Portal Hypertension Treatment in Mumbai

Dr. Gaurav Gupta is one of the leading surgeons for liver transplant in Mumbai. He is presently associated with Fortis Hospitals as a Head of the Liver Transplant and HPB Surgery Department. He has rich surgical experience and has handled complicated cases of Liver Transplant across India.

What is Portal Hypertension and how does it affect us?

Portal hypertension is when the pressure inside the portal vein rises. It is because obstruction in the blood flow via the liver causes the pressure to rise.

Increased pressure in the portal vein causes prominent veins (varices) to form across the esophagus and stomach to get past the obstruction. The varices become weak and prone to bleeding.

If a patient is suffering from this complication, he or she should visit Dr. Gaurav Gupta. 

What are the causes of developing Portal Hypertension? 

Liver scarring or cirrhosis is the most prevalent cause of portal hypertension. Cirrhosis occurs when a liver injury from hepatitis, alcohol overconsumption or different other liver damage causes. Cirrhosis causes scar tissue to form in the liver, obstructing blood flow and impairing the patient’s liver’s function.

Thrombosis, or a portal vein blood clot, can also lead to portal hypertension.

What are the signs and symptoms of the disease?

There can be no symptoms of portal hypertension in the beginning. So, it is not easy to reveal what is going on in the liver. However, if the patient has a liver disease that progresses to cirrhosis, then he or she is more likely to get portal hypertension.

The following are the most common signs and consequences of portal hypertension –

• Black, tarry stools or blood in the stools and blood vomiting from varices that have spontaneously ruptured and bled.
• features of hypersplenism- low platelet count, anemia, and low White Blood cell count.
• A fluid buildup in the abdomen, known as Ascites.
• Poor liver function and a diversion of blood flow away from the liver, which causes confusion and amnesia.

Different Portal Hypertension types:

Pre hepatic: It occurs from a blockage in the patient’s portal vein before the liver.

Intrahepatic:  It occurs from the damage in the patient’s liver structure.

Post hepatic: It occurs when there is a blockage in the vein outside the patient’s liver.

Who is likely to get the disease? 

Portal hypertension is more common in people who have a high risk of liver disease and cirrhosis. Cirrhosis is more frequent in males than females. People over the age of 50 are more prone to acquire it.

Several other reasons can cause cirrhosis. Like –

• Overconsumption of alcohol
• Diabetes type 2
• Obesity or being overweight

Diagnosis of the disease: 

If symptoms aren’t apparent, diagnosing Portal Hypertension might be tricky. Screenings like a doppler ultrasound can be beneficial. An ultrasound can indicate the state of the portal vein and the flow of blood through it. A CT scan may be helpful if an ultrasound is unclear.

An assessment of the flexibility of a patient’s liver and surrounding tissue is another screening approach that is becoming increasingly popular. When tissue is pressed or probed, elastography is used to determine how it reacts. A lack of flexibility indicates the presence of illness.

If someone has gastrointestinal bleeding, the doctor will most likely perform an endoscopic examination. This procedure includes using a small, flexible gadget with a camera on one end that lets the doctor view the interior organs. All such diagnostic facilities are available.

What are the treatment options available for a patient? 

There are some types of portal hypertension that can be cured by surgery. Following are the name of the surgeries:

• Portosystemic Shunt: Portosystemic shunt is type of surgery where  portovenous system is bypassed to systemic venous system. This bypass blood flow from high pressure portosystemic circulation to systemic circulation decreasing pressure in portal system and hence relieving portal hypertension features.

Two most common types of shunt performed are

1. Distal Splenorenal shunt
2. Proximal Splenorenal shunt

Other non-surgical treatment options are:

Lifestyle adjustments can aid in the treatment of Portal Hypertension:

• enhancing the diet with nutrients
• avoiding alcoholic beverages
• regular physical activity
• If a patient smokes, he or she should consider stopping.

Beta-blockers and other medications are also helpful in lowering portal pressures. Other drugs, such as propranolol and isosorbide, may also assist in reducing portal vein pressure. They can also help to prevent further internal bleeding.

If someone has ascites, the doctor may prescribe a diuretic to help lower the amount of fluid in the body. One should limit sodium intake to minimize fluid retention.

TIPSS, as an effective procedure, can control sudden bleeding. It allows blood to flow from the portal vein into other blood arteries via new routes.