Portal hypertension (patient information)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Portal hypertension
Overview
What are the symptoms?
What are the causes?
Who is at highest risk?
Diagnosis
When to seek urgent medical care?
Treatment options
Where to find medical care for Portal hypertension?
Prevention
What to expect (Outlook/Prognosis)?
Possible complications
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Directions to Hospitals Treating Portal hypertension
Risk calculators and risk factors for Portal hypertension

Overview

Increasing blood flow and vascular resistance in portal vein is called portal hypertension. Common symptoms of portal hypertension include bloody vomiting, tarry stools, abdominal distention, fatigue, and loss of appetite. Patients who are at high risk for portal hypertension include intravenous drug use (IVDU), tattooing or piercing in unhygienic condition, needlestick injury, blood transfusion before 1992, viral hepatitis, unprotected sexual intercourse, schistosomiasis in childhood, and family history of hereditary liver disease. The mainstay of treatment in portal hypertension is surgery. The medical therapy for decreasing the tone of liver veins and decreasing the pressure is suggested. Common complications of portal hypertension include peritoneum infection, renal insufficiency, severe confusion, spleen enlargement, abdominal distension, bloody vomiting, renal failure, and pulmonary failure.

What are the symptoms of Portal hypertension?

Symptoms of portal hypertension include:

• Bloody vomiting
• Tarry stools
• Abdominal distention
• Fatigue
• Loss of appetite

• Abdominal pain
• Confusion
• Forgetfulness
• Drowsiness
• Slurred speech
• Bleeding easily
• Easy bruising
• Itchy skin
• Jaundice
• Nausea
• Peripheral swelling
• Weight loss
• Palms Redness
• Testicular shrinkage in men
• Breast enlargement in men
• Bloody stool

What causes Portal hypertension?

Common causes of portal hypertension include:

• Bacterial intestinal infections
• Congenital abnormalities
• Renal transplantation
• Liver transplantation

• Alcoholic hepatitis
• Antiretroviral therapy
• Arsenicals
• Autoimmune disease
• Chronic hepatitis
• Crohn’s disease
• Familial cases
• Fatty liver
• Schistosomiasis

• Congestive heart failure
• Inherited thrombophilias 
• Sickle cell disease

Who is at highest risk?

Patients who are at high risk for portal hypertension include:

• Intravenous drug use (IVDU)
• Tattooing or piercing in unhygienic condition
• Needlestick injury
• Blood transfusion before 1992
• Viral hepatitis
• Unprotected sexual intercourse
• Schistosomiasis in childhood
• Family history of hereditary liver disease

Diagnosis

Portal hypertension is diagnosed based on:

• Physical examination
  • Enlarged spleen
  • Dilated veins around the umbilicus
  • Yellowish discoloration of skin (icterus)
• CT-scan and MRI
  • Dilated veins around the liver
  • Enlarged spleen
  • Accumulation of fluid in abdominal cavity
• Color-doppler ultrasound
  • Increased flow through portal vein and stomach veins
• Endoscopy
  • Dilated veins at the lower portion of esophagus

When to seek urgent medical care?

Patients with the following symptom have to seek urgent medical care:

• Bloody vomiting
• Tarry stool
• Severe abdominal pain
• Yellowish discoloration of skin
• Dilated veins around the umbilicus

Treatment options

• The mainstay of treatment in portal hypertension is surgery.
• The medical therapy for decreasing the tone of liver veins and decreasing the pressure is suggested.

Where to find medical care for Portal hypertension?

Directions to Hospitals Treating Portal hypertension

Prevention

Effective measures for the primary prevention of portal hypertension, include:

• Hepatitis B vaccination
• Avoiding unprotected sex relations
• Precise screening of the blood products before injection
• Alcohol consumption reduction
• Overweight and obesity prevention
• Diabetes mellitus prevention.

Effective measures for the secondary prevention of portal hypertension, include:

• Hepatitis B and hepatitis C infections management
• Alcohol abuse management
• Weight loss management
• Proper management of diabetes mellitus

What to expect (Outlook/Prognosis)?

• The symptoms of portal hypertension usually develop in the third and fourth decades of life.
• Dilated esophageal veins are typically developed 5-15% per year after hepatic fibrosis.
• Most of the cirrhotic patients will develop the varices during the lifetime.
• Approximately 60% of patients with cirrhosis develop ascites in 10 years.
• The presence of variceal bleeding, spontaneous bacterial peritonitis, and renal insufficiency are associated with a particularly poor prognosis among patients with portal hypertension. They are the leading causes of death among patients with portal hypertension.

Possible complications

Common complications of portal hypertension include:

• Peritoneum infection
• Renal insufficiency
• Severe confusion
• Spleen enlargement
• Abdominal distension
• Bloody vomiting
• Renal failure
• Pulmonary failure