What is Portal Hypertension?
is the formation of high blood pressure in the portal vein of the liver and other hepatic veins (veins of the liver). The portal vein is the main blood vessel of the liver which drains blood from the gastrointestinal tract and the spleen to the liver. Precisely, when the pressure in this vein of the liver exceeds 5 to 10 millimeters of mercury (mm Hg) it causes the discussed condition.
Causes of Portal Hypertension.
Due to liver cirrhosis and hepatic fibrosis:
The former indicates scarring and intensive damage to the liver disease due to liver disease. The latter indicates malfunction caused by the formation of excess connective tissue in the liver. Hepatic Fibrosis could be congenital (born with) or caused by diseases like Wilson’s disease(excess accumulation of copper in tissues) or Hemochromatosis (excess accumulation of iron in tissues).
Due to Portal Vein Thrombosis or congenital artesia:
Portal Vein Thrombosis is the formation of a blood clot in the portal vein which inhibits the blood flow. It is caused by complications arising in diseases like cirrhosis, pancreatitis, diverticulitis or by the formation of cancerous masses especially in the bile ducts. In congenital artesia sometimes babies are born with a birth defect in which the bile duct connecting the liver and the small intestine is blocked or absent.This can cause increased pressure in the portal vein.
Due to hepatic vein thrombosis:
Any blood clot in any other vein of the liver can also cause it.
Due to inflammation in the pericardium( Constrictive Pericarditis):
Pericardium is the muscular sac that contains the heart and the roots of the major veins to the liver.When it gets swollen it might cause the increased pressure.
Symptoms of the increased pressure in the portal vein
- Ascites (Fluid retention in the membrane separating the abdominal wall and the abdominal cavity).
- Hepatic Encephalopathy (Enlargement of the liver).
- Splenomegaly (Enlargement of the spleen).
- Increased risk of bacterial infection in the abdominal organs.
- Increased risk of infection in the kidneys and consequent malfunction.
- Increased risk of esophageal and gastric varices (dilation of the blood vessels of the esophagus and gastric cavity due to the increased pressure) which may ultimately cause gastrointestinal bleeding.
Treatment of Portal Hypertension
- Drugs such as beta blockers and nitrates reduce pressure in the portal vein. The occurrence of bleeding varices are also greatly improved because of it.
- To resolve any blood clot creating the additional pressure, drugs can be administered to dissolve the blood clot.
- Anti coagulants such as Heparin can be prescribed in people prone to blood clots to prevent future obstructions.
- A drug known as Octreotide is administered to reduce the volume of blood directed through the liver to bring down the hypertension.
- In infants, this condition is mostly caused by an infected umbilical cord or appendix. The problems are generally treated with surgery and antibiotics to provide relief from the increased pressure in the blood vessel.
- When all other efforts to treat this condition fails, surgery is performed whereby a shunt is placed and an alternative route for the blood flow is made.