Portal hypertension

As portal hypertension This is the term used to describe excessive pressure in the portal vein, the porta vein. The term is also synonymous Portal hypertension used. The portal vein is responsible for carrying the blood from the abdominal organs, such as the stomach, intestines and spleen, into the liver. All pressure values ​​that exceed 4-5 mmHg in the portal vein are considered portal hypertension.

What is portal hypertension?

If there is portal hypertension, it is not uncommon for bypass circuits to form in the blood. Enlargement of the spleen, abnormal accumulation of water in the abdomen or hepatic encephalopathy, i.e. a functional disorder of the brain, can be associated with the disease.
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From one portal hypertension one speaks when the pressure of the vein is 2 to 6 mmHg above the normal pressure, which in healthy people must be between 6 and 10 mmHg.

An abnormal increase in pressure in the portal vein is caused by an increase in resistance. Portal hypertension is usually due to a congestion of the blood in the vein or to a reduced flow of blood into the circulation. If there is an obstruction in the vein that blocks the blood flow, this can be local, but it can also extend over very large areas in entire vascular regions.

In the different cases one speaks of pre-hepatic, intrahepatic or post-hepatic obstructions, i.e. obstacles within the vein or the vascular region.

causes

A portal hypertension usually occurs as a result of liver cirrhosis. In rarer cases, the causes are also pathological changes in the hepatic vessels, blockages within the spleen or the portal vein itself.

Portal hypertension can spread to esophageal varices (life-threatening bleeding of the lining of the esophagus), which occurs when the venous pressure is greater than 12 mmHg, or hepatic encephalopathy.

In a large number of cases, portal vein disease is related to alcohol abuse or infection with hepatitis C.

Symptoms, ailments & signs

Portal hypertension itself does not show any symptoms, but it can cause various disorders in the body, which are then accompanied by certain complaints. The effect on the liver, whose function can be impaired, is typical. This is shown in a feeling of fullness and pressure in the upper abdomen as well as in various skin signs.

Dilated vessels become visible through the skin, which is known as banknote skin. In addition, so-called spider naevi (liver stars) are formed, which are small, star-shaped red dots on the face and upper body. The palms and feet turn red, the lips become smooth and shiny and look like lacquered red, the tongue also turns red.

If the liver can no longer properly break down the harmful substances, they reach the brain and can trigger hepatic encephalopathy, which is associated with confusion and dizziness. Furthermore, it can lead to loss of appetite and weight loss and water can form in the abdomen, which is known as ascites or ascites.

The spleen can enlarge and cause pain in the upper left abdominal area that sometimes extends to the back. Varicose veins can develop in the esophagus and stomach. Since these tend to bleed more heavily, vomiting of dark matter, reminiscent of coffee grounds, and black, so-called tarry stools can occur.

Diagnosis & course

Complaints are with one portal hypertension often not felt. Problems are more likely to be caused by the complications that follow from it. One of the most serious is esophageal variceal bleeding, a bleeding from the lining of the esophagus that is often life-threatening. Such bleeding is due to the widening of the veins within the esophagus. In most cases, such bleeding occurs without the presence of pain or other symptoms.

If there is portal hypertension, it is not uncommon for bypass circuits to form in the blood. Enlargement of the spleen, abnormal accumulation of water in the abdomen or hepatic encephalopathy, i.e. a functional disorder of the brain, can be associated with the disease.The detoxification functions of the body can be restricted, changes in the blood count are possible.

The pressure in the portal vein can only be measured through a venous catheter, an examination that is associated with a high risk for the patient. A diagnosis can also be made using computed tomography or ultrasound. An endoscopy can reveal changes in the lining of the stomach or bleeding in this area.

Complications

Portal hypertension poses a risk of serious complications. This means that blood and lymph from the liver can no longer drain off as usual. The body tries to maintain the circulation and for this purpose falls back on the otherwise unused portocaval anastomoses, which are located between the systemic and hepatic circulation. However, this threatens various serious consequences.

Due to the portal hypertension, bypass circuits arise. They connect to the superior or inferior vena cava, bypassing the liver. The blood from the entire digestive region, which otherwise uses the passage through the portal vein, flows directly to the heart via the vena cava. As a result, the abdominal skin veins (caput medusae) expand significantly.

