Portal Hypertension: Causes and Symptoms

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If you are looking for detailed information about portal hypertension or want to know how this condition affects health, follow this article from EndoBlog.

Portal Hypertension: What is it?

Portal hypertension is a syndrome characterized by increased blood pressure in the portal system region, which is responsible for transporting blood from the gastrointestinal tract to the liver.

This condition is closely linked to liver dysfunctions and changes in the blood vessels that make up the portal system.

We can understand portal hypertension through an analogy with the principles of Ohm’s law, relating pressure, blood flow, and resistance.

In this context, the main factors that determine the pressure in the portal system are blood flow and the resistance found in the vessels that make up this system.

Causes

Portal hypertension is a complex condition that can arise from various causes, with liver cirrhosis being the most common in Western countries.

Liver cirrhosis, in turn, can originate from viral hepatitis B and C, chronic alcohol consumption over a lifetime, and hepatic steatosis (accumulation of fat in the liver). Cirrhosis creates an increase in resistance to blood flow in the liver, contributing to portal hypertension.

Besides cirrhosis, there are other causes for portal hypertension, such as:

• Polycystic liver disease, which involves the abnormal growth of cysts in the liver;
• Schistosomiasis;
• Congenital hepatic fibrosis, a condition of abnormal liver formation from birth;
• Right heart failure;
• Budd-Chiari syndrome, a disease that involves obstruction of the hepatic veins;
• Thrombosis in the liver and spleen veins.

Symptoms

The symptoms of portal hypertension can vary and, in many cases, they may not be immediately apparent. However, individuals with a liver condition that increases the risk of cirrhosis are more susceptible to developing portal hypertension.

When it manifests with visible symptoms, it can cause:

• Ascites (accumulation of fluid in the abdomen);
• Lower limb edema (swelling in the legs and feet);
• Hematemesis (vomiting of blood);
• Melena, which are dark stools due to gastrointestinal bleeding;
• Esophageal varices, which are dilated veins in the esophagus.

It is important to be aware of these symptoms and seek medical attention if you or someone you know shows signs of portal hypertension.

How is the diagnosis made?

The diagnosis of portal hypertension involves several approaches, starting with a detailed medical evaluation. The doctor will examine the patient’s history, paying attention to any pre-existing liver disease, and will also observe physical signs, such as abdominal swelling and dilated veins.

Upper gastrointestinal endoscopy should always be performed to investigate esophageal or stomach varices.

Laboratory tests play an essential role in the diagnosis, and they may include a complete blood count, coagulation profile, creatinine analysis, bilirubins, electrolytes, as well as liver enzymes AST and ALT.

For patients with advanced liver cirrhosis, hepatic elastography is a useful tool to identify the presence of clinically significant portal hypertension, and the results are interpreted together with the blood platelet count.

In addition, imaging tests, such as magnetic resonance imaging, Doppler ultrasonography, and computed tomography, may be requested to examine the presence of various indicators, such as spleen enlargement (splenomegaly), collateral circulation, changes in liver morphology, fluid accumulation in the abdomen (ascites), and modifications in blood flow in the portal system.

Possible treatments

The treatment of portal hypertension is focused on preventing additional damage to the liver and managing complications, such as bleeding from ruptured blood vessels.

The doctor may prescribe medications to prevent the rupture of blood vessels, although it is important to note that they can cause various side effects and not all people tolerate their use.

When bleeding from vessels occurs, elastic ligation of the varices in the esophagus through endoscopy is often the treatment of choice to stop the bleeding and prevent future episodes. This procedure is also used as a preventive measure to avoid vascular ruptures and hemorrhages.

In situations where the bleeding is not related to esophageal varices but rather in the stomach, endoscopic treatment may involve the injection of a biological glue directly into the affected vessels in the stomach.

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