Portal hypertension is a disease that many people experience. This pathology is associated with impaired blood flow and increased pressure in the portal vein system. Mostly, problems with blood flow affect the functioning of the digestive system. Also, against the background of such a pathology, there is a risk of rupture of blood vessels with subsequent internal hemorrhage.
Of course, many people are looking for additional information about the disease. Why does pathology develop? What are the symptoms of portal hypertension syndrome? How dangerous can an illness be? What treatments are considered the most effective? When is surgery necessary? The answers to these questions are provided by our article.
General information
Portal hypertension syndrome is a pathology that is accompanied by impaired blood flow in the portal vein. A similar problem can arise both at the level of the capillary network, and in larger vessels (for example, in the inferior vena cava).
Obstruction of blood flow leads to increased pressure inside the veins. Hypertension also negatively affects the structure of blood vessels, leading to the expansion of their lumen and thinning of the walls. Such veins are more prone to damage and rupture. Moreover, impaired blood flow adversely affects the functioning of internal organs.
It is worth noting that portal hypertension is rarely an independent disease. In most cases, it acts as a symptom or consequence of another pathology.
Forms of the disease
The following forms of portal hypertension are distinguished depending on the location of the obstruction that disrupts the blood flow:
- Prehepatic form - blood flow is disturbed until the portal vein enters the liver.
- Intrahepatic portal hypertension - an obstruction of blood flow is localized in that part of the portal vein that is located inside the liver.
- Posthepatic hypertension - there is a violation of blood flow in the inferior genital vein or vessels that flow into it.
Portal hypertension can be mixed. In this case, obstacles to normal blood flow are formed in several places at once.
What causes the development of the disease
The causes of portal hypertension may be different. As already mentioned, pathology is associated with a violation of normal blood flow. This can be caused by the presence of a mechanical obstruction (for example, narrowing of the lumen of the veins, the formation of tumors and cysts), an increase in blood volume in the vessels, as well as an increase in the resistance of the venous walls.
If we are talking about the development of prehepatic portal hypertension, then the list of reasons is as follows:
- Thrombosis of the portal and / or splenic vein (a blood clot forms inside the vessel, which interferes with the normal flow of blood).
- Narrowing of the portal vein, congenital atresia.
- Compression of the portal vein, due to the appearance and active growth of the tumor.
- An increase in blood volume due to the formation of arteriovenous fistulas.
The causes of portal hypertension within the liver are very diverse:
- Schistosomatosis (a parasitic disease common in the tropics that develops against flatworm infestation).
- Initial biliary cirrhosis.
- Inflammatory processes on the background of sarcoidosis.
- Tuberculosis.
- Myeloproliferative pathologies, which are accompanied by excessive production of blood cells in the bone marrow.
- The formation of multiple cysts in the liver or nearby structures.
- Tumors or metastases in the tissues of the liver that compress blood vessels, interfering with the normal flow of blood.
- Acute alcoholic hepatitis.
- Peliotic hepatitis (an infectious disease accompanied by damage to the small vessels of the liver, as a result of which they become full of blood and put pressure on the liver tissue).
- Veno-occlusive disease, which usually develops after bone marrow transplant surgery.
- Fibrosis of the liver, in particular, those forms whose development is associated with prolonged intake of vitamin A and some other drugs.
- The idiopathic form of hypertension, the causes of which cannot be determined.
Violation of blood flow in the posthepatic region can be caused by:
- Thrombosis of the hepatic veins.
- Obstruction of the inferior vena cava.
- Right ventricular heart failure, especially in cases where it develops against the background of restrictive cardiomyopathy or pericarditis.
- The formation of a fistula, through which blood flows directly from the artery into the portal vein.
- An increase in blood volume in the spleen.
A mixed form of pathology often develops against the background of chronic forms of hepatitis. This type of portal hypertension in cirrhosis is also not uncommon, especially if it is accompanied by secondary thrombosis of the portal vein and its branches. During diagnosis, it is extremely important to determine the exact cause of circulatory disorders - the algorithm of therapeutic measures depends on this.
Portal hypertension: symptoms
The initial stages of the development of the disease can be asymptomatic. But with progression, very characteristic signs of portal hypertension appear:
- Patients suffer from various dyspeptic phenomena, in particular, from bloating and flatulence, nausea and vomiting. A person loses his appetite, and a feeling of fullness occurs even after eating a small amount of food. Gradually, he loses weight.
