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. Mainly, 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 more information about the disease. Why does pathology develop? What are the symptoms of portal hypertension syndrome? How dangerous can the disease be? What treatments are considered the most effective? When is surgery necessary? Our article provides answers to these questions.
General information
Portal hypertension syndrome is a pathology that is accompanied by impaired blood flow in the portal vein. A similar problem can occur both at the level of the capillary network, and in larger vessels (for example, in the inferior vena cava).
Presence of obstaclesfor blood flow leads to an increase in pressure inside the veins. Also, hypertension negatively affects the structure of blood vessels, leads to the expansion of their lumen and thinning of the walls. These veins are more prone to injury and rupture. Moreover, impaired blood flow negatively 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.
Disease forms
Depending on the location of the obstacle that disrupts blood flow, the following forms of portal hypertension are distinguished:
- Prehepatic form - blood flow is disrupted to the point where the portal vein enters the liver.
- Intrahepatic portal hypertension - an obstruction to 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 lower pudendal 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
Causes of portal hypertension can 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.
When it comes to developmentprehepatic portal hypertension, the list of causes is as follows:
- Thrombosis of the portal and / or splenic vein (a blood clot forms inside the vessel, which prevents normal blood flow).
- Narrowing of the portal vein, congenital atresia.
- Compression of the portal vein due to the appearance and active growth of the tumor.
- Increase in blood volume due to the formation of arteriovenous fistulas.
The causes of portal hypertension inside the liver are very diverse:
- Schistosomatosis (a parasitic disease common in the tropics that develops against the background of invasion by flatworms).
- Initial biliary cirrhosis.
- Inflammatory processes associated with sarcoidosis.
- Tuberculosis.
- Myeloproliferative pathologies that are accompanied by excessive production of blood cells in the bone marrow.
- Formation of multiple cysts in the liver or nearby structures.
- Tumours or metastases in liver tissue that compress blood vessels, preventing normal blood flow.
- Acute alcoholic hepatitis.
- Peliotic hepatitis (an infectious disease, accompanied by damage to the small vessels of the liver, as a result of which they overflow with 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, the development of which is associated with long-term intake of vitamin A and certain other drugs.
- Idiopathic form of hypertension with no known cause.
Impaired blood flow in the posthepatic area can be caused by:
- Hepatic vein thrombosis.
- Obstruction of the inferior vena cava.
- Right ventricular failure, especially when it occurs in association with restrictive cardiomyopathy or pericarditis.
- The formation of a fistula, through which blood flows directly from the artery into the portal vein.
- Increased blood volume in the spleen.
Mixed form of pathology often develops against the background of chronic forms of hepatitis. This kind 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 the 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 as it progresses, 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. He is gradually losing weight.
- Portal hypertension in liver cirrhosis,accompanied by yellowing of the skin tissues, sclera of the eyes.
- Possibly fever, weakness, lethargy, increased irritability.
- The list of symptoms includes an enlarged spleen and liver, which is accompanied by discomfort and sometimes severe pain in the right upper quadrant.
- Impaired circulation affects the state of internal organs. Erosions and ulcers begin to appear on the surface of the mucous membranes of the stomach and duodenum.
- 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 report a general malaise and intermittent discomfort in the right side), so it can only be diagnosed with the help of special equipment.
- The second stage (compensated) is accompanied by severe symptoms. Patients suffer from flatulence, heaviness in the right hypochondrium, dyspeptic disorders. During the diagnosis, an enlargement of the spleen and liver can be observed.
- The third (decompensated) stage is manifested by seriousviolations. Pain intensifies, pronounced digestive disorders are observed. The person feels weak, broken, does not sleep well. Free fluid begins to accumulate in the abdomen, causing the abdomen to enlarge.
- At the fourth stage of portal hypertension, there are already various complications. 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 periodically rupture, resulting in bleeding.
Diagnostic process
Diagnosis of portal hypertension is a lengthy process, because it is important not only to identify a violation of blood flow, but also to determine the cause of its occurrence.
- To begin with, the doctor studies the anamnesis, collects information about the symptoms that bother 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 clots.
- Also, blood is examined for the presence of markers of various types of viral hepatitis.
- A general urine test is carried out, which helps to determine the presence of certaindisorders in the functioning of the kidneys and urinary tract.
- Fibroesophagogastroduodenoscopy is also informative. During the procedure, the doctor carefully examines the internal surfaces of the esophagus, stomach, and upper sections of the small intestine using an endoscope. The study helps to determine the presence of ulcers, erosions, dilated veins.
- During an ultrasound examination of the abdominal organs, a specialist can accurately determine the size of the spleen and liver, study their structure, and check for neoplasms. In the same way, free fluid in the abdominal cavity can be detected.
