All About Portal hypertension
Portal Hypertension refers to high blood pressure in the portal veins, which is caused by liver problems. Portal Hypertension is often linked to liver complications and illnesses such as hepatitis and liver cirrhosis. In this article, we will explore the common causes, symptoms, and treatments of portal hypertension.
Portal hypertension
Portal Hypertension is diagnosed when the level of blood pressure in the portal veins are more than 10 millimetres of mercury. The portal vein carries nutrients rich blood from the spleen, pancreas, stomach, and some other digestive organs to the liver. The portal vein is not referred to as a true vein because it does not have any connection to the heart. However, 75% of blood supplied to the liver occurs through the portal vein.
The liver acts as a filtrate which removes toxic materials that are present in the blood. The liver also processes nutrients before sending them to the whole body. Portal Hypertension causes damage to the liver and results in inflammation. Conversely, liver scar tissues (aka cirrhosis) can also damage the portal vein. Heightened blood pressure in the portal vein over a long-term can cause serious problems such as kidney failure, infection, and gastrointestinal bleeding.
Symptoms
Initially, as with other types of hypertension, portal hypertension does not have any clear symptoms. Symptoms usually only surface when the problem is already severe, resulting in serious complications.
Portal hypertension along with its complications results in nonspecific symptoms. Some are following:
– Internal bleeding – It is caused due to the broken varices, due to the damage to the varices the stool becomes bloody or black sometimes.
– Ascites – This refers to the condition in which the abdomen swells largely. It is caused by the fluid which is present between the organs and inner abdominal space.
– Varices – This refers to the condition in which the veins of the stomach and esophagus become enlarged.
– Encephalopathy – Encephalopathy causes damage to the brain. The patient goes through a memory loss problem and also loss the ability to focus well on anything.
– Anemia – This refers to the deficiency of iron. It occurs due to the chronic loss of blood.
– Weak immune system – The immune system of a person becomes weak when the production of white blood cells inside the body decreases significantly. A weak immune system increases the chances of getting any disorder.
– Reduced blood clotting – The blood clotting becomes reduced due to the decrease in the level of platelets inside the body.
– Splenomegaly – It means a large size spleen. This condition can also occur in some other cases. Portal hypertension reduces the flow of blood from the spleen, causes the spleen to grow into a large size, and an excess amount of blood to accumulate inside the spleen. It can also result in another dangerous condition which is known as hepatosplenomegaly. In this condition the spleen and liver become inflamed.
Causes
One of the most common causes of portal hypertension is called cirrhosis. Cirrhosis is a kind of liver problem in which healthy liver tissues are replaced by scar tissues. These scar tissue block the passage of blood flow, causing the blood pressure in the portal vein to significantly increase.
Cirrhosis occurs in the individual due to the following reasons:
– Nonalcoholic fatty liver problem
– Liver congestion due to chronic heart failure
– Autoimmune problems of the liver such as primary sclerosing cholangitis and primary biliary cirrhosis
– Use of medication such as non-steroidal anti-inflammatory drugs (NSAIDs) and antibodies
– Chronic hepatitis infection
There is another type of portal hypertension that occurs without cirrhosis. It is called Idiopathic non-cirrhotic portal hypertension INCPH.
Some common causes of INCPH are:
– Formation of a blood clot inside the portal vein
– Weak immune system
– Crohn’s disorder
– An inherited disease, including Turner syndrome and Adams-Oliver syndrome.
– Underdeveloped bile duct
– Parasitic or bacterial infections
Complications
Portal hypertension can cause several complications which can be dangerous and life-threatening.
Some complications include:
– Edema – It is the swelling in the feet and the legs
– Jaundice – It causes the yellowing of eyes and skin
– Ascites – It is caused due to the accumulation of fluid in the abdomen
– Hepatic Encephalopathy – It can cause the loss of memory, change in personality, and confusion
Risk Factors
Those individuals that suffer from cirrhosis and liver problems are at a high risk of getting portal hypertension.
