Portal Hypertension

Portal hypertension, which is characterized by increased blood pressure within the portal vein, can lead to serious complications.
The portal vein carries blood from the stomach, intestines, gallbladder, pancreas and spleen to the liver. When a blockage prevents blood from flowing through the liver as it normally would, it raises blood pressure within the portal vein. This can force blood to instead travel through smaller veins in the esophagus and stomach, and as a result, these smaller veins can become abnormally dilated and more likely to rupture and bleed. This is a life-threatening condition known as variceal hemorrhaging or variceal bleeding. Other potential complications of portal hypertension include infection and kidney failure.

Causes of Portal Hypertension

The type of blockage that leads to portal hypertension is most commonly caused by scarring of the liver, or cirrhosis. When the liver is injured—for example, by hepatitis or alcohol abuse—it has to repair itself, and in doing so, it produces scar tissue. This scar tissue can block blood from flowing through the liver, leading to portal hypertension.

Portal hypertension can also be caused by:

Blood clots within the portal vein (thrombosis)
Crohn’s disease
Chronic infection (bacterial or parasitic)
An inherited disorder such as Adams-Oliver syndrome or Turner syndrome
Underdeveloped bile ducts
A weakened immune system

Symptoms of Portal Hypertension

Early-stage portal hypertension often doesn’t cause any noticeable symptoms. However, once this condition progresses, it can cause:

Gastrointestinal bleeding, which might cause someone to vomit blood or produce stool that is bloody, black or tar-like
Abdominal swelling (ascites)
An iron deficiency (anemia)
Decreased platelet levels and white blood cell counts
Confusion, forgetfulness and difficulty concentrating (encephalopathy)

Diagnosing Portal Hypertension

If a physician suspects that a patient might have portal hypertension, he or she may confirm the diagnosis and determine the severity of the condition using:

Angiography
Biopsy
Blood tests
Computed tomography (CT) scans
Elastography
Endoscopy
Magnetic resonance imaging (MRI) scans
Ultrasounds
X-rays

Treatment for Portal Hypertension

The specialists at Tampa General Hospital often treat portal hypertension using a combination of:

Endoscopic therapy, which may include banding or sclerotherapy
Lifestyle changes such as eating a nutritious diet that’s low in sodium, regularly exercising, limiting or eliminating alcohol intake and quitting smoking
Medications such as beta blockers, vasodilators, antibiotics and diuretics
Radiologic procedures such as a transjugular intrahepatic portosystemic shunt (TIPS) procedure
Surgical procedures such as a distal splenorenal shunt (DSRS) procedure, paracentesis, a devascularization procedure or, in cases involving end-stage liver disease, a liver transplant