Portal Hypertension

Portal Hypertension

Portal hypertension is high blood pressure of the portal vein. The portal vein is in your abdomen. It collects nutrient-rich blood from your intestines and carries it to the liver. The liver cleans the blood for your body to use.

When you have portal hypertension, the blood from the liver can no longer use the portal vein to travel back to the heart. This means it has to use smaller veins in the esophagus, stomach, and intestines. These veins are much weaker than the portal vein and may swell up and burst under the added pressure.

Symptoms

Having a higher than normal pressure inside the portal vein can lead to a number of related symptoms and complications. These include:

  • Enlarged liver

  • Varicose veins of the esophagus

  • Internal hemorrhoids

  • Yellowing of the skin, or jaundice

  • Weight loss from malnutrition

  • Ascites, or fluid buildup in the abdomen

Causes

These are the most common cause of portal hypertension:

  • Cirrhosis, or scarring of the liver. This blocks the blood flow in the liver and leads to portal hypertension.

  • Clotting of the portal vein

  • Clotting of the veins in the liver

Diagnosis

Unfortunately, health providers can’t measure high blood pressure in the portal vein with a cuff as they can regular high blood pressure. If you are at risk for or already have cirrhosis, your doctor will likely do various lab tests, X-rays, and endoscopic exams to see if you have portal hypertension.

Treatment

Health providers treat portal hypertension in several ways. You might need to take beta blockers, or medicines that improve how your heart and blood vessels work. These medicines often also reduce the risk of bleeding from swollen veins. If you have internal bleeding because of portal hypertension, your doctor might inject medicine into the vein to help stop the bleeding. Or he or she may place bands around veins to stop the bleeding.

In more severe situations, your doctor may treat portal hypertension with shunting. This involves putting stents in the portal vein to open it and improve blood flow. Shunting can be done with or without surgery. Surgical shunting can cause more complications than the nonsurgical method.

Complications

The small veins overloaded because of portal hypertension can burst and cause internal bleeding. This usually happens where the esophagus and stomach meet. This complication can cause sudden, explosive vomiting of blood. It can be fatal.

Fluid buildup in the abdomen can also lead to kidney failure. This extra fluid can cause you to feel full quickly, leading to weight loss and malnutrition. The discomfort from carrying all that fluid can also reduce how well you can get around.

Prevention

Healthy lifestyle habits can help prevent portal hypertension. Avoid binge drinking and alcohol dependence. If you are a woman, you should have no more than one alcoholic drink a day. Men should have no more than two. Also, practice safe sex and avoid needle drugs, or use clean needles, to avoid liver infections. Protect your liver from the side effects of over-the-counter drugs. Never use more than the recommended dose of medications that can damage the liver, such as acetaminophen (Tylenol).

When to call the doctor

Portal hypertension is a dangerous condition with severe, life-threatening complications.  Call your doctor immediately if you notice any of these symptoms:

  • Yellowing of the skin

  • Unusually swollen abdomen

  • Unexpected weight loss

Living with portal hypertension

If you have serious liver damage, you need to change the way you live. This will help prevent portal hypertension. Eat a healthy, balanced diet to promote a healthy weight. Avoid too much salt, sugar, and protein, all of which can lead to swelling or fluid retention. In some cases, you may need a special diet, so discuss this with your health care provider.

Other steps that can help are safe, moderate exercise and propping up your feet and legs when resting to prevent swelling.