- Portal hypertension with cirrhosis, accompanied by yellowing of skin tissues, sclera of the eyes.
- Perhaps an increase in body temperature, weakness, lethargy, increased irritability.
- The list of symptoms may include an increase in the spleen and liver, which is accompanied by discomfort, and sometimes severe pain in the upper right quadrant.
- Circulatory disorders affect the condition of internal organs. On the surface of the mucous membranes of the stomach and duodenum erosions and ulcers begin to appear.
- Portal hypertension leads to ascites - free fluid begins to accumulate in the abdominal cavity.
- The disease gradually leads to varicose veins of the esophagus, stomach, umbilical region and anorectal zone.
Stages of development and their features
Signs of portal hypertension directly depend on the stage of development of the pathology. To date, doctors distinguish four stages:
- The first stage is considered preclinical. In most cases, it is asymptomatic (only some patients note a general malaise and occasional discomfort in the right side), therefore, it can only be diagnosed with the help of special equipment.
- The second stage (compensated) is accompanied by severe symptoms. Patients suffer from flatulence, severity in the right hypochondrium, dyspeptic disorders. During diagnosis, an increase in the spleen and liver can be observed.
- The third (decompensated) stage is manifested by serious violations. The pain intensifies, severe digestive disorders are observed. A person feels weak, broken, sleeps poorly. In the abdominal cavity, free fluid begins to accumulate, as a result of which the abdomen grows.
- At the fourth stage of portal hypertension, various complications are already present. Patients suffer from ascites, which is practically not amenable to medical treatment. This stage is characterized by varicose veins that collect blood from various internal organs. Due to the weakening of the walls, the vessels break periodically, resulting in bleeding.
Diagnostic process
Diagnosis of portal hypertension is a long process, because it is important not only to identify blood flow disorders, but also to determine the cause of its occurrence.
- To begin with, the doctor studies the anamnesis, collects information about the symptoms that concern the patient. During a general examination, the specialist notes whether there is yellowing of the sclera, whether there is pain in the right hypochondrium during palpation.
- A complete blood count helps to detect a decrease in the number of platelets, red and white blood cells.
- A coagulogram is also mandatory, which helps to identify blood clotting disorders, in particular, a decrease in the rate of blood clot formation.
- Blood is also examined for the presence of markers of various types of viral hepatitis.
- A general urinalysis is performed, which helps to determine the presence of certain violations in the work of the kidneys and urinary tract.
- Fibroesophagogastroduodenoscopy is also informative. During the procedure, the doctor with the help of an endoscope carefully examines the inner surfaces of the esophagus, stomach, and upper parts of the small intestine. The study helps to determine the presence of ulcers, erosion, dilated veins.
- During an ultrasound examination of the abdominal organs, a specialist can accurately determine the size of the spleen and liver, examine their structure, and check for the presence of neoplasms. In the same way, free fluid in the abdominal cavity can be detected.
- Dopplerography helps to evaluate the functioning of the portal and hepatic veins, as well as the volume of blood in the vessels, to see the places of their narrowing and expansion.
- Sometimes X-ray contrast scanning is also performed. A special substance is introduced into the test vessel, and then, with the help of appropriate equipment, the movement of contrast is monitored. This procedure allows you to carefully study the nature of blood flow.
- The results of computer and magnetic resonance imaging are informative. The doctor can study three-dimensional images of the necessary organs, evaluate their structure, see the vessels and places of their injuries.
- Blood pressure in the portal system is measured (normally it can vary from 5 to 10 mmHg).
- If there is a suspicion of damage to the heart and pericardium, then the patient is sent for echocardiography.
- Elastography allows you to determine the presence of fibrotic changes in the tissues of the liver.
- A final biopsy of the liver will help to make a final diagnosis with further laboratory examination of the samples taken.
- If there are neurological symptoms, the patient is sent for a consultation with a psychiatrist. Memory impairment, increased irritability, drowsiness - all this may indicate the development of hepatic encephalopathy.
Conservative treatment
Drug treatment of portal hypertension directly depends on the cause of the development of the disease.
- Hormone therapy (taking Somatostatin analogues) helps to narrow the abdominal arterioles and reduce the pressure in the portal vein.
- Nitrates help dilate blood vessels. As a result of this effect, blood accumulates in the small arterioles and veins, which reduces blood flow to the liver.
- Beta-blockers are also used, which reduce the strength and frequency of heart contractions.
