Portal hypertension is defined as excessive pressure in the portal vein, the Vena Portae. The term portal hypertension is also used synonymously. The portal vein is responsible for carrying blood from the abdominal organs, such as the stomach, intestines and spleen, to the liver. Any pressure that exceeds 4-5 mmHg in the portal vein is considered portal hypertension.
What is portal hypertension?
One speaks of portal hypertension when the pressure in the vein is 2 to 6 mmHg above the normal pressure, which in healthy people should be between 6 and 10 mmHg. See howsmb for HES Definition and Meaning.
An abnormal increase in pressure in the portal vein is caused by an increase in resistance. Portal hypertension is usually due to a stagnation of blood in the vein or to a reduced flow of blood into the circulatory system. If there is an obstruction in the vein that blocks the flow of blood, this can be local, but it can also extend over very large areas in entire vascular regions.
In the different cases, one speaks of prehepatic, intrahepatic or posthepatic obstructions, i.e. obstacles within the vein or the vascular region.
Portal hypertension usually occurs as a result of cirrhosis of the liver. In rarer cases, the causes are also pathological changes in the liver vessels, blockages within the spleen or the portal vein itself.
Portal hypertension can progress to esophageal varices (life-threatening bleeding from the lining of the esophagus) that occur when venous pressure is greater than 12 mmHg, or hepatic encephalopathy.
In a large number of cases, portal vein disease is related to alcohol abuse or hepatitis C infection.
Symptoms, Ailments & Signs
Portal hypertension itself does not show any symptoms, but it can cause various disorders in the body, which are then associated with certain symptoms. Typical is the effect on the liver, whose function can be impaired. This is reflected in a feeling of fullness and pressure in the upper abdomen and in various skin signs.
Dilated vessels are visible through the skin, known as bill skin. In addition, so-called Spider Naevi (liver asterisks) form, which are small star-shaped converging red dots on the face and upper body. The palms of the hands and feet turn red, the lips become smooth and shiny and look like they have been varnished red, and the tongue also turns red.
If the liver can no longer properly break down the harmful substances, they travel to the brain and can trigger hepatic encephalopathy, which is associated with confusion and dizziness. Loss of appetite and weight loss can also occur, and fluid can build up in the abdomen, which is known as dropsy or ascites.
The spleen can enlarge and cause pain in the upper left abdomen, sometimes radiating to the back. Varicose veins can develop in the esophagus and stomach. Since these tend to bleed more heavily, vomiting of a dark mass reminiscent of coffee grounds and black, so-called tarry stools can occur.
Diagnosis & History
In the case of portal hypertension, there are often no symptoms to be felt. Problems are more likely to arise from the complications that follow. One of the most serious is esophageal variceal bleeding, bleeding from the lining of the esophagus that is often life-threatening. Such bleeding is due to the dilation of the veins within the esophagus. In most cases, such bleeding occurs without the presence of pain or other symptoms.
If portal vein hypertension is present, it is not uncommon for bypass circuits to form in the blood. An enlargement of the spleen, abnormal accumulation of fluid in the abdomen or hepatic encephalopathy, i.e. a functional disorder of the brain, can be associated with the disease. The body’s detoxification functions may be limited, changes in the blood count are possible.
The pressure in the portal vein can only be measured via a venous catheter, an examination that involves a high level of risk for the patient. A diagnosis can also be made using computer tomography or ultrasound. An endoscopy can detect changes in the gastric mucosa or bleeding in this area.
There is a risk of serious complications due to portal hypertension. As a result, blood and lymph from the liver can no longer drain as usual. The body attempts to maintain circulation, and for this purpose it resorts to the otherwise unused portocaval anastomoses located between the systemic and hepatic circulation. This, however, threatens various serious consequences.
Due to the high pressure in the portal vein, bypass circulation occurs. They connect to the superior and inferior vena cava, respectively, bypassing the liver. The blood from the entire digestive region, which otherwise uses the passage through the portal vein, flows directly to the heart via the vena cava. As a result, the abdominal skin veins (caput medusae) expand significantly.