National Institute of Diabetes and Digestive and Kidney Disease suggested that individuals over the age of 50 years are at a greater risk of developing cirrhosis. So, it is common in old individuals and the percentage of cirrhosis is more in males as compared to females
Some other factors of cirrhosis are
– Type 2 diabetes
– Obesity
– History of alcohol use disorder
Diagnosis
Portal hypertension is not easy to diagnose as it does not show any clear symptoms. However, a medical health specialist can identify the presence of portal hypertension in a patient through medical history and the current health status of the patient.
For the diagnosis of portal hypertension, doctors use different techniques.
Ultrasound
It is one of the most frequently used techniques by doctors. In ultrasound, the pictures of an individual internal structure can be seen through which makes it easy to diagnose portal hypertension.
With the help of ultrasound, doctors can check the rate of blood flow from the portal vein and the health of the spleen and stomach can also evaluate.
Elastography
It is a method in which the elasticity present inside the tissues of the liver are assessed. Those areas that have low elasticity suggest that scar tissues are present. Some other techniques used by doctors are MRI scans and CT scans.
When the result of these tests is not clear enough to diagnose the disease. The doctors perform another technique which is called a liver biopsy. In this technique, small pieces of liver tissues are removed. Then these issues are examined by the pathologist for inflammation, scarring, and other signs.
Treatment
Portal Hypertension is very difficult to treat, as it is usually aggravated by other liver problems, vice versa. Therefore, most efforts are focused on prevention and management of the condition. The treatment of portal hypertension involves the following medicines that are recommended by doctors.
– Lactulose – It is mostly used in the treatment of hepatic encephalopathy and lactulose is a synthetic sugar.
– Antibiotics – These are used to decrease the level of toxins in the brain and to treat bacterial infections. The commonly used Antibiotic for such issues is rifaximim (Xifaxan).
– Beta-blockers – They are used to decrease the level of blood pressure. An example is such as propranolol (Hemangeol).
For the efficient treatment of portal hypertension, lifestyle changes and healthier routines are also essential to support medical efforts. These changes include:
– Daily exercise
– Reduction of sodium intake
– Quit smoking
– Avoid consuming alcohol
Following procedures are also adopted for portal hypertension treatment
– Liver transplant
– Paracentesis
– Variceal ligation
– Transjugular intrahepatic portosystemic shunt ( TIPS)
Preventions
To Prevent portal hypertension following Prevention should be adopted
– Lose excess weight
– Exercise regularly
– Stop smoking
– Avoid the overuse of medication
– Eat healthy food
– Getting the vaccination for hepatitis
Conclusion
Portal hypertension is usually caused by cirrhosis. Other causes include blood clots, autoimmune diseases and chronic infections such as hepatitis. If you do not pay attention to portal hypertension and it remains untreated, then it can cause severe problems such as swelling of the abdomen, liver disease, and internal bleeding.
Therefore it is important to get diagnosed early and start treatment. Lifestyle changes will also supplement the effects of treatment and help you regain a healthy body. During this process, you’ll also need to self-monitor your blood pressure. Self-monitoring is an important key to understanding the effectiveness of your healthcare regime.
It is therefore imperative to use clinically-validated solutions to self-monitor your progress. This ensures that you can accurately monitor your progress. ForaCare’s hypertension solutions for self-monitoring offer professional clinically-validated accuracy for ease of mind when testing.
References
– Björnsson, E. S. (2016). Hepatotoxicity by drugs: The most commonly implicated agents. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783956/
– Carneiro, C., et al. (2019). All about portal vein: A pictorial display to anatomy, variants, and physiopathology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428891/
– Chapman, J., et al. (2020). Splenomegaly. https://www.ncbi.nlm.nih.gov/books/NBK430907/
– Cirrhosis. (2018). https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/all-content
– McConnell, M., & Iwakiri, Y. (2018). Biology of portal hypertension. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090883/
– Oliver, T. I., et al. (2019). Portal hypertension. https://www.ncbi.nlm.nih.gov/books/NBK507718/
– Schouten, J, N. L., et al. (2015). Idiopathic non-cirrhotic portal hypertension: A review [Abstract]. https://www.ncbi.nlm.nih.gov/pubmed/26025214
– Sigrist, R, M, S., et al. (2017). Ultrasound elastography: Review of techniques and clinical applications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5399595/