What is Portal Hypertension Syndrome?

Portal hypertension is a serious pathological condition that causes damage to the liver. In this case, there is a significant increase in the blood pressure of the portal vein. This is the vein that carries blood from the intestines to the liver. It can lead to death from gastric bleeding, so it is necessary to start treatment on time, while the situation can still be corrected.

Portal hypertension can cause cirrhosis of the liver, hepatitis, cancer.

This is not an independent disease, but a condition that occurs due to other diseases that disrupt the circulation of the hepatic and portal veins.

Factors causing the development of the disease

Portal hypertension syndrome develops when something blocks the flow of blood through a vein. Such a problem can occur both in the liver itself and near it. As a result, the pressure increases sharply, the veins fill with blood, begin to stretch and burst.

There are many factors that cause the development of portal hypertension.

The main ones are:

• Damage to the parenchyma (liver cells). This can happen with cirrhosis, acute hepatitis, tumors. Sometimes flatworms that parasitize in the human body contribute to organ damage.
• Congested bile in or near the liver. For example, stones or neoplasms clogged the bile ducts.
• Poisoning with toxic substances or the abuse of chemicals that destroy liver cells.
• Neoplasm in the portal vein, deposition of blood clots, congenital pathologies of the portal vein.
• Diseases that violate the patency of the vessels of the liver.
• Injuries, sepsis, complications after operations, burns of large areas of the body.

The most common cause of the development of a pathological condition is cirrhosis of the liver.

In the course of this disease, the following changes in the portal vein bed occur:

• Collagen begins to accumulate between liver cells.
• The shape of the sinusoids (blood-filled spaces in the liver) is disturbed.
• The venous system of the liver is deformed.
• Shunts occur in the liver between the portal and hepatic trunks.

These factors contribute to the development of portal hypertension. Pathology can begin to manifest itself due to infections, abuse of alcohol, diuretics and tranquilizers, the predominance of protein foods of animal origin in the diet.

Signs of the onset of pathology

Symptoms of hypertension may include:

1. Bloating and marked enlargement of the abdomen.
2. The veins of the esophagus, stomach and hemorrhoidal veins expand.
3. Bleeding may occur in the stomach and esophagus. This phenomenon has symptoms such as vomiting blood or blood in the mouth.
4. Right under the ribs there are strong painful sensations.
5. If bleeding begins in the intestines, then blood impurities can be seen in the feces. The stool itself will be black in color.
6. Vomiting of blood and blood in the stool speaks of gastric and esophageal bleeding. The stool itself will also be black.
7. An enlarged liver can be observed.
8. Loss of appetite or loss of appetite. The patient begins to lose weight rapidly.
9. The skin may turn a little yellow.
10. Hepatosplenomegaly or simultaneous enlargement of the liver and spleen. This symptom can be seen with the development of portal hypertension, not only on ultrasound, but also visually. If a person has hepatosplenomegaly, then a bulge can be seen on the right under the ribs, which shifts when inhaling. Initially, only the spleen may enlarge, but gradually changes in the size of the liver are also observed. Hepatosplenomegaly requires long-term follow-up.
11. Very often, the presence of the disease is indicated by the accumulation of fluid in the abdominal cavity. This phenomenon is called ascites. Together with portal hypertension, the pathology is severe and almost untreatable.

In rare cases, symptoms such as nosebleeds and pinpoint hemorrhages may occur.

Regardless of the form of the disease, those with portal hypertension experience symptoms such as impaired ability to work and mental activity, a constant feeling of weakness. In the last stages, the functions of the central nervous system are disturbed.

Stages of the disease

There are four stages in the development of the disease.

Each of them is manifested by certain symptoms:

• The first stage cannot be determined without special diagnostic methods. It is accompanied by a feeling of heaviness in the right side under the ribs, bloating and general weakness.
• The second stage has more characteristic features. In addition to heaviness, bloating and weakness, the patient suffers from digestive disorders. You can also observe an enlarged liver and spleen.
• In the third stage, a person is concerned about all the symptoms of the disease, in addition, fluid begins to accumulate in the abdominal cavity. At this stage, patients often become disabled, as they suffer from regular bleeding, swelling of the abdomen and an enlarged spleen.
• At the fourth stage, complications develop that are difficult to treat: severe repeated bleeding from internal organs, fluid in the abdominal cavity. Inflammation of the abdomen and liver failure develops.

Features of the development and course of pathology in children

This disease can also occur in children under three years of age. In this case, it has an innate character. The causes of portal hypertension in children are unknown. It is believed that such disorders may occur due to complications of pregnancy: these may be the formation of blood clots in the hepatic vein.

