Portal Hypertension

What is portal hypertension?

Portal hypertension is high blood pressure in the portal vein. The portal vein is located in your belly (abdomen). It gets blood from your digestive organs (large and small intestines, stomach, pancreas, spleen) and carries it to the liver. The liver cleans and filters waste from the blood. The blood then travels to the heart and into general circulation for your body to use. With liver disease, blood flow can be blocked through the liver. This raises the pressure in the portal vein.

When you have portal hypertension, this increased pressure makes it harder for blood to flow normally through the portal vein. Blood is redirected away from (bypasses) the liver. The body forms new vessels for the blood to flow through, especially to the esophagus and stomach. These veins become enlarged and twisted. They swell up and may burst (rupture) under the added pressure. Treatment is needed to prevent them from bursting and bleeding. If bleeding occurs, it can be fatal. Other areas of the body where blood vessels may form and enlarge can include the belly or rectum.

What causes portal hypertension?

These are the most common causes of portal hypertension:

• Scarring of the liver (called cirrhosis)

• Clotting of the portal vein

• Clotting of the veins in the liver

In developing countries, one of the most common reasons is an infection called schistosomiasis.

What are the symptoms of portal hypertension?

At first, you may have no symptoms. They may not develop until there are complications. Having a higher than normal pressure inside the portal vein can lead to a number of related symptoms. These include:

• Enlarged liver and spleen

• Enlarged veins (varices) of the esophagus and stomach. These can cause abnormal bleeding, such as vomiting blood.

• Internal hemorrhoids

• Weight loss from malnutrition

• Fluid buildup in the belly (ascites)

• Kidney malfunction

• Low platelets

• Fluid on the lungs

How is portal hypertension diagnosed?

Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. The provider will do a physical exam. Unfortunately, healthcare providers can’t measure high blood pressure in the portal vein with a cuff like they can for regular high blood pressure. If you are at risk for or already have cirrhosis, you may need several tests:

• Lab tests. You may have various blood tests. A low platelet count is the most common sign of portal hypertension.

• Imaging tests. These give your healthcare provider pictures of the liver or blood flow in the liver. They let your provider check for enlarged veins around the liver and assess the risk of bleeding. Common imaging tests done include ultrasound and CT scans.

• Endoscopic exam. This is done to see inside the upper digestive tract. During the test, an endoscope is used. This is a thin, flexible tube with a tiny camera on the end. The provider puts it through your mouth. They guide it down through your esophagus, stomach, and the first part of your small intestine. This lets the provider check for enlarged veins and find any bleeding.

How is portal hypertension treated? 

Healthcare providers treat portal hypertension in several ways:

• Medicines. You may need to take medicines called beta blockers. These improve how your heart and blood vessels work. These medicines often also lower the risk of bleeding from swollen veins. If you have internal bleeding because of portal hypertension, your healthcare provider might inject medicine into the vein to help stop the bleeding. Or they may place bands around veins to stop the bleeding.

• Shunting. If you have a severe case, you may need shunting. This involves putting stents in the portal vein to open it and improve blood flow. Shunting can be done with or without surgery. Surgical shunting can cause more complications than the nonsurgical method.

• Liver transplant. This treatment may be needed if you have liver failure.

What are possible complications of portal hypertension?

The possible complications of portal hypertension are:

• Internal bleeding. Esophageal varices are enlarged veins at the lower end of the esophagus. With portal hypertension, blood backs up in nearby veins in the esophagus and stomach, causing varices. Varices are a serious problem. They can burst and cause internal bleeding. This often happens where the esophagus and stomach meet. This complication can cause sudden, explosive vomiting of blood. It can be fatal.

• Fluid buildup in the stomach. This can cause you to feel full quickly, leading to weight loss and malnutrition. The discomfort from carrying all that fluid can also reduce how well you can get around. Sometimes the fluid pushes up on the diaphragm and causes trouble breathing.

• Serious kidney problems

• Lung problems

When should I call my healthcare provider?

Portal hypertension is a dangerous condition with severe, life-threatening complications. Call your healthcare provider right away if you notice any of these symptoms:

• Yellowing of the skin

• Abnormally swollen belly

• Unexpected weight loss

• Vomiting of blood or what looks like coffee grounds

Key points about portal hypertension

• Portal hypertension is high blood pressure of the portal vein. The portal vein is located in your belly. It collects nutrient-rich blood from your intestines and carries it to the liver.

• Cirrhosis, or scarring of the liver, is one of the most common causes of this health problem.

• Some symptoms include an enlarged liver and spleen, varicose veins of the esophagus and stomach, and weight loss from malnutrition.

• Certain medicines may help treat portal hypertension. In severe cases, shunting or a liver transplant may be needed.

• Internal bleeding and fluid buildup in the stomach are possible complications.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new directions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends and holidays.