The ONE organ responsible for high blood pressure.
The main symptoms and complications of portal hypertension include: Gastrointestinal bleeding marked by black, tarry stools or blood in the stools, or vomiting of blood due to the spontaneous rupture and hemorrhage from varices. Ascites (an accumulation of fluid in the abdomen)
Pharmacologic therapy for portal hypertension includes the use of beta-blockers, most commonly propranolol and nadolol. Brazilian investigators have suggested that the use of some statins (eg, simvastatin) may lower portal pressure and potentially improve the liver function.
Portal Hypertension SymptomsIf you have an advanced liver disease, such as cirrhosis, you have an increased risk of developing portal hypertension. Be aware of unusual symptoms and report them to your doctor right away. Symptoms and signs of portal hypertension include:
- Gastrointestinal bleeding: You may notice blood in the stools, or you may vomit blood if any large vessels around your stomach that developed due to portal hypertension rupture.
- Ascites: When fluid accumulates in your abdomen, causing swelling
- Encephalopathy, or confusion and fogginess in thinking
- Jaundice, the yellowing of the skin and the whites of the eyes
- Edema, (swelling) of the legs
- Caput medusa, a visible network of dilated veins surrounding your navel
Portal Hypertension DiagnosisThere are a number of ways to diagnose portal hypertension. For patients with end-stage liver disease who present with ascites and varices, the doctor may not need to perform any diagnostic tests and can confirm a diagnosis based on symptoms. Diagnostic procedures your doctor may order include:
- Imaging and blood tests
- Pressure measurement studies
- Endoscopic diagnosis
Imaging StudiesAn imaging study helps in the diagnosis of cirrhosis and portal hypertension. They are noninvasive and can give your doctor a detailed image of your portal venous system. A duplex Doppler ultrasound is typically the first imaging test ordered. A Doppler ultrasound uses sound waves to see how the blood flows through your portal vein. The ultrasound gives your doctor a picture of the blood vessel and its surrounding organs, as well as the speed and direction of the blood flow through the portal vein.
Pressure Measurement StudiesAn interventional radiologist may perform a pressure measurement study to evaluate the level of pressure in the hepatic (liver) vein. This can be done as an outpatient, where a radiologist will access one of your veins, usually via internal jugular vein.
Endoscopic DiagnosisEndoscopy is another way to diagnose varices, which are large vessels associated with portal hypertension. An endoscopy can provide a definitive diagnosis of the varices and allow your doctor to treat and reduce the risk of bleeding or active bleeding. During a gastrointestinal endoscopy, your doctor can see the mucous lining of the upper gastrointestinal tract, including the esophagus, stomach and duodenum (first part of the small intestine). During an upper endoscopy:
- You receive an anesthetic to help relax your gag reflex. You will also receive pain medication and a sedative.
- You lie on your left side, referred to as the left lateral position.
- Your doctor inserts the endoscope (a thin, flexible, lighted tube with a camera) through your mouth and pharynx, into the esophagus.
- Your doctor can visualize the esophagus, stomach and duodenum with the endoscope.
Complications of Portal Hypertension
AscitesAscites is excess fluid in your abdominal cavity. Patients with chronic liver disease often develop ascites, though it may be caused by other factors. Symptoms of ascites include:
- Early feeling of fullness
- Increase in size of abdomen
- Feeling out of breath (if the fluid begins pushing on your lungs)