Portal hypertension


Portal hypertension

Description of portal hypertension

It is a persistent increased blood pressure in the portal vein watershed y (Latin portal vein). Portal vein basin covers almost all the veins bringing blood from the abdominal cavity organs to the liver. Specifically, the veins of the lower esophagus, stomach, small and large intestine, pancreas, gallbladder and spleen, which are then combined in only the portal vein, which carries blood full nutrients to the liver for processing.

Portal hypertension is the result of disease (see. Causes), which limits to impossible tributary flow or outflow of blood rich in nutrients and other substances by the liver for subsequent processing ..

The causes of portal hypertension

Portal hypertension may be due to many causes, which are divided into three groups according to localization.

Prehepatic causes (anatomically disease before liver)

Congenital anomalies portal vein and its basin, infections in the abdomen (eg. Peritonitis rarely appendicitis and gallbladder) cancer of the abdominal cavity, thrombosis (formation of blood clots in the vein)

Causes hepatic (liver disease)

Liver cirrhosis (in adulthood an overwhelming), liver fibrosis, blood diseases (leukemia, lymphoma), toxic liver damage (copper, arsenic), cancer

Posthepatic causes (illness after leaving the hepatic veins of the liver)

Tumor-infiltrating hepatic vein thrombosis (blood clot formation), right-sided heart failure

Risk factors portal hypertension

Most risk factor, but also the most easily modifiable, excessive alcohol consumption – daily alcohol intake greater than 1-2 dl of wine or a small beer for women or 2-3 dl of wine or one beer for men.

In our geographic belt are the second leading cause of liver cirrhosis and portal hypertension subsequently viral hepatitis (viral hepatitis) – especially hepatitis B and C. On the other hand, rarely occurring autoimmune inflammation of the liver or their metabolic disorders. From extrahepatic risk factors it is important to mention excessive blood clotting (tendency to blood clots).

Furthermore, one should avoid overdose of medications that can be toxic to the liver tissue (eg. A commonly used paracetamol – Paralen, Panadol etc., some kinds of antibiotics, cytostatics = medicines to treat cancer and many others).

Finally, we must not forget to mention the family tendency to cancer (particularly tumors of the abdominal cavity) and congenital malformations portal vein. An example is the absence of the portal vein and its replacement by several small veins, which are insufficient.

Prevention of portal hypertension

Prevention of this disease is very wide and varied, because it has a large variety of causes.

On the most important place is the only abstinence or moderate drinking (day 1-2 dl of wine or 1 small beer for women. 2-3 dl of wine or 1 beer for men).

Preventing infectious inflammation of the liver (hepatitis) – adherence to basic hygiene habits in case of hepatitis A, avoiding to operate unprotected sex and drug injection, in the case of hepatitis B, C and others.

Treatment and prevention of excessive blood clotting using drugs and adequate fluid intake, insufficient physical activity. On the other hand, it is equally important for treatment and prevention of inadequate blood clotting, especially when the hepatic impairment as prevention of variceal bleeding (see. The symptoms and signs of portal hypertension – oesophageal varices).

Proper intake of medicines, ie. not exceeding the maximum daily intake of medication compliance prescribed amount of medicines by doctors.

Symptoms and signs of portal hypertension

The most common symptom is the formation of collateral blood vessels (blood, which had to pass through the liver, bypasses and passes through small veins of other organs that are beginning to swell and can lead to life-threatening bleeding). As a very frequent example we can mention, for example, esophageal varices (varicose veins of the esophagus are similar to varicose veins in the lower limbs), variceal bleeding manifests as altered blood in the stool (melena), spitting and even vomiting often large amounts of blood (hematemesa) and the most frequent cause of death patients suffering from portal hypertension. Rarely can appear to patients enlargement of abdominal subcutaneous veins around the navel, which resembles the shape of a jellyfish head (Latin caput medusae)

Another very common symptom is an enlarged spleen (splenomegaly) and an enlarged liver (hepatomegaly), which are caused by stagnation of blood in these organs.

Patients can also be diagnosed scaled up fluid in the abdominal cavity (ascites) is seldom present jaundice (icterus), or yellowing of the whites of the eyes only (subikterus).

