Portal hypertension

Definition

Increased blood pressure within the portal vein. The portal vein is one of the thickest and most important veins in the vascular system of the human body. Its mission is to collect blood from the spleen, pancreas, stomach, small intestine, large intestine and gallbladder and lead it to the liver to be filtered.

Increased pressure inside the portal vein can cause it to dilate, which can rupture and bleed easily, or it can make it difficult for blood to pass through it, which causes other smaller veins to form through it. from which blood can flow and which in turn can dilate () and bleed easily.

How does the disease occur?

The most common cause of portal hypertension is chronic liver disease known as liver cirrhosis.

Portal hypertension can be produced by any other cause that involves an obstacle to the passage of blood through the portal vein, such as a thrombus, a fistula, a parasite or a tumor, among others.

Symptoms of the disease

Portal hypertension can be asymptomatic for many years and may be discovered as a chance finding when the patient is studied for other reasons, such as.

In other cases, the first symptoms of portal hypertension are those of the cause that has caused them, in most cases symptoms of liver cirrhosis.

The characteristic symptoms of advanced portal hypertension are:

• Unjustified weight loss
• Abdominal obesity with thin limbs (arms and legs)
• Enlargement of the liver and spleen
• Accumulation of fluid in the abdominal cavity (ascites)
• Presence of blood vessels in the abdominal wall
• Thin and thin skin, reddened palms
• Esophageal varices
• Bleeding from varicose veins leading to emission of blood from the mouth, black stools or presence of peritonitis
• Accumulation of toxins in the blood that affect the brain causing hepatic encephalopathy.
• In some cases, portal hypertension occurs in the form of massive hemathemesis, resulting in the death of the patient.

Diagnosis of the disease

The diagnosis of portal hypertension is made by the general practitioner, the internist or the digestive system specialist in the consultation of the medical center or hospital.

The diagnosis is based on the physical examination of the patient, the symptoms that he presents and the result of the complementary studies that are carried out, among which are a blood test that allows detecting alterations in liver function, an imaging study by means of an ultrasound or an abdominal tomography that allows to visualize an increase in the size of the liver or spleen or portal vein and to detect the presence of ascites or collateral venous circulation or a vascular study by means of Doppler ultrasound, arteriography or esophageal endoscopy among others that allow visualization of the dilated vessels or detect possible bleeding.

Treatment of the disease

The treatment of portal hypertension consists of treating the cause that has produced it and treating the symptoms of the disease itself.

Treatment of symptoms includes:

• Drugs that decrease pressure inside the portal vein or its collateral vessels to decrease the risk of bleeding
• Drugs that decrease blood flow through the portal vein or its collateral vessels to reduce the risk of bleeding
• Diuretic drugs in cases of ascites
• antibiotic treatment in cases of peritonitis
• Esophageal endoscopy and surgical techniques for the elimination of esophageal varices or the treatment of bleeding.
• Shunt systems in cases of encephalopathy or ascites.

Disease prevention

The most common cause of portal hypertension is cirrhosis of the liver. Avoiding factors that favor the development of cirrhosis, such as alcohol, or chronic infections due to the hepatitis B and C virus, contributes to avoiding the development of portal hypertension.