Basically, the following symptoms of pathology in children are distinguished:

• The veins of the esophagus and stomach may bleed a little or a lot.
• The liver and spleen, or one of these organs, is enlarged.
• When examined in children, you can notice an increase in the abdomen and protruding veins.

But if treatment is started in time, one can hope that the child will lead a more or less normal life.

Treatment of pathology in children is not aimed at stabilizing the condition, but at creating normal conditions for development. Surgical intervention is performed if children develop varicose veins of the esophagus and stomach or start bleeding from them. The operation helps to reduce the pressure of the portal vein and prevent the development of bleeding. For this, vascular anastomoses are formed. They ensure the passage of blood from the portal vein to the system of the superior and inferior vena cava.

Diagnosis of the disease

The condition requires a serious and lengthy diagnosis. It is very important to consult a specialist in the early stages of the disease. This will greatly facilitate the treatment process.

First study the pathogenesis of portal hypertension. The doctor must be aware of bad habits, pathologies of internal organs, medications taken. He must also know where the patient works, as this is an important criterion if it is necessary to establish a disability.

During the examination, the doctor can already see the signs of the disease: the veins on the surface of the abdomen are enlarged, there is an accumulation of fluid in the abdominal cavity, hemorrhoids, an umbilical hernia, a bulge on the right under the rib.

After the examination, laboratory and instrumental diagnostic measures are prescribed:

1. A blood test for antibodies and viruses that cause hepatitis, a complete blood count, an immunoglobulin test.
2. To determine exactly where the blockage is located in the portal vein system, to predict the course of the operation and to determine whether it is possible to create anastomoses between the vessels, X-ray studies are prescribed with or without contrast.
3. To determine the degree of damage to the liver and spleen, changes in size are prescribed ultrasound of the abdominal cavity. The procedure also allows you to determine the presence of fluid in the abdominal cavity. This study allows you to find the location of blood clots. The procedure does not require the use of a contrast agent and does not bring any harm to health.
4. Doppler ultrasound. The procedure allows you to determine how much the portal vein has expanded or narrowed. Her varicose veins can be diagnosed as portal hypertension. Such a study is a mandatory diagnostic measure.
5. Splenomatometry. During the procedure, the level of portal pressure is measured.
6. Among the mandatory studies are endoscopic techniques: they examine the esophagus, stomach, small and large intestine. These studies help determine the presence of dilated veins of the gastrointestinal tract.
7. For severe cases, laparoscopy is indicated. This is a diagnostic method, during which an incision is made in the abdominal cavity, a tube with a video camera is inserted into it, and an image of the internal organs is displayed on the monitor screen.
8. A biopsy may be ordered to determine the cause of the liver enlargement. During the study, a small amount of material is taken with a thin needle for laboratory research. The procedure allows you to determine abnormalities in the liver that could not be previously established. Because of the pain and possible complications, a biopsy is done in extreme cases.
9. To determine the cause of portal hypertension, several specific procedures may be prescribed: to rule out or confirm the presence of flatworms, examine feces for the presence of parasites; To determine tuberculosis, tuberculin tests are injected under the skin.

In the process of making a diagnosis, doctors must rule out diseases that also include an enlarged liver and spleen.

How the disease is treated

Treatment of portal hypertension depends on the stage of development of the disease.

If the pathology was detected at the initial stages, then medications can be dispensed with. Running conditions require prompt intervention.

To reduce high pressure of the portal vein, the following drugs are prescribed:

• Containing pituitary hormones. They reduce blood flow to the liver and help reduce pressure in the portal vein. This happens because under the influence of hormones, the arterioles narrow.
• Nitrates, such as nitroglycerin. They contribute to the expansion of veins and arterioles, reduce blood flow to the liver.
• Beta blockers. Such drugs help to reduce the heart rate, due to which the blood circulation speed decreases, less blood flows to the liver.
• Somatostatin analogues. These medicines reduce pressure in the portal vein by constricting the arterioles in the abdominal cavity.
• Diuretic drugs. They help to remove excess fluid from the body. This reduces blood volume and helps lower blood pressure.
• Synthetic analogs of lactose/lactulose. They cleanse the intestines of toxic substances that accumulate as a result of liver problems.
• Antibacterial drugs. They stop reproduction and destroy pathogenic microorganisms that are the causative agents of many diseases. The drug can be prescribed only after determining the type of pathogen. If this fails, then broad-spectrum antibiotics are prescribed. They are effective against most microorganisms.

Surgical methods

Portal hypertension syndrome is also treated with surgery. This therapy has been used for over a hundred years with good results.

Surgery may be needed if the patient has varicose veins of the stomach or esophagus, an enlarged spleen, or fluid has formed in the abdominal cavity.

