal and gastric varices with blood vomitings and blood in the stool
- Ascites(fluid accumulation in the abdomen)
- Hepatic encephalopathy
- Splenomegaly
- Decreased blood platelets and white blood cell counts
Cause Of Portal Hypertension
Liver cirrhosis is the main cause of portal hypertension. The condition leads to scarring of the liver caused due to various conditions such as hepatitis or alcohol abuse. In liver cirrhosis condition, the scar tissue obstructs the blood flow through the liver.
Some other causes of portal hypertension are blood clots in the portal vein, clogs in the veins which carry blood to the heart from the liver, schistosomiasis(a parasitic infection) and focal nodular hyperplasia, a disease noticed in HIV infected people.
- Fatty liver
- Wilson’s disease
- Hemochromatosis (excess iron buildup)
- Cystic fibrosis
- Primary sclerosing cholangitis(hardening of bile ducts)
- Biliary atresia(improper formation of bile ducts)
Treatment For Portal Hypertension
Unfortunately, portal hypertension is very complicated. The main focus of the treatment is to prevent or manage complications such as bleeding from the varices. Improved diet, lifestyle changes, medications such as beta-blockers, endoscopic therapy, and radiology procedures play a key role in treating or in preventing the complications.
Shunt Surgery For Portal Hypertension
If the above treatment doesn’t successfully control bleeding, the doctor might suggest one of the following shunt procedures minimise the pressure in the veins.
Transjugular intrahepatic portosystemic shunt (TIPS): This is a procedure in which a stent (a tubular device) is placed in the middle of the liver. The stent helps in the rerouting of the blood flow in the liver by connecting the hepatic vein with the portal vein and relieves pressure in abnormal veins.
Distal splenorenal shunt (DSRS): This procedure involves connecting the veins from your spleen to the left kidney to decrease pressure in the varices on order to control bleeding.