Also Known As:

What is Portal Hypertension?

Portal Hypertension is abnormally high blood pressure in the hepatic portal system.

The hepatic portal system is a venous system consisting of the portal vein and its branches. The portal vein receives blood from the gastrointestinal tract, gallbladder, pancreas and spleen and delivers it to the liver. After entering the liver, the vein divides into right and left branches and then into tiny channels that run through the liver. When blood leaves the liver, it flows back to the heart through the hepatic vein.

This increase in pressure within the portal vein can lead to serious complications including:
•   Splenomegaly: Enlarged spleen which can lead to a decrease in white blood cells and platelets.
•   Varices: Veins in the oesophagus and in the stomach become dilated and twisted, potentially resulting in profuse bleeding.
•   Ascites: Accumulation of protein-containing fluid within the abdomen.
•   Hepatic Encephalopathy: Decline in brain function when a damaged liver doesn’t remove toxins from the blood.

Causes

The two factors that can increase blood pressure in the portal blood vessels are:
•   An increased volume of blood flowing through the vessels
•   Increased resistance to the blood flow through the liver

The most common cause of portal hypertension is increased resistance to blood flow caused by extensive scarring of the liver in Cirrhosis. Other factors that can lead to portal hypertension include:
•   Portal Vein Thrombosis
•   Schistosomiasis
•   Liver virus
•   Heart failure
•   Hemochromatosis
•   Family history of Portal Hypertension
•   Narrowed portal vein at birth
•   Focal Nodular Hyperplasia
•   Primary Sclerosing Cholangitis
•   Chronic Pancreatitis
•   Hereditary Haemorrhagic Telangiectasia
•   Congenital Hepatic Fibrosis
•   Nodular Regenerative Hyperplasia

Symptoms

The symptoms of Portal Hypertension will vary based on the underlying condition, as well as any associated complications. Symptoms may include:

•   Purplish, Pale skin, swollen fingers
•   Red or itchy skin or palms
•   Yellowing of the whites of your eyes
•   Dark brown urine
•   Abdominal swelling, pain and tenderness
•   Swollen veins across the abdomen or rectum
•   Spider veins on your stomach or back
•   Tumours with new, visible blood vessels
•   Enlarged breast tissue in men, or shrunken testicles
•   Fast or pounding heartbeat
•   Hepatic Encephalopathy (Confusion or drowsiness)
•   Muscle twitches or hand movements that you cannot control
•   Loss of appetite or sudden weight loss
•   Gastrointestinal bleeding causing black, tarry stools
•   Stomach cramps, bloating, and shortness of breath
•   Vomiting blood

Diagnosis & Treatment

Portal Hypertension is diagnosed by a Doctor using a physical examination, blood tests and scans. The Doctor may also order the following tests:
•   Ultrasound Scan
•   MRI Scan
•   CT Scan
•   Liver Function Tests (LFT)
•   Liver Elastography
•   Endoscopy
•   Hepatic Venous Pressure Gradient (HVPG) measurement

The exact treatment used will be determined by the underlying condition, as well as any associated complications. Treatments may include:
•   Beta Blockers
•   Liver Transplant
•   Fluid removal
•   Diuretic Medications
•   Sclerotherapy
•   Endoscopic Band Ligation (EBL)
•   Transjugular Intrahepatic Portosystemic Shunt (TIPSS)
•   Octreotide Medications
•   Anticoagulant Medications
•   Thrombolytic Medications
•   Lactulose Medications

If a person notices any symptoms of Portal Hypertension, it is crucial to seek immediate medical attention, because severe life-threatening complications can occur.

Additional Information

The portal vein is not a true vein, because it delivers blood to capillary beds in the liver and not directly back to the heart. Approximately 75 percent of total liver blood flow is through the portal vein, with the remainder coming from the hepatic arteries. The blood leaves the liver to the heart in the hepatic veins.

Also see: Portal Vein Thrombosis, Hypertension