Portal hypertension: what is it?

Portal hypertension is accompanied by various diseases of the liver and bile ducts. A disease manifested by characteristic symptoms and can cause severe complications. It occurs both in men and women.

What is it, and what is the pathogenesis of its development?

Portal hypertension is a pathological condition which is accompanied by characteristic signs. It is due to disorders in the circulatory system and increase the system pressure to the portal vein (normal pressure is 5 to 6 mm Hg.St.).

The mechanism of the damaging action is as follows: the pressure increase in the system of the portal vein above the norm leads to varicose veins. When portal blood flow is impaired, the blood begins to circulate through collateral pathways, for example, through anastomoses with veins of the stomach, esophagus, rectum, and umbilical veins.

These veins are not designed for such intense blood flow, which leads to their expansion or even rupture. This state is called the syndrome of portal hypertension, which patients manifested the characteristic symptoms.

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Causes of pathology

There are many different reasons for developing this pathology. Depending on the location of the obstacles portal blood flow, the following types of portal hypertension:

Suprarenal blockade. This variant of the disease caused by a blockage of the portal vein above the liver, for example, due to compression of blood vessels by the tumor, scarring or due to thrombosis of hepatic veins.

Intrahepatic blockade. This form is caused by damage of hepatocytes in liver cirrhosis, hepatitis, tumors or trauma of the liver.

Extrahepatic portal hypertension. Develops due to thrombosis or fibrosis of the portal vein and its branches. In addition, the reason for this condition may be a tumor or a congenital stenosis of the vein port and its branches.

Mixed form combines the lesions of the liver, e.g. in cirrhosis with portal vein thrombosis and other associated pathology.

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Clinical signs and symptoms of the disease

The clinical picture of the disease is largely determined by the primary pathology and the level of the block portal blood flow. Consider the basic symptoms of the disease at different levels of the block:

1. Suprarenal form (Budd-Chiari). Signs of this condition may be the following symptoms:

pain and enlarged liver;
the development of ascites (free fluid in the abdominal cavity), which is difficult to treat diuretics;
swelling of the feet;
temperature rise;
jaundice etc.

In acute form, the disease quickly passes into hepatic coma, followed by death of the patient, advancing within a few days.
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2. Hepatic form. Signs depend on the degree of violation of the functional activity of the liver. The patient may be disturbed in the early stages:

disorders of the digestive system;
bloating;
fatigue;
problems with sleep and appetite;
weight loss, and others.

Later joined hemorrhagic diathesis, increasing the size of the liver and spleen, ascites appears, expand saphenous vein in the abdomen (a typical sign of portal hypertension, known as the «head of Medusa»), have pain in the intestine and liver, changes in the blood.

3. Extrahepatic option. The disease develops slowly, with constant esophageal-gastric bleeding. In addition, the patient may disturb:

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violations of the chair;
heaviness in the abdomen;
the increase in size of the spleen;
small ascites;
nasal and esophageal bleeding.

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In children this form can some time be asymptomatic and detected only through accidentally discovered the enlarged spleen.

How does the test work

To diagnose the disease and assess the degree of damage helps a whole complex of laboratory and instrumental examinations. The whole complex of research aims to accurately assess the level of destruction of the system of the portal vein, to recognize the degree of impairment of liver function and to select qualified surgical or conservative treatment. For diagnostic use:

Ultrasound. Allows to estimate the diameter of the veins and the extent of their expansion.
Measuring the pressure in the veins of the liver and spleen (splenomegaly and hematometra).
Biochemical analysis of blood in dynamics, to assess the level of liver enzymes.
Radiographic studies with contrast (angiography, venography). Into the vessel is injected contrast and conducted a series of x-rays. The technician then evaluates them.
EGD to assess dilatation of the esophagus and stomach.
Scintigraphy of the liver.
CT of the liver.
If necessary, laparoscopic surgery and biopsy.

Treatment approaches

The treatment of the disease involves treatment of the underlying disease and the elimination and prevention of severe complications:

Esophageal-gastric bleeding. Stop bleeding using hemostatic agents (aminocaproic acid, Menadione, etc.), used sclerosant and special probes. If conservative failed to stop the bleeding resort to surgery and stitch the veins.

Ascites. The patient is prescribed a diet with restriction of sodium and water, as well as prescribe a mild diuretic. If the amount of fluid in the abdomen disrupts the working of other organs and systems, then resort to pumping fluid or assign it directly to the track of vessels.

The increase in size of the spleen is particularly common in children and leads to the development of sepsis (blood infection). Treatment conservative, in rare cases, resort to splenectomy.

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In severe cases resort to surgical treatment. Perform various types of operations aimed at normalization of the patient’s condition:

pumped fluid from the peritoneal cavity in ascites;
create new ways of outflow of blood to relieve the portal system;
reduce blood flow in the vein system of the port;
cover the anastomoses between the portal vein and the veins of the stomach and esophagus;
used surgery that improves blood flow and liver function.

Portal hypertension is a serious condition, the prognosis of which depends on the original cause and the preservation of liver function. In complex cases, in most patients, the disease ends in death within a few months.