portal hypertension in a patient

by Dr. Mavis Marquardt Sr. 4 min read

Portal Hypertension: Causes, Symptoms, Diagnosis

15 hours ago What are other treatment procedures for portal hypertension? Liver transplant is done in cases of end-stage liver disease. Devascularization is a surgical procedure that removes the bleeding varices. This procedure is done when a TIPS or a... The accumulation of fluid in the abdomen … >> Go To The Portal


Portal hypertension is elevated pressure in your portal venous
portal venous
The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents.
https://en.wikipedia.org › wiki › Portal_vein
system
. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver.

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Portal hypertension is fairly uncommon, but when it occurs, it most often occurs in older adults and may result in death, if untreated. How does portal hypertension occur? Portal hypertension occurs when there is an obstruction of blood flow through the liver, and pressure rises within the portal vein.

How serious is portal hypertension?

What are the consequences of portal hypertension? The main symptoms and complications of portal hypertension include: Gastrointestinal bleeding marked by black, tarry stools or blood in the stools, or vomiting of blood due to the spontaneous rupture and hemorrhage from varices.

What are the consequences of portal hypertension?

Portal hypertension (PHTN) is a well-established risk factor for ... Patients met inclusion criteria if they had a diagnosis of PHTN and underwent initial endoscopy prior to age 18 years. Patients were grouped into primary prophylaxis if their initial ...

What is the prognosis for portal hypertension?

  • Hematemesis or melena - May indicate gastroesophageal variceal bleeding or bleeding from portal gastropathy
  • Mental status changes - Such as lethargy, increased irritability, and altered sleep patterns; these may indicate the presence of portosystemic encephalopathy
  • Increasing abdominal girth - May indicate ascites formation

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What are clinical signs of portal hypertension?

What happens when you have portal hypertension?

When you have portal hypertension, this increased pressure makes it harder for blood to flow normally through the portal vein. Blood is redirected away from (bypasses) the liver. The body forms new vessels for the blood to flow through, especially to the esophagus and stomach. These veins become enlarged and twisted.

What are the clinical findings in a patient with portal hypertension?

The main symptoms and complications of portal hypertension include: Gastrointestinal bleeding: Black, tarry stools or blood in the stools; or vomiting of blood due to the spontaneous rupture and bleeding from varices. Ascites: An accumulation of fluid in the abdomen.

What is the most common complication of portal hypertension?

Variceal hemorrhage is the most common complication associated with portal hypertension. Almost 90% of patients with cirrhosis develop varices, and approximately 30% of varices bleed. The estimated mortality rate for the first episode of variceal hemorrhage is 30-50%.

How do you manage portal hypertension?

Pharmacologic therapy for portal hypertension includes the use of beta-blockers, most commonly propranolol and nadolol. Brazilian investigators have suggested that the use of some statins (eg, simvastatin) may lower portal pressure and potentially improve the liver function.

What are the 3 categories of portal hypertension?

With regard to the liver itself, causes of portal hypertension usually are classified as prehepatic, intrahepatic, and posthepatic.

What are the differential diagnosis of portal hypertension?

Cirrhosis of any etiology (viral hepatitis, autoimmune cirrhosis, alcohol-related cirrhosis, primary biliary cirrhosis, etc) Hepatic infiltrative diseases (eg, Wilson disease, hemochromatosis, sarcoidosis) Hepatoportal arteriovenous fistula. Portal vein obstruction.

What is the most common cause of portal hypertension?

Portal hypertension is elevated pressure in your portal venous system. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver.

What stage of liver disease is portal hypertension?

Portal hypertension is defined as the pathological increase of portal venous pressure, mainly due to chronic end-stage liver disease, leading to augmented hepatic vascular resistance and congestion of the blood in the portal venous system.

How long can you live with portal hypertension?

These complications result from portal hypertension and/or from liver insufficiency. The survival of both stages is markedly different with compensated patients having a median survival time of over 12 years compared to decompensated patients who survive less than 2 years (1, 3).

What are symptoms of poor liver function?

SymptomsSkin and eyes that appear yellowish (jaundice)Abdominal pain and swelling.Swelling in the legs and ankles.Itchy skin.Dark urine color.Pale stool color.Chronic fatigue.Nausea or vomiting.More items...•

Does CT scan show portal hypertension?