The anal veins are also affected, which in turn leads to the formation of hemorrhoids, as well as the gastric and esophageal veins. If sudden pressure or mechanical irritation occurs, there is a risk that the affected veins will burst. This can result in intense, life-threatening bleeding. Patients vomit blood or suffer from circulatory shock.

Ascites is another serious complication of portal hypertension. It occurs because the liver produces fewer proteins in the event of functional disorders. The lack of proteins leads to the squeezing of fluid from the portal veins, which then causes water to accumulate in the abdomen. Hepatic encephalopathy is also possible.

When should you go to the doctor?

If you experience stomach pain or gastrointestinal bleeding, this may be an indication of portal hypertension. A doctor's visit is necessary if the symptoms do not subside on their own or if they rapidly increase in intensity. If you have a fever, kidney or spleen problems and other signs of portal hypertension, medical help is recommended. People suffering from ascites or chronic cardiovascular disease should inform their doctor. Medical advice is needed at the latest when the condition has an impact on wellbeing.

In addition to the general practitioner, portal hypertension can be followed by a cardiologist or gastroenterologist. Further contacts are the nephrologist and the ENT doctor. First of all, the family doctor can be consulted about the condition, who can make a suspected diagnosis based on an examination of the cardiovascular system. In the case of severe symptoms, an inpatient hospital stay is necessary. Patients should also consult a doctor closely after treatment and inform him about unusual symptoms and any side effects and interactions of the prescribed medication.

Treatment & Therapy

As for one portal hypertension Other diseases are always the cause, such as hepatitis C or alcoholism, these should first be treated taking into account nutritional deficiencies, the tendency to increased bleeding and damage to the liver and the cardiovascular system.

If esophageal variceal bleeding occurs, the mortality rate is around one third. Surviving patients have to reckon with a renewed bleeding risk within the following two years, which is 50 to 70 percent. This risk can be reduced with medication.

If the patient's treatment does not respond well, a stent connection in the liver or a shunt may improve the condition. Even so, the long-term prognosis can look bad. In some cases, a liver transplant can help the patient.

prevention

To avoid a portal hypertension it is imperative that the patient maintain absolute abstinence from alcohol. Only in this way can pathological changes in the tissue of the liver be prevented, stopped or at least slowed down. As a precautionary measure, beta-blockers can be prescribed to prevent rebleeding in patients who have survived bleeding from the esophageal lining.

Aftercare

Portal hypertension can be treated quite well in the aftercare phase. First, patients should be aware that certain habits such as alcohol consumption and unhealthy diet are the triggers for the disease. By completely avoiding alcohol and high-fat foods, you can protect your cardiovascular system and your liver. This means that the pathological changes in the liver tissue can be slowed down or even prevented entirely.

Depending on the individual case, doctors may prescribe beta blockers to be taken by patients as recommended. Furthermore, the diet has an effect on the high blood pressure. Too much salt puts a strain on the body and increases blood pressure. That is why it is important to reduce the consumption of salt considerably and to use other spices instead.

Healthy foods like fruits, vegetables, and nuts help lower high blood pressure. Physical activity is also part of successful aftercare. Regular, gentle exercise outdoors will gradually normalize blood pressure. A combination of nutrition plan and sporting activities ensures better well-being. This is particularly interesting for overweight patients who reduce their weight through more exercise and thus put less strain on their heart.

You can do that yourself

Those affected can counteract portal hypertension independently by rearranging their everyday life a little. Self-help in everyday life is quite possible.

For example, it is advisable for patients to watch their diet. Salty foods in particular have a negative effect on blood pressure. It is therefore advisable to avoid salt as much as possible and use other spices instead. In addition, the diet can be supplemented with nuts. Those affected who use nuts in moderation have a positive effect on their high blood pressure.

In addition to nutrition, the focus should be on sports activities. This does not mean that those affected should participate in high-performance sports, but regular exercise in the fresh air can normalize blood pressure. Both diet and exercise are central if the affected person is overweight.

Often, being overweight, even light, is a possible cause of high blood pressure. If you weigh too much and suffer from portal hypertension, you should try to reduce your weight a little. Otherwise, those affected should take it easy. Stress and excessive exercise lead to high blood pressure. If these two potential causes can be eliminated, this will also allow blood pressure to normalize.