What is portal hypertension?
The portal venous system works to drain blood from various parts of your body like the pancreas, liver, gallbladder, GI tract and spleen and then direct it back into your liver through the portal vein. Once the blood reaches the liver, it gets circulated back to the heart. When diagnosed with portal hypertension, you are likely experiencing elevated blood pressure in your portal venous system due to a block of blood flow in the portal vein.
What causes portal hypertension?
The main cause of portal hypertension is severe liver disease also known as cirrhosis of the liver. Cirrhosis of the liver happens with there is scarring of the liver tissue which then blocks blood flow to the liver’s portal vein. An uncommon cause of portal hypertension is blood clots, restricting the blood flow to the portal vein.
Symptoms of portal hypertension
While it is likely inevitable that you will experience enlarged veins with portal hypertension, the symptoms experienced from these enlarged veins can differ from person to person. Any of the following symptoms or complications may be present:
- Mental disorientation as the liver is not able to deactivate toxins in the blood.
- Blood in your vomit or excrement from varices
- Ascites; fluid builds up in the abdomen due to restricted portal vein outflow.
How is portal hypertension diagnosed?
If your doctor is not able to provide a complete diagnosis from your symptoms and a physical exam then they may request additional testing such as blood tests, imaging tests or an endoscopy.
What are treatment options for portal hypertension?
This depends on the underlying problem. If the cause of portal hypertension is cirrhosis then you will be followed by a hepatologist in the Center for liver disease that will manage your condition with medications, paracentesis, and endoscopy until your condition is sweet enough to require a liver transplant. Sometimes a shunt can be placed to reduce the pressure in the portal vein. The type of shunt is determined by weather the portal vein is open or clotted.
- If the portal vein is open and the patient is not encephalopathic then the preferred treatment is a Transjugular intrahepatic portosystemic shunt (TIPS):
- The interventional radiologist created a shunt from the portal vein of the liver to the hepatic vein in a minimally invasive way.
- If the main portal vein is down the Distal splenorenal shunt (DSRS) is preferred: The distal splenorenal shunt relieves pressure of the portal vein by directing blood flow away from the portal vein. This surgery still allows blood to flow through the liver by disconnecting the portal vein in the spleen and attaching it to the left kidney.
- If the main portal vein is down but the left portal vein is open then a Mesorex shunt can be performed. This restores portal flow to the liver and keeps it healthy. This is the preferred option.
- Mesocaval shunt can also be done depending on the anatomical consideration.