Conclusions. Multi-slice CT serves as an important non-invasive imaging modality in the diagnosis of collaterals in cases of portal hypertension. CT portography can replace endoscopy in the detection of high-risk varices.

What Is Portal Hypertension?

Portal hypertension is high blood pressure in the portal vein of your liver. Your portal vein is the main blood supply for your liver. Certain dise...

What Causes Or Increases My Risk For Portal Hypertension?

1. Cirrhosis (liver failure) caused by alcohol abuse or hepatitis 2. Blood clot or blockage of blood in your portal vein or in a vein that brings b...

What Are The Signs and Symptoms of Portal Hypertension?

1. Pale skin, swollen fingers, or red or itchy skin or palms 2. Yellowing of the whites of your eyes, or dark brown urine 3. Swelling of your abdom...

How Is Portal Hypertension Diagnosed?

Your healthcare provider will ask about your signs and symptoms and history of liver problems. He or she may also ask if you have had an injury to...

How Is Portal Hypertension Treated?

1. Beta-blockers lower the blood pressure in your portal vein by slowing your heart rate and making your blood vessels wider. A lower pressure may...

What Can I Do to Manage Portal Hypertension?

1. Limit sodium (salt) as directed. Too much sodium can affect your fluid balance. Check labels to find low-sodium or no-salt-added foods. Some low...

When Should I Contact My Healthcare Provider?

1. Your abdomen swells. 2. You urinate very little. 3. Your heartbeat is faster than normal for you. 4. You have increased confusion or forgetfulne...

What is the goal of portal hypertension?

The goal of treatment for portal hypertension is to prevent further complications and decrease pressure. However, it can be difficult to maintain the proper pressure. Learn more about portal hypertension treatment at Johns Hopkins.

What is the first imaging test for portal hypertension?

They are noninvasive and can give your doctor a detailed image of your portal venous system. A duplex Doppler ultrasound is typically the first imaging test ordered. A Doppler ultrasound uses sound waves to see how the blood flows through your portal vein.

What is a pressure measurement study?

Pressure Measurement Studies. An interventional radiologist may perform a pressure measurement study to evaluate the level of pressure in the hepatic (liver) vein. This can be done as an outpatient, where a radiologist will access one of your veins, usually via internal jugular vein.

Does Johns Hopkins have portal hypertension?

Portal Hypertension Diagnosis at Johns Hopkins. There are a number of ways to diagnose portal hypertension. For patients with end-stage liver disease who present with ascites and varices, the doctor may not need to perform any diagnostic tests and can confirm a diagnosis based on symptoms. Diagnostic procedures your doctor may order include:

Can cirrhosis cause portal hypertension?

If you have an advanced liver disease, such as cirrhosis, you have an increased risk of developing portal hypertension. Be aware of unusual symptoms and report them to your doctor right away. Symptoms and signs of portal hypertension include:

Is portal hypertension a hepatic encephalopathy?

Hepatic encephalopathy is impairment in neuropsychiatric function associated with portal hypertension. Symptoms are usually mild, with subtle changes in behavior, changes in sleep pattern, mild confusion or slurred speech. However, it can progress to more serious symptoms, including severe lethargy and coma. Although we lack clear understanding of encephalopathy, there is an association with increase in ammonia concentration in the body. (However this does not correlate to regular blood test levels of ammonia).

What causes portal hypertension?

The main cause of portal hypertension is cirrhosis. This is a scarring of the liver. It can result from several conditions such as hepatitis (an inflammatory disease) or alcohol abuse. Autoimmune diseases of the liver such as autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cholangitis also are causes ...

How to reduce blood pressure in portal vein?

improving your diet. avoiding alcohol consumption. exercising regularly. quitting smoking if you smoke. Medications such as beta-blockers are also important to help reduce your blood pressure and relax your blood vessels. Other medications, such as propranolol and isosorbide, may help lower the pressure in the portal vein, too.

