Portal Hypertension

The portal vein is the large blood vessel that brings blood from your intestines to your liver.

Hypertension is a medical term for high blood pressure.

So, portal hypertension is high blood pressure in your portal vein.

• Most people get portal hypertension from cirrhosis (a liver disease in which scar tissue replaces normal liver tissue)

• Portal hypertension is dangerous because it can lead to bleeding in your stomach and esophagus (the tube that connects your throat to your stomach)

• Medicine can lower blood pressure in your portal vein

• You will need emergency treatment if you have bleeding in your stomach and esophagus

Blood Supply of the Liver

Portal hypertension is usually caused by:

• Cirrhosis of the liver

Cirrhosis is severe liver scarring. The scarring blocks blood flow in the liver and raises the pressure in the blood vessels that go to the liver. You can get cirrhosis from chronic liver diseases such as chronic hepatitis C and alcohol-related liver disease.

The main complication is:

• Bleeding

The high blood pressure in the portal vein forces blood into other blood vessels. These other blood vessels include those around your stomach and esophagus (the hollow tube that carries food to your stomach). These blood vessels swell up with blood, which makes them bleed easily. Bleeding from these vessels can be severe and even fatal.

Portal hypertension itself doesn't cause symptoms, but its effects may cause symptoms:

• Swelling and a tight feeling in the belly from fluid building up there (ascites)

• Swollen veins on your belly

If portal hypertension causes bleeding from your stomach and esophagus, you may have:

• Throwing up blood or black stuff that looks like coffee grounds

• Dark stools (poop) that look like tar

• Bleeding from your anus (the opening where stool comes out)

You may also have symptoms of liver failure such as:

• Jaundice (yellow skin and the whites of the eyes)

• Bleeding and bruising more easily

• Dizziness and confusion (hepatic encephalopathy)

Doctors suspect portal hypertension if you have:

• Liver disease, particularly if the liver disease caused cirrhosis

• Swollen veins on your belly

There aren't any specific tests for portal hypertension, but doctors may do tests on your liver, including:

• Blood tests

• Imaging tests such as ultrasound , MRI (magnetic resonance imaging), or CT (computed tomography) scan

If you're bleeding, doctors will look down your throat with a flexible scope (endoscope). The scope will let them see exactly where in your esophagus and stomach the bleeding is coming from. They can then treat the bleeding.

Bleeding from the veins of the stomach and esophagus is a medical emergency. Doctors treat this bleeding by:

• Giving medicines to slow the bleeding

• Giving blood transfusions

• Closing off the bleeding veins with rubber bands or clips (using an endoscope)

To prevent bleeding from the veins of the stomach and esophagus, doctors use:

• Medicines to lower blood pressure

• Placement of a tube into the liver to connect the portal vein to hepatic vein (portosystemic shunting) which lowers the pressure in the portal vein

• Surgery to lower the pressure in the portal vein by redirecting blood so it doesn’t pass through the liver (portosystemic shunting)

• As a last resort, liver transplant (surgery to remove a failing liver and replace it with a healthy one from a donor)