The portal vein carries blood from your stomach, pancreas, and other digestive organs to your liver. It differs from other veins, which all carry blood to your heart. The liver plays an important role in your circulation. It filters out toxins and other waste matter that the digestive organs have deposited in your bloodstream. When the blood pressure in the portal vein is too high, you have portal hypertension.
The main cause of portal hypertension is cirrhosis. This is a scarring of the liver. It can result from several conditions such as hepatitis (an inflammatory disease) or alcohol abuse. Other cirrhosis causes include:
The main symptoms and complications of portal hypertension include:
The most common tests used to diagnose portal hypertension are an upper gastrointestinal endoscopy and ultrasonography of the abdomen. An endoscopy is done is done by passing a tube with a camera at its tip to examine the esophagus (food pipe) and the stomach. Presence of abnormally enlarged veins in these parts confirms the diagnosis of portal hypertension.
An ultrasonography is a simple test which can also be useful in diagnosing portal hypertension. Apart from these there are also advanced tests which can further be used to identify the exact cause and the severity of portal hypertension.
The treatment of portal hypertension is in two parts, one is the treatment of the complications of portal hypertension and the other is the treatment of the cause of the problem. The most important complication which needs effective control is bleeding. This is usually done by endoscopy.
The swollen veins are sealed using an injection with a sclerosant or tied off using a banding device. This achieves good control of bleeding in majority of the patients. In patients where endoscopy fails to control the bleeding emergency surgery might be required.In patients who have very severe portal hypertension not controlled by medicines or endoscopy, a shunt may be needed.
Shunt can be created by angiographic technique called TIPPS or it can be created surgically. Both these methods have their own indications and outcomes. They are carefully chosen based on various parameters of the patients problem. In cases where the portal hypertension is due to cirrhosis liver transplantation remains the most effective way to cure the problem.