Portal Hypertension Symptoms

The portal vein, is the vein located in the abdominal cavity and carries blood to the liver. It is not a true vein as it does not carry blood to the heart directly but to the liver. Increased pressure in this vein leads to a condition known as portal hypertension. The immediate effect of increased pressure in this vein is seen on the liver. This condition is a major complication that arises when a person is suffering from liver disorders especially liver cirrhosis.

Causes
An increase in the pressure of the hepatic portal vein by 10mm Hg leads to the condition known as portal hypertension. There can be innumerable underlying causes for it, however one major and common cause observed is scarring of the liver tissue as seen in liver cirrhosis. The blood flow in this vein is affected due to damage to the liver tissue that affects the pressure in this vein. Other reason for this problem is hepatic fibrosis that is caused due to diseases such as Wilson's disease, congenital fibrosis and hemochromatosis (Iron linked disorder). Portal vein thrombosis and congenital atresia are considered to be prehepatic causes of portal hypertension, which means that the liver is not scarred but an alteration in the blood vessels supplying blood to the liver are affected. Other causes are post hepatic obstructions that may occur due to hepatic vein thrombosis and constrictive pericarditis.

Symptoms
Symptoms of portal hypertension are not always specific, but in general there are alterations and complications that lead to compromised liver functions. The major symptoms and complications of this condition are;

• Ascites, which is a condition marked by accumulation of fluids in the stomach.
• Gastrointestinal bleeding occurs when pressure increases in the portal vein, which leads to other symptoms such as black stools, bloody stools and also blood in vomit due to varices that are caused due to hemorrhaging of blood vessels.
• Hepatic encephalopathy is another symptom, wherein a person appears confused all the time and is often forgetful.
• The count of blood platelets, white blood cells and red blood cells is reduced significantly. This condition is known as pancytopenia which is a low count of all types of blood cells, mostly the result of a compromised liver. The spleen shows an enlargement due to reduced blood cells as it over works to produce more cells. This condition is known as splenomegaly.
• The risk of spontaneous bacterial peritonitis is more. This is an infection of the abdominal cavity even when there hasn't been any sort of possible exposure to pathogenic bacteria. This is the sign of a compromised immune system. It is seen in almost all the patients of portal hypertension.
• Hepatorenal syndrome may also develop, where there is a progressive decline in the kidney function. This is seen in patients with liver cirrhosis.
• Portacaval anastomosis is also a symptom of this hypertension. It is the joining of two blood vessels which previously were branched. Here, these veins are those of portal circulation and systemic circulation that causes gastric varices and esophageal varices. These bleeding blood vessels are a constant cause of concern in the case of a liver disorder or disease.

Treatment
As variceal bleeding is the primary symptom of portal hypertension and therefore management of these is necessary. First the individual is treated with vasodilators and then endoscopic banding, balloon tamponade is done to treat the varices. Ascites is managed by a diet restriction of salt, treatment with diuretics, paracentesis (draining fluid from the abdominal cavity using a needle) and transjugular intrahepatic portosystemic shunt procedure, which is an artificial channel made in the liver connecting the hepatic portal vein to the hepatic vein.

A variety of symptoms primarily affect the liver and therefore, this condition's diagnosis is based on liver function tests. A damaged liver is a cause of concern and symptomatic treatment and disease management has to be done on a regular basis. Liver transplant is another option when the liver is damaged, but may not always be possible.