Portal Hypertension is the hypertension, which is also understood as a high blood pressure, present in the portal vein system. The portal vein system consists portal vein and the associated tributaries and branches. Portal hypertension is caused from the hepatic venous pressure gradient elevation to the extent of greater than 5mmHg.
Causes for Portal Hypertension
The causes for the prehepatic blockage happening before the liver, at the portal vein are,
- Congenital atresia
- Portal vein thrombosis
- Extrinsic compression, like tumors
- Splenic vein thrombosis
The causes with hepatic are,
- Chronic hepatitis
- Idiopathic portal hypertension
- Fibropolycystic diseases, such as congenital hepatic fibrosis
- Myeloproliferative diseases
Causes from posthepatic are,
- Sclerosing hyaline necrosis
- Budd chlari syndrome
- Heart failure at right
- Constrictive peridcarditis
- Veno occlusive disease existing with smaller hepatic venules or veins
There are also other causes, apart from the above.
- Hepatic blood flow increase, that may lead to splenic blood flow increase and hepatoportal arteriovenous fstula
Signs and Symptoms for Portal Hypertension
- Dilated veins present in the caput medusa and abdominal wall
The other signs of liver failure are,
- Small or enlarged liver
- Hyperdynamic circulation signs
- Testiculuar or gynaecomastia atrophy
Portal hypertension is diagnosed from many blood tests, scans, portal hypertension measurement, vascular imaging, liver biopsy and endoscopy.
Portal Hypertension Treatment
Portal Hypertension is difficult to treat. The treatment is usually recommended with liver transplantation and treatment of underlying cause.
So, the treatment can be done using drugging with beta blockers, nitrates and vasoactive drugs. Other treatment can be endoscopic procedure, which contains endoscopy, endoscopic vein ligation and optionally endoscopic variceal obturation for certain cases, like gastric varices resulting acute bleeding.
Another treatment is TIPS or Transjugular Intrahepatic Portosystemic Shunt, which is a radiological procedure. TIPS is usually preferred for ascites, hepatic hydrothorax, budd-chlari syndrome, hepatorenal syndrome and hepatopumonary syndrome.
When the above treatments cannot solve the problem, then the surgical procedure is preferred to perform.
Portal Hypertension Surgery
Surgical portosystemic shunts is the appropriate surgical procedure to treat the portal hypertension. The surgery has to be performed by the qualified and experienced surgeon. The shunts that are used can be partial, total or selective. During the procedure, the pressure of hepatic vein wedge is measured.
Devascularisation procedure involves transaction of gastro-oesophageal devascularisation oesophegeal and splenectomy.
Surgical shunts are also done for the portal hypertension. Shunt surgeries are helpful to redirect the blood flow, or occasionally happening fluid flow through abdomen through different areas of the body. Shunt surgical procedure are rarely performed, as there are many complications that may arise from it. So, this procedure must be done only by the qualified and experienced surgeon. The selection of the candidates for this procedures is also limited, like candidates with good function of the liver, non-liver transplant candidates, other treatments find no benefits, ascites candidates and who do not have enough medical care access.
The complications associated with the portal hypertension and or cirhhosis are the following.
- Complications related to ascites, like hepatic hydrothorax, etc.
- Bleeding happening from oesophageal vertices or gastric varices
- Complications related to pulmonary complications
- Hepatic encephalopathy
- Liver failure
- Cirrhotic cardiomyopathy
The complications that are associated with the shunt surgical procedures are mental function.
Cost of Portal Hypertension Surgery
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