Portal hypertension refers to elevated blood pressure in the portal venous system, which is a vital vein that connects the liver to 4 organs (stomach, intestine, spleen and pancreas). It is commonly caused by the obstruction in the liver, intrinsic liver disease, or any other structural changes which may lead to an increased hepatic resistance or elevated portal venous flow. This resistance results in amplified pressure, causing dilations or varices of the veins.
Pressure in the portal system predominately depends on:
Typically, the pressure of portal vein ranges between 4 mm Hg and 14 mm Hg higher than the hepatic vein-free pressure. Pressures exceeding these limits may result in portal hypertension.
Usually, an individual suffering from portal hypertension does not exhibit any symptom until complications develop.
Some of these symptoms include:
Some of the common causes of portal hypertension include:
If an individual is experiencing aforementioned symptoms, it is advisable to visit a specialist. Your doctor will ask patients questions pertaining to the medical history and symptoms, including questions related to their family members. Besides, your doctor would also perform a physical examination.
In some cases whereby the diagnosis of the disease is not straightforward, a doctor may recommend performing some invasive examination or testing to gauge the vein pressure or assess liver tissues to have a better understanding of the problem.
Portal hypertension is generally treated by managing of symptoms of the disease. One of the most common symptoms of portal hypertension is bleeding, which may cause severe complications, if it is not quickly treated.
Three frequently recommended options for treating portal hypertension include:
If the aforementioned procedures and medications fail to manage bleeding, other two radiological and surgical procedures are recommended, viz., TIPS and DSRS.
Transjugular Intrahepatic Portosystemic Shunt (TIPS):
This method aims at decreasing both portal hypertension and the blood clotting by inserting a stent (or tube-like device) in the liver.
Distal Splenorenal Shunt (DSRS):
It is a surgical procedure that controls both bleeding and pressure by creating a channel-like route between the left kidney and the spleen. Thus, DSRS decreases the portal circulation.
Along with the previously mentioned procedures, your doctor may further prescribe some medications for portal hypertension treatment.
Portal hypertension treatment may cause certain complications, including encephalopathy and ascites. Check with your doctor to know more information!
As portal hypertension is sometimes associated with cirrhosis of the liver and may also cause bleeding and other symptoms (such as ascites), it is important to get a suitable guidance from a qualified doctor.
Senior Consultant Surgeon
MBBS (Singapore), FRCS (Edinburgh), MMed (Surgery), MSc (Bioinformatics),
FAMS (General Surgery)
With 20 years of surgical experience, Dr Lee is trained and skilled in using minimally invasive techniques for liver, pancreas, gallbladder and hernia procedures.
His busy practice aside, Dr Lee is actively involved in postgraduate teaching and workshops for junior surgeons, and is still actively involved in academic research at the National University of Singapore.
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