What are the other Names for this Condition? (Also known as/Synonyms)

• Cirrhotic Portal Hypertension
• Increased Portal Venous Pressure

What is Portal Hypertension? (Definition/Background Information)

• Portal Hypertension occurs when there is an increase in blood pressure of the portal vein, which primarily carries blood from the intestine to the liver
• Cirrhosis (scarring of the liver) is the most common cause of Portal Hypertension due to its effect of impeding blood flow to the liver. This results in an increase in blood pressure of the portal venous system
• The common signs and symptoms of Portal Hypertension include vomiting blood and dark tarry stools. The formation of varices in the esophagus and stomach, which can rupture and bleed profusely, is one of the most significant complications of Portal Hypertension
• Portal Hypertension is generally treated through endoscopic therapy and the use of medications to slow bleeding from the ruptured varices. The prognosis of the condition depends on its severity and the provision of early adequate treatment

Who gets Portal Hypertension? (Age and Sex Distribution)

• Individuals with liver disease and cirrhosis have an increased risk for Portal Hypertension. It is generally more common in individuals over the age of 50
• Portal Hypertension is more common in males than females
• Worldwide, all racial and ethnic groups may be affected, and no preference is observed

What are the Risk Factors for Portal Hypertension? (Predisposing Factors)

The risk factors for Portal Hypertension may include:

• Cirrhosis (scarring of the liver), which can result from excess alcohol consumption, hepatitis infection, and other conditions that damage the liver
• Portal vein thrombosis (formation of a blood clot in the portal vein)
• Congestive heart failure, which can result in increased fluid and blood pressure in the portal vein
• Fatty liver disease

It is important to note that having a risk factor does not mean one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Portal Hypertension? (Etiology)

Portal Hypertension is primarily caused by liver cirrhosis, in which scar tissue reduces blood flow to the liver and increases the vascular resistance of the portal venous system. This may be caused by:

• Heavy alcohol consumption, which overwhelms the liver, and it is damaged (by being unable to properly breakdown alcohol)
• Chronic hepatitis infection
• Fatty liver disease
• Injury to the bile ducts, which can occur in conditions such as primary biliary cirrhosis, primary sclerosing cholangitis, and biliary atresia - all of which may increase the risk of developing liver cirrhosis

What are the Signs and Symptoms of Portal Hypertension?

The signs and symptoms of Portal Hypertension may include:

• Melena (dark, tarry stools) as a result of gastrointestinal bleeding
• Vomiting blood due to ruptured varices in the esophagus and stomach
• Swelling of the abdomen from ascites (fluid accumulation)
• Hepatic encephalopathy, indicated by a feeling of drowsiness and confusion as a result of poor liver function
• Decreased levels of platelets and white blood cells (as observed through blood tests)
• Visible collateral blood vessels on the abdomen may be present. These blood vessels appear dilated and can readily be seen on visual exam

How is Portal Hypertension Diagnosed?

Portal Hypertension is diagnosed based on the following information:

• A complete physical examination which may reveal visible blood vessels on the abdomen and/or the presence of an enlarged spleen by indication of a bulge in the upper-left quadrant of the abdomen
• Assessment of the presenting signs and symptoms
• Blood tests, including complete blood cell count and liver function test
• Laboratory and imaging tests, such as ultrasonography, which examines blood flow in the portal vein
• Upper GI endoscopic examination will show the presence of dilated blood vessels in the esophagus (food pipe)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Portal Hypertension?

The leading cause of Portal Hypertension is liver cirrhosis, in which scar tissue reduces blood flow to the liver and increases the vascular resistance of the portal venous system. This can lead to complications such as:

• The development of collateral vessels (veins that bypass the liver) in the esophagus and stomach, which can become swollen varices that may rupture and lead to profound blood loss (internal bleeding)
• Ascites (increased fluid in the abdomen)
• Hepatic encephalopathy (brain function loss from the accumulation of toxins in blood from liver injury)
• Enlarged spleen (splenomegaly) leading to pain in the upper-left abdomen
• Pulmonary arterial hypertension (increased blood pressure within the lung arteries)

How is Portal Hypertension Treated?

Most cases of Portal Hypertension cannot be fully treated because cirrhosis (liver scarring) is generally irreversible. Portal Hypertension requires case-by-case treatment interventions to manage the associated complications, and this may include:

• Banding and sclerotherapy as a form of endoscopic therapy. Banding is performed by a gastroenterologist and involves the use of rubber bands to stop the blood flow in varices. Sclerotherapy is usually used as an adjunct to banding and involves injecting blood-clotting solution into the ruptured varices
• Administration of beta-blockers (medications) to reduce bleeding from varices, including: timolol, nadolol, propranolol, and carvedilol
• Lactulose to reduce confusion from hepatic encephalopathy
• Diuretics to reduce swollen abdomen from ascites
• Portosystemic shunting, in which the portal vein is connected to a vein in the general circulation to reduce the overall pressure in the portal vein. It should be noted that this procedure is usually performed when bleeding from the varices continues or recurs despite prior treatment measures
• Individuals with very severe cases of Portal Hypertension and liver disease may require liver transplantation

Regular medical screening at periodic intervals with tests and physical examinations is necessary and highly recommended.

How can Portal Hypertension be Prevented?

Portal Hypertension most often results from poor liver function. The preventative measures focus on maintaining liver health, such as:

• Avoidance of alcohol
• Avoidance of street (illegal) drugs
• Adherence to the guidelines indicated by the healthcare provider when taking prescription medications
• Regularly having a low-sodium diet

What is the Prognosis of Portal Hypertension? (Outcomes/Resolutions)

The prognosis of Portal Hypertension generally depends on the timing of diagnosis and the severity of associated complications.

• If Portal Hypertension can be managed adequately, then a favorable prognosis may be noted with early diagnosis and prompt medical treatment
• A late diagnosis may allow the condition to advance to late-stage with severe bleeding from ruptured varices, potentially resulting in a poor prognosis

Additional and Relevant Useful Information for Portal Hypertension:

The following link is a useful resource for more information on liver cirrhosis:

https://www.dovemed.com/diseases-conditions/liver-cirrhosis/