What causes a blood clot in the portal vein?

liver infections. reaction to certain medications, such as methotrexate. Cirrhosis can cause the normally smooth inner walls of the portal vein to become irregular. This can increase resistance to blood flow. As a result, blood pressure in the portal vein increases. A blood clot can also form in the portal vein.

What is the best way to check for portal veins?

Screenings such as a doppler ultrasound are helpful. An ultrasound can reveal the condition of the portal vein and how blood is flowing through it. If an ultrasound is inconclusive, a CT scan may be helpful.

What does it mean when your blood pressure is too high?

When the blood pressure in the portal vein is too high, you have portal hypertension. Portal hypertension can be quite serious, though it’s treatable if diagnosed in time. It’s not always easy to diagnose, however. Typically, you become alerted to the condition when you start experiencing symptoms.

Which organs carry oxygen rich blood to the heart?

Arteries carry oxygen-rich blood from your heart to your organs, muscles, and other tissue. Veins carry blood back to your heart, except for the portal vein, which carries blood to your liver.

What is the role of the liver in the heart?

The liver plays an important role in your circulation. It filters out toxins and other waste matter that the digestive organs have deposited in your blood stream. When the blood pressure in the portal vein is too high, you have portal hypertension.

What is portal hypertension?

Portal hypertension is high blood pressure in the portal vein of your liver. Your portal vein is the main blood supply for your liver. Certain diseases cause scar tissue that narrows the veins in your liver. The scar tissue slows blood flow through your liver. This causes the blood pressure in your liver to rise.

How is portal hypertension diagnosed?

Your healthcare provider will ask about your signs and symptoms and history of liver problems. He or she may also ask if you have had an injury to your abdomen or blood clotting problems. Tell him or her if you have used birth control pills or taken vitamin A recently. You may also need any of the following:

How is portal hypertension treated?

Beta-blockers lower the blood pressure in your portal vein by slowing your heart rate and making your blood vessels wider. A lower pressure may prevent damage to your liver and help prevent bleeding.

What can I do to manage portal hypertension?

Limit sodium (salt) as directed. Too much sodium can affect your fluid balance. Check labels to find low-sodium or no-salt-added foods. Some low-sodium foods use potassium salts for flavor. Too much potassium can also cause health problems. Your healthcare provider will tell you how much sodium and potassium are safe for you to have in a day.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medication

If there are enlarged veins in your esophagus or stomach due to portal hypertension, physicians can treat it with medications to lower the pressure in these veins and prevent them from bleeding. Medications used to treat enlarged veins in the esophagus and stomach include:

Endoscopic Therapy

An endoscopy can treat gastrointestinal hemorrhage. There are a number of endoscopic treatments for this purpose:

Shunting Procedures

Shunting is another method of controlling acute bleeding. If you have had recurrent bleeding despite medical or endoscopic treatment, you may require either of the two methods of shunting:

Liver Transplantation

Liver transplantation is the only effective treatment for cirrhosis and portal hypertension. Liver transplantation means your diseased liver is replaced with a healthy one from deceased donors or living donors who donate portions of the liver. The surgery is long and complex, requiring the removal and replacement of your body's largest solid organ.

Why does portal hypertension persist?

However, even when portal blood flow is entirely diverted through collaterals, portal hypertension persists because of a concomitant increase in portal venous inflow, which in turn is caused by splanchnic vasodilatation, 9mostly mediated by an increase in nitric oxide.7.

What is the mechanism of portal hypertension?

The initial mechanism in the genesis of portal hypertension is an increase in vascular resistance that can occur at any level within the portal venous system. Portal hypertension is therefore classified as prehepatic (portal or splenic vein thrombosis); intrahepatic (cirrhosis), and posthepatic (Budd-Chiari syndrome).

What is the portal vein?

Anatomically, the portal vein is formed by the union of the superior mesenteric vein and the splenic vein. The mesenteric vein collects blood from the splanchnic circulation. Thus, portal venous inflow is determined by the state of constriction or dilatation of splanchnic arterioles.

Is HVPG safe?

Pharmacologic therapies should thus be ideally tailored to a target decrease in HVPG. Even though the HVPG procedure is simple and safe, its use is not widespread in the United States because it is invasive and because it has not been appropriately standardized.17. Pharmacologic Therapy for Portal Hypertension.