Portal Hypertension - Causes, Symptoms and Treatment

Portal hypertension is a condition in which the pressure in the portal venous system rises. The portal vein is formed when the veins of the stomach, intestine, spleen and pancreas come together.

Gaurav Gupta Created on 4th May, 21

Portal hypertension is a complication where pressure increases within the portal venous system. The portal vein forms by merging veins from the stomach, intestine, spleen, and pancreas. It then divides into smaller vessels and flows through the liver. 

Our body cannot circulate blood properly through the liver if there is any blockage due to liver damage. As a consequence, patients will experience high pressure in the portal system. 


It may lead to swollen veins (varices) in the esophagus, stomach, rectum, or umbilical region. Varices can rupture and bleed, posing a life-threatening danger.


Many people in Mumbai and the surrounding area search for a proper treatment for Portal Hypertension. To know about the possible treatments, visit Liver Care, one of the best liver transplant center in Mumbai


Portal Hypertension in Cirrhosis

Cirrhosis of the liver is the most significant reason for portal hypertension. Cirrhosis is scarring that occurs after a liver injury, whether from hepatitis, alcohol, or other less frequent cause of liver damage. Cirrhosis causes increased resistance to portal blood in the liver. 


This increased resistance leads to backpressure in the Portal venous system leading to Portal hypertension. In patients with cirrhosis, portal hypertension is one of the most common causes of hospitalization, liver transplantation, even death. The best treatment for cirrhosis-related advanced portal hypertension is liver transplantation surgery.


Causes of Portal Hypertension, and to prevent it? 

Other than the cirrhosis of the liver,

  • Blood clots in the portal vein.
  • Blockages of the veins that carry blood from your liver to the heart.
  • A bacterial infection like schistosomiasis.
  • NCPF. Non cirrhotic Portal hypertension
Blood clots in the portal vein
Image Source : https://cirrhosiscare.ca/

Symptoms of Portal Hypertension?

The symptoms of Portal hypertension are as follows:

  • Due to a sudden rupture and bleeding from varices, patients may experience dark, tarry stools or blood in the stool.
  • Patients may experience blood in vomiting too.
  • There can be an accumulation of fluid in  abdomen known as ascitis
  • Patients may suffer from confusion and forgetfulness due to impaired liver function.
  • The condition can lower platelet levels in your blood.
  • Weight loss as a result of malnutrition.
  • There can be Kidney malfunctions.
  • Patients may experience fluid accumulation in your lungs.


What is the treatment for Portal Hypertension?

It is important to know the cause of portal Hypertension. In patients of cirrhosis, the only therapeutic and permanent treatment is Liver Transplant. Till the patient is waiting for a liver transplant, the treatment revolves around preventing or controlling complications, especially variceal bleeding. Proper diet, medicines, endoscopic therapy, surgery, and radiology procedures are there to protect patients from any difficulties.  


Endoscopic therapy: It consists of either banding or sclerotherapy. It is typically the first line of treatment for variceal bleeding. Banding is a process in which a gastroenterologist closes a blood vessel with rubber bands to avoid bleeding. Sclerotherapy involves the insertion of a blood-clotting solution into the bleeding varices to prevent bleeding. 


Medications: Your doctor may suggest Nonselective beta-blockers (nadolol or propranolol) alone or with endoscopic therapy. It will reduce the risk of bleeding by lowering the varices pressure. Nonselective beta-blockers are also used to avoid first variceal bleeding in patients with varices and suspected of bleeding. 


Changes in your lifestyle and diet: Stop drinking alcohol and avoid over-the-counter or prescription medications without consulting your doctor. These drugs can aggravate your condition.


Patients must adopt a low-sodium diet, which means the patient will have to cut down on their salt intake. Patients should limit their sodium intake to no more than 2 grams a day. 


All of these are the primary treatments. If these treatments do not work, doctor may suggest: 


Transjugular intrahepatic portosystemic shunt (TIPS): 

It is a radiological method where doctors insert a stent into the liver. A radiologist inserts a needle into the liver to make a tunnel that connects the portal vein and hepatic veins. A metal stent is inserted into this tunnel to hold it open. 


This operation redirects blood flow through the liver and decreases pressure in portal veins, including those in the stomach, oesophagus, bladder, and liver.


Splenorenal shunt (SRS): 

In this surgical procedure, Surgeon connect the splenic vein to  left kidney vein. It helps in controlling the pressure in varices and prevents bleeding. This procedure is advocated in Non Cirrhotic Portal hypertension( NCPH)



Relevant Questions

Q. My wife has issue with abdomen pain & according to Dr the lever is fatty We have done USG of upper & lower abdomen & it shows bit enlargement of lever What shall we do next

If on USG liver is fatty, the Patient should undergo some more blood tests to find the cause and degree of fatty liver. We should also check whether this fatty liver is causing hepatitis or not. Treatment will depend upon finding of these tests. I will suggest you to consult a liver specialist and then further treatment can be started.

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Q. My brother is hospitalized in Nair hospital since last 15days because of alcoholic liver infection, not getting improvement .. So i want to consult with you.

If a patient has alcohol-related liver injury generally treatment depends upon the degree of liver injury. some of the patients will recover after alcohol-related liver injury but in case of severe alcoholic hepatitis, liver transplant may be needed. 

If you want to know more, you can refer the article on Alcohol Liver Disease.

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Q. Hello, I'm a 49-year-old male whose platelet count has dropped to 27000 in the last several months. Gastroenterologists use sonography and endoscopy to detect compensated liver cirrhosis. I'm curious about the long-term effects and what kind of diet I should follow. Thanks

If your doctor has told you that you have compensated cirrhosis, this means you are in the early stages of the disease. The cause of cirrhosis in such patients must be thoroughly investigated. These individuals must also be monitored by liver experts on a frequent basis in order to diagnose and treat issues when they emerge. These individuals must also adhere to a rigorous liver-related diet. Diets are usually changed and tailored to the specific needs of each patient. I hope this answers your question, and please contact me if you have any other questions!

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Q. What can potentially cause damage liver?

The 3 main causes of liver damage are: Obesity, undiagnosed hepatitis infection and alcohol misuse. There are some other factors that lead to liver damage. That is,

  • Too Much Vitamin A From Supplements
  • Excess intake of Soft Drinks
  • Too much sugar
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