- Diuretics are also included in the treatment regimen. These drugs relieve swelling, remove excess fluid from the body.
- Lactulose preparations provide the excretion of dangerous substances from the intestines, which are formed in the body against the background of liver dysfunction.
- If hypertension is associated with infectious diseases, then broad-spectrum antibiotics are used.
- If there was bleeding, then after surgery, the patient is injected with plasma and erythromass.
- In hypersplenism, patients are prescribed drugs (for example, synthetic analogues of hormones secreted by the adrenal glands) that stimulate the production of blood cells.
Proper diet
Treatment of portal hypertension necessarily includes a correction of the diet.
- It is important to limit the amount of salt consumed. Its daily dose should not exceed 3 g. This will help get rid of edema and prevent the accumulation of fluid in the body, reduce blood pressure.
- It is recommended to reduce the daily amount of protein to 30 g in order to avoid the development of hepatic encephalopathy.
- It is necessary to abandon alcohol, as their use creates an additional burden on the liver.
- It is better to include vegetables and fruits in the diet. Dishes are recommended to steam, boil or bake in the oven.
- Spices, spices from the menu are better to exclude.
Surgical treatment of portal hypertension
Unfortunately, in some cases, surgical intervention is indispensable.
Operations with portal hypertension are performed if the following diseases are observed in a sick person:
- Varicose veins of the stomach and esophagus (the walls of the vessels become thinner, which increases the likelihood of rupture and extensive bleeding).
- A significant increase in the size of the spleen, the destruction in its tissues of too many blood cells.
- Accumulation of fluid in the abdominal cavity.
- With rupture of blood vessels, bleeding, peritonitis, emergency surgical intervention is required.
The choice of treatment methods depends on the degree of vascular damage, the presence of certain complications.
- Sometimes the so-called portosystemic shunting is performed. In this case, the surgeon creates an additional blood flow path, connecting the cavities of the portal and inferior vena cava. In this case, blood partially passes the liver, which ensures a decrease in pressure.
- Splenorenal bypass involves the creation of an additional path between the renal and splenic veins.
- Ligation of some veins and arteries of the stomach and esophagus is effective. This procedure helps prevent bleeding.
- Hepatic failure requires transplantation. This is a rather complicated procedure, which is not often done, as finding a suitable donor is not easy.
- If vein rupture has already happened, then they are sutured surgically.
- Sclerotherapy is sometimes effective. This is an endoscopic operation, during which the doctor, using special equipment, injects a sclerosant inside a bleeding vessel. This substance provides gluing of the walls of the vein.
- In some cases, surgical removal of the spleen is indicated - so you can restore the normal number of blood cells.
Possible complications
This is a dangerous disease that cannot be ignored. In the absence of timely treatment, the patient's condition will constantly worsen. The consequences of the disease can be fatal.
- Hypertension affects the state of the spleen - in its tissues blood cells begin to actively decompose, which leads to anemia, thrombocytopenia, leukopenia. Due to a sharp decrease in the level of leukocytes, the body becomes more susceptible to various kinds of infections.
- There are other complications that accompany portal hypertension. Bleeding from the veins of the esophagus, stomach, rectum, if untreated, can lead to massive blood loss and even death of the patient.
- Hidden bleeding within the digestive system is also possible. They often occur without the manifestation of any symptoms, but lead to the development of anemia and other complications.
- Hepatic encephalopathy is considered extremely dangerous. The fact is that the affected liver at some point ceases to cope with its functions. Nitrogen exchange products appear in the blood, which negatively affect the brain. Encephalopathy is accompanied by drowsiness, weakness, depression, increased anxiety, memory problems, concentration and orientation. Often the disease ends in a coma.
- The formation of hernias is possible.
- The list of complications also includes severe forms of ascites, which are practically not treatable, infectious peritonitis, various systemic infections, renal and liver failure.
Predictions for such a disease directly depend on timely diagnosis and adequate treatment.
Is it possible to prevent the development of the disease
Unfortunately, specific prophylactic agents do not exist. You should avoid risk factors that can lead to the development of hypertension, in particular, do not abuse alcohol, do vaccinations against viral hepatitis, eat right.
If hypertension already occurs, then the patient should carefully monitor the state of health. Regularly need to undergo medical examinations, take tests, do fibroesophagogastroduodenoscopy. Such manipulations help the specialist in time to detect the appearance of deterioration and take appropriate measures. Doctors recommend a low-protein diet, as this reduces the likelihood of developing encephalopathy.