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Diagnosis / Portal Hypertension

Portal hypertension is a condition where the vein that is responsible for transporting blood from your digestive organs to your liver (known as the portal vein) is blocked, causing increased pressure in the vein. It is most common in people with cirrhosis of the liver, though it can also be the result of a blood clot in the vein. The scarring from cirrhosis blocks the blood flow through the liver, resulting directly in portal hypertension.

When the portal vein is blocked, the blood from your digestive organs reroutes itself to other, smaller blood vessels. This causes the development of varices, or large veins, across your abdomen and esophagus, but because these vessels aren’t meant to carry that volume of blood, they become fragile, and may bleed easily. Additionally, when the blood is no longer routed through the liver for filtering, organs like the kidneys become overworked, trying to eliminate excess sodium without the assistance of the liver. This results in fluid buildup in the legs and feet (edema) and in the abdomen (ascites).

Symptoms of Portal Hypertension

If you have cirrhosis or cancer of the liver, the chances of developing portal hypertension are high. But while portal hypertension is associated with liver disease, your symptoms may not seem to be liver-related. The most common symptoms and complications associated with portal hypertension include:

  • Gastrointestinal bleeding – if the varices rupture, the bleeding will cause vomiting of blood or black, tarry stools.
  • Ascites – the accumulation of serous fluid in your abdomen.
  • Encephalopathy, forgetfulness, confusion – these are also symptoms of poor liver function and the lack of blood and oxygen in the liver.
  • Decrease in platelets or white blood cells

You may need to undergo lab tests, x-rays or an endoscopic exam to determine if you have variceal bleeding. Variceal bleeding can be a recurring problem, so you will need to address it through treatment to prevent further issues.

Treatments for Portal Hypertension

Maintaining good nutritional habits and a healthy lifestyle will help your liver function properly. Options your doctor may recommend to address portal hypertension include the following:

  • Diet and lifestyle changes – To help your liver function at an optimum level, you should reduce or completely eliminate alcohol, drastically reduce your sodium intake, and avoid NSAID pain relievers and other medications that can affect your liver.
  • Medications – Certain medications can reduce the pressure in the variceal veins, reducing the risk of recurrent rupture or bleeding.
  • Endoscopic therapy – to address the enlarged variceal veins, you may undergo sclerotherapy or banding. Sclerotherapy is the injection of a solution into the veins to collapse them, controlling or eliminating bleeding. Banding is the use of rubber bands to close off the blood supply to the variceal veins.

If the above treatments are not able to control variceal bleeding, you may require either a transjugular intrahepatic portosystemic shunt (TIPS), or a distal splenorenal shunt (DSRS), both of which are designed to reduce pressure in the variceal veins and control bleeding.

If you are living with cirrhosis of the liver or liver cancer, and think you may be suffering from portal hypertension, it is important that you seek treatment immediately. Call IVC today at 503-612-0498 and schedule an appointment for a consultation.

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Jason Bauer, MD RVT
Michael Pfister, MD RVT

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