Upon full cessation of blood flow to the liver (especially posthepatic causes) threatens the emergence of shock and subsequent liver failure patients acutely life-threatening.

Among the initial subjective nonspecific symptoms include fatigue, loss of appetite, constipation, bloating, decreased libido, pressure and pain in the hypochondrium and abdomen, weight loss. Later swelling throughout the body caused by lack of protein.

Other symptoms may include enhanced capillary blood vessels in the dermis especially on the chest (called spider nevi), excessive bleeding, impaired brain function (encephalopathy) – such as tremor of the limbs, reduced brain capacity, incompetence purposeful movements etc.

Diagnosis of portal hypertension

Imaging method is most commonly used ultrasound examination of the abdomen for his safety and low cost of further contrast examination using computed tomography (CT) display portal veinangiography, magnetic resonance (MR angiography) or rarely angiography (invasive X-ray examination of blood vessels), especially before the scheduled operation surgery.

It is also possible to measure the pressure in the portal vein. Standard catheterization liver (hepatic) lived mostly through the femoral or jugular vein.

Then is the normal blood collection – blood count, biochemistry (protein content, ions in the blood etc.), blood clotting.

Treatment of portal hypertension

Treatment relies primarily on the prevention of portal hypertension and thereafter on treating the symptoms and complications, especially in the case of portal hypertension caused by cirrhosis of the liver. The most important is proper and early treatment of esophageal varicealbleeding (most often endoscopic ligation endoscopic = varicosity strangling small rubber ring or endoscopic sclerotization = endoscopic application of a substance into the varicose veins who destroys him).

Another option is to reduce the pressure in the portal (the portal) blood stream using vasoactive substances (substances which reduce blood flow). Uses include vassopresin. As adjunctive medical therapy drugs are used to high pressure (antihypertensives).

When massive bleeding can perform urgent surgery esophagus if the previous methods have not been effective.

Another possibility at least partial reduction of portal hypertension is called interventional TIPS = transjugular intrahepatic portosystemic shunt, the liver through interventional radiologist connects via a stent portal (the portal) vein and the hepatic vein.

In the case of portal hypertension caused by blood clots (thrombus) or by the growth of the tumor is the goal of treatment to dissolve or mechanically destroy the clot, in the case of cancer, or at least to shrink the tumor.

When portal hypertension induced systemic level of liver transplant is very rare irreversible damage to the liver.

How can I help treat

In our latitudes, the most common cause of portal hypertension, cirrhosis of the liver caused by excessive alcohol intake (of the Czech Republic’s doubly true, consistently ranks near the top in alcohol consumption). Therefore, the best prevention is abstinence or at least sober attitude towards alcohol. If you already have liver problems you have, you may not enjoy alcohol at all.

In the case of cirrhosis of infectious reasons it is necessary to observe basic hygiene – washing hands with soap after every visit to the toilet, washing hands before eating and after the use of public transport. In the case of hepatitis B and C, it is important to use protection during sexual intercourse (condom) and avoid inject drugs.

It is also important to observe the dosage of drugs, especially beware of drug overdose that damage the liver and compliance advice and recommendations of doctors.

Complications of portal hypertension

One of the most common and most serious complication is the development of esophageal varicesand bleeding, which gives a very frequent cause of death in patients with portal hypertension.

Another frequent complication is reduced blood clotting caused by the inability of the liver produce substances for proper blood clotting essential. The result is frequent bleeding and bruising.

For unpleasant complications are considered hepatorenal syndrome (functional renal failure due to low blood flow) and portosystemic encephalopathy, which leads to states of confusion and agitation. When more severe course there may be stronger disturbance of consciousness (sopor, coma).

Furthermore, the patient in the course of the disease more susceptible to infectious diseases, especially the rapidly increasing incidence of bacterial peritonitis (bacterial peritonitis) which can be life-threatening complications. Finally mention has to be multiplied fluid in the abdomen (ascites).

Other names: Hypertension in the portal bloodstream, the portal hypertension, elevated blood pressure in the portal bloodstream, increased blood pressure in the portal bloodstream

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