The anal veins are also affected, which in turn leads to the formation of hemorrhoids, as well as the gastric and esophageal veins. If sudden pressure or mechanical irritation occurs, there is a risk that the affected veins will burst. This can result in intense life-threatening bleeding. The patient vomits blood or suffers a circulatory shock.
Another serious complication of portal hypertension is abdominal dropsy (ascites). It occurs because the liver produces fewer proteins in the event of dysfunction. The lack of proteins leads to the squeezing out of fluid coming from the portal veins, which then causes the accumulation of water in the abdominal cavity. Hepatic encephalopathy is also possible.
When should you go to the doctor?
If stomach pain or gastrointestinal bleeding occurs, this may indicate portal hypertension. A doctor’s visit is necessary if the symptoms do not go away on their own or rapidly increase in intensity. If fever, kidney or spleen problems and other signs of portal hypertension occur, medical help is recommended. People suffering from ascites or a chronic cardiovascular disease should inform their family doctor. At the latest when the condition affects your well-being, medical advice is needed.
In addition to the general practitioner, a cardiologist or a gastroenterologist can be consulted with portal hypertension. Other contacts are the nephrologist and the ENT doctor. First of all, the family doctor can be consulted with the condition, who can make a suspected diagnosis based on an examination of the cardiovascular system. In the case of severe symptoms, inpatient hospitalization is necessary. Patients should also consult a doctor closely after treatment and inform them of any unusual symptoms and any side effects and interactions of the prescribed medication.
Treatment & Therapy
Since other diseases are always the cause of portal hypertension, such as hepatitis C or alcoholism, these should be treated first, taking into account nutrient deficiency, the tendency to increased bleeding and damage to the liver and cardiovascular system .
If esophageal variceal bleeding occurs, the mortality rate is about one third. Surviving patients face a 50 to 70 percent risk of bleeding again within the next two years. This risk can be reduced with medication.
If the patient is responding poorly to treatment, a stent connection in the liver or a shunt may improve the condition. Nevertheless, the long-term prognosis can look poor. In some cases, a liver transplant can help the patient.
To avoid portal hypertension, it is imperative that the patient maintains absolute abstinence from alcohol. This is the only way to prevent, stop or at least slow down pathological changes in the tissue of the liver. Beta- blockers may be prescribed as a precautionary measure to prevent rebleeding in patients who survive an esophageal bleed.
Portal hypertension can be treated quite well in the follow-up phase. First of all, patients should be aware that certain habits such as alcohol consumption and unhealthy diet are the triggers for the disease. By completely avoiding alcohol and high-fat foods, you can protect your cardiovascular system and your liver. As a result, the pathological changes in the liver tissue can be slowed down or even prevented entirely.
Depending on the individual case, doctors may prescribe beta-blockers, which patients must take as recommended. Diet also affects high blood pressure. Too much salt puts a strain on the body and increases blood pressure. That’s why it’s important to drastically reduce salt consumption and use other spices instead.
Healthy foods like fruits, vegetables, and nuts help lower high blood pressure. Physical activity is also part of successful aftercare. Regular, gentle exercise outdoors gradually normalizes blood pressure. A combination of a nutrition plan and sporting activities ensures better well-being. This is particularly interesting for overweight patients who lose weight through more exercise and thus put less strain on their heart.
You can do that yourself
Those affected can counteract portal hypertension independently by rearranging their everyday life a little. Self-help in everyday life is quite possible.
For example, it is advisable for patients to watch their diet. Salty foods in particular have a negative effect on blood pressure. It is therefore advisable to avoid salt as much as possible and use other spices instead. Nuts can also be added to the diet. Affected people who eat nuts in moderation achieve a positive effect on their high blood pressure.
In addition to nutrition, the focus should be on sporting activities. This does not mean that those affected should do high-performance sports, but regular exercise in the fresh air can normalize blood pressure. Both diet and exercise are key when the individual is overweight.
Obesity, even slight, is often a possible cause of high blood pressure. Anyone who weighs too much and suffers from portal hypertension should try to reduce their weight a little. Otherwise, those affected should take it easy. Stress and overexertion lead to high blood pressure. If these two potential causes can be eliminated, this also means that the blood pressure can normalize.