Portal hypertension is a serious condition caused by an increase in blood pressure within the portal venous system. There are veins that come in from the spleen, intestines, stomach, and pancreas and form the portal vein, which then branches off and travels through the liver. When the liver is damaged, the blood cannot flow through, and high pressure develops. Without proper treatment, a patient can suffer from complications, some of them very severe. There are several ways to treat and even prevent portal hypertension.
Medications can be used by themselves or in conjunction with endoscopic therapy. The goal is to reduce the risk of bleeding by reducing the varices’ pressure, which is caused by the liver not being able to handle the blood flow sent to it through the portal vein. When this happens, the blood causes pressure on various blood vessels, including in the esophagus. If a doctor feels the varices may be at risk for bleeding, they may recommend beta-blockers, which are used to help reduce blood pressure. Beta blockers work by reducing the heart’s beating, which in turn reduces blood pressure. There is also a medication, known as lactulose, that can help treat confusion and changes in mental status due to encephalopathy.
Following A Healthy Diet
As with many illnesses and conditions, following a healthy diet can help alleviate some symptoms and complications. Portal hypertension is no different. Making some changes in lifestyle can help patients avoid portal hypertension and improve liver function, such as limiting alcohol consumption. Additionally, not taking over-the-counter or prescribed medications that negatively affect the liver is important. Doctors may also give patients a list of dietary restrictions that will help the liver function better. Some of these restrictions include salt and protein. These may need to be reduced if there seems to be any liver function damage. Furthermore, if a liver problem develops, some foods may need to be avoided to reduce confusion caused by portal hypertension. Employing a healthy lifestyle can not only help a patient if they have liver problems, but it can also help with other problems they have, like obesity.
If the patient has variceal bleeding, which occurs in the esophagus, endoscopic therapy intervention is usually done first. One procedure involves banding blood vessels to stop the bleeding and get rid of the varices. Banding the blood vessels that are bulging will cut off the blood flow and will create a small ulceration, which will heal quickly. This is a safe procedure for the esophagus because it does not cause any damage. If the banding does not work, the doctor may try sclerotherapy, which involves injecting a blood-clotting solution where the varices are bleeding to stop the bleeding. This solution can be injected directly into the varices, creating a clot, or right next to the varices. This will cause a bulging effect that will cut off the blood flow. Both methods have the chance of being needed more than one time. New varices may present themselves, and the process may need to be repeated.
Two radiology procedures can be attempted if portal hypertension is diagnosed. The first is transjugular intrahepatic portosystemic shunt (TIPS), and involves placing a shunt into the middle of the liver. There is a tunnel made through the liver connecting the portal vein to the hepatic veins using the shunts to keep it open. This means all the blood that normally goes through the entire liver now only goes through part of the liver, because the rest may be damaged. The result of this can be that there is a buildup of toxins, which can affect the brain. Usually, medicines are used in conjunction with this procedure to help the body get rid of the excess toxins. If the medicines are not used after the TIPS procedure, toxins can build up, especially in the brain. These toxins can cause confusion, hepatic encephalopathy, and even death.
Another radiological procedure that can be done is called distal splenorenal shunt (DSRS). During this process, the spleen’s vein is connected to the left kidney. This procedure reroutes the splenic vein without taking blood away from the liver. The purpose is to reduce the pressure of the varies in the stomach and esophagus, thus reducing the bleeding. These procedures do not require open surgery, and are done using interventional radiologists. Image guidance is used to complete the procedure. After they are performed, the patient can generally go home the next day.
There are few different surgical remedies to portal hypertension, the first of which is devascularization. This procedure is done when the bleeding of the varices cannot be controlled through the use of the TIPS procedure. It involves disconnecting the esophagus and the stomach from the portal system. Another surgical solution is a liver transplant, which is done when the liver is not functioning properly, and all other procedures have failed to control portal hypertension and the complications associated with it. A liver transplant can give a person a new lease on life. The liver can come from two places. A living donor, usually a relative or friend, may be able to donate part of their liver to the patient. Then, over the next few weeks, the livers will grow to normal size. The other kind of donor is a deceased donor. This means the patient has to wait until someone dies and is a match for them. Then, that individual’s whole liver can be transplanted into the patient. There is a waiting list established for this kind of donor. As a patient becomes iller, they rise further up the donor list. This means the sickest patients typically get transplanted livers first.