- Dopplerography helps to evaluate the work 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 injected into the test vessel, and then, using the appropriate equipment, the movement of the contrast is monitored. This procedure allows you to carefully study the nature of the blood flow.
- The results of computed and magnetic resonance imaging are informative. The doctor can study three-dimensional images of the necessary organs, evaluate their structure, see the vessels and the places of their damage.
- Measure the blood pressure in the portal system (normally it can vary from 5 to 10 mmHg).
- If there is a suspicion of damage to the heart and pericardium, the patient is sent for echocardiography.
- Elastography allows you to determine the presence of fibrotic changes in liver tissues.
- A liver biopsy will help to make a final diagnosis with furtherlaboratory examination of the samples taken.
- If there are neurological symptoms, the patient is referred for a consultation with a psychiatrist. Memory impairment, 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 disease.
- Hormonal therapy (somatostatin analogues) helps to narrow the arterioles of the abdominal cavity and reduce pressure in the portal vein.
- Nitrates help dilate blood vessels. As a result of such exposure, blood accumulates in 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 ensure the elimination of dangerous substances from the intestines that are formed in the body against the background of liver dysfunction.
- If hypertension is associated with infectious diseases, broad-spectrum antibiotics are used.
- If there was bleeding, then after surgery, the patient is injected with plasma and erythromass.
- Hypersplenism patients are prescribed drugs (such as synthetic analogues of hormones secreted by the adrenal glands) that stimulate the production of blood cells.
Correctdiet
Treatment of portal hypertension necessarily includes dietary adjustments.
- It is important to limit your s alt intake. Its daily dose should not exceed 3 g. This will help get rid of edema and prevent the accumulation of fluid in the body, lower blood pressure.
- It is recommended to reduce the daily amount of protein to 30 g to avoid the development of hepatic encephalopathy.
- Need to give up alcoholic beverages, 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 be steamed, boiled or baked in the oven.
- Spices, spices should be excluded from the menu.
Surgical treatment of portal hypertension
Unfortunately, in some cases, surgery is indispensable.
Surgeries for portal hypertension are performed if a sick person has the following pathologies:
- Varicose veins of the stomach and esophagus (the walls of the vessels become thinner, which increases the likelihood of their rupture and extensive bleeding).
- Significant enlargement of the spleen, destruction of too many blood cells in its tissues.
- Accumulation of fluid in the abdomen.
- In case of vascular rupture, bleeding, peritonitis, emergency surgical intervention is required.
The choice of treatment methods directly depends on the degree of vascular damage, the presence of certain complications.
- Sometimes a so-called portosystemic shunt is performed. In this case, the surgeon creates an additional blood flow path, connecting the cavities of the portal and inferior vena cava. The blood at the same time partially bypasses the liver, which provides a decrease in pressure.
- Splenorenal shunting involves creating an additional pathway between the renal and splenic veins.
- Effective is the ligation of some veins and arteries of the stomach, esophagus. This procedure helps prevent bleeding.
- Liver failure requires transplantation. This is a rather complicated procedure and is not done often, as it is not easy to find a suitable donor.
- If the rupture of the veins has already happened, then they are surgically sutured.
- Sclerotherapy is sometimes effective. This is an endoscopic operation, during which the doctor, using special equipment, injects a sclerosant into the bleeding vessel. This substance provides gluing of the walls of the vein.
- In some cases, surgical removal of the spleen is indicated - this way 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 - blood cells begin to actively break down in its tissues, which leads to anemia, thrombocytopenia, leukopenia. Due to a sharp decrease in the level of leukocytes, the body becomesmore susceptible to various kinds of infections.
- There are other complications that accompany portal hypertension. Bleeding from the veins of the esophagus, stomach, rectum, if left untreated, can lead to massive blood loss and even death of the patient.
- Occult bleeding within the digestive system is also possible. They often occur without 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 a certain point ceases to cope with its functions. Nitrogen metabolism products appear in the blood, which negatively affect the brain. Encephalopathy is accompanied by drowsiness, weakness, depression, increased anxiety, problems with memory, concentration and orientation. Often the disease ends in a coma.
- Possible hernia.
- The list of complications should also include severe forms of ascites, which are practically untreatable, infectious peritonitis, various systemic infections, kidney and liver failure.
Prognosis for such a disease directly depends on timely diagnosis and adequate treatment.
Is it possible to prevent the development of the disease
Unfortunately, there are no specific preventive measures. It is worth avoiding risk factors that can lead to the development of hypertension, in particular, do not abuse alcohol, get vaccinated against viral hepatitis, eat right.
Ifhypertension already occurs, the patient should carefully monitor the state of he alth. Regularly you need to undergo medical examinations, take tests, do fibroesophagogastroduodenoscopy. Such manipulations help the specialist to detect the appearance of deterioration in time and take appropriate measures. Doctors recommend eating a low-protein diet as it reduces the chance of developing encephalopathy.