Portal hypertension is treated with the following surgical methods:

1. To reduce the risk of bleeding, some veins in the esophagus and stomach may be tied off. The procedure is called sclerotherapy, as it closes the lumen of the vessels.
2. Create vascular portal-caval anastomoses. These are new pathways for blood to travel from the portal vein to the inferior vena cava, bypassing the liver. The procedure may be supplemented by the removal of the spleen.
3. Abdominal drainage. This procedure is necessary if there is fluid in the abdominal cavity.
4. During the treatment of children, artificial portocaval anastomoses are created. This is the only option that allows you to save the child from the manifestations of the disease.
5. Liver transplant. It is necessary if by no means the patient can restore liver function. A relative's organ transplant is usually practiced. Most often, this therapy is used to treat children.

In the presence of complications, portal hypertension is treated in the following ways:

1. The veins of the esophagus are sutured. Such treatment is necessary when bleeding occurs repeatedly.
2. Elastic rings bandage the dilated veins of the esophagus.
3. To stop bleeding, a probe is inserted into the esophagus and stomach, which is equipped with two balloons. These balloons inflate and cover the bleeding veins, thereby stopping the bleeding.

To compensate for blood loss, the patient is transfused with plasma and erythrocytes from a donor, and plasma substitutes are also prescribed.

Nutrition for pathology

Proper nutrition can relieve the unpleasant manifestations of the disease and increase the effectiveness of treatment. It consists primarily in reducing salt intake. Salt leads to fluid retention in the body, which contributes to an increase in pressure in the portal vein, as well as the formation of fluid in the abdominal cavity.

It is important to limit your intake of animal protein. This will slow down the progression of the disease.

The diet should consist of vegetable soups, lean meats and seafood. It is better to drink more kefir, compotes, fruit drinks. It is strictly forbidden to drink coffee, eat chocolate, eggs, fried, salty, smoked and fatty foods. Alcoholic beverages are out of the question.

Complications of the disease

Portal hypertension can have serious consequences for a person's health.

Due to the destruction of blood cells in a patient:

• The level of hemoglobin decreases.
• The level of platelets decreases, which causes bleeding.
• The level of white blood cells, which protect the body from infections, decreases. This leads to the fact that a person is easily infected with infectious diseases.

Also, due to violations of the liver, toxic substances accumulate in the body. They disrupt the brain. Because of this, the patient's memory is disturbed, emotional disorders, paranoia occur, a person may fall into a coma. This condition is called hepatic encephalopathy.

Kidney function may be impaired, systemic infections may develop.

Recovery prognosis

The prognosis of the disease depends on its form and stage. If portal hypertension develops outside the liver, then the chances of a normal life in a person are quite high. But with intrahepatic flow, the risk of death is high. Patients usually die from bleeding in the stomach and intestines and from liver failure. Surgical interventions, during which anastomoses are formed, can add several years to life.

How successful the treatment will be depends on the stage at which the diagnosis was made. If the disease was identified at the very beginning of development, then the prognosis is favorable.

But it is impossible to completely get rid of the disease. It becomes chronic and requires constant monitoring by a gastroenterologist, as well as maintenance therapy. Given the severe symptoms and consequences of the pathology, a person cannot work and lead a normal life, so most patients receive a disability.

Disability is assigned depending on how much a person cannot do without outside help. There are three categories of disability. For the most severe cases, the first group is drawn up.

Prevention

To avoid the development of the disease, it is necessary not to refuse vaccination against hepatitis B, which is one of the causes of the development of pathology. It is also important to stop smoking and drinking alcoholic beverages, eat right. In general, avoid anything that can disrupt liver function.

If the disease is already developing, then it is important to start treatment on time. To do this, you must not ignore the symptoms. For any deviations, visit a gastroenterologist.

To prevent the development of bleeding, you must:

• Anyone who suffers from diseases that can provoke an increase in pressure in the portal vein, once a year or two, have an inspection of the surface of the esophagus, stomach and duodenum.
• If the patient suffers from varicose veins of the esophagus and stomach, then such an examination must be carried out at least once every six months.
• If the expansion of the veins is not too large, the examination is carried out every two or three years.

To avoid brain damage, you must:

• Reduce your daily protein intake. No more than 30 grams per day is allowed. This will reduce the amount of toxic substances that can damage the brain.
• Consume lactose/lactulose analogues regularly. Such drugs remove toxins from the body that accumulate due to violations of the liver.

Portal hypertension is a dangerous, life-threatening disease. Its development puts an end to a normal lifestyle. A person will constantly have to be treated, and often the treatment does not work. Therefore, it is advisable to avoid any activities that can cause liver disease.