Portal Hypertension is abnormally high pressure in the vein that delivers blood to the liver from the intestine (portal vein). The increase in portal vein pressure is caused by a blockage in the blood flow through the liver. The blockage can be caused by severe scarring of the liver (cirrhosis) or formation of a blood clot in the portal vein. Increased pressure in the portal vein requires the veins of the esophagus and stomach to bypass the blockage. The abnormally high blood flow and pressure in the veins of the esophagus and stomach cause increased tension in the wall and increased size, forming varices that become fragile and can bleed easily. The increased portal vein pressure also causes sweating from the liver and intestine resulting in an accumulation of fluid in the abdomen. The is called ascites.
Cirrhosis is the leading cause of portal hypertension. Historically a surgical procedure called a mesocaval shunt was performed to relieve increased pressure to lower the risk of bleeding. With advances in intervention radiology, a procedure called a Transjugular-Intrahepatic-Portalsystemic-Shunt or TIPS procedure is now used in most patients with portal hypertension. In patients with a completely blocked portal vein, TIPS is usually not possible. In these patients a surgical shunt is usually the procedure of choice. The most common shunt used is called a mesocaval shunt. Patients who have a completely blocked portal vein commonly have an abnormally high tendency to form blood clots, otherwise known as a hypercoagulable state. These patients also need to take blood thinners to prevent future blood clots in their TIPS or surgical shunt.
Initial treatment for ascites is a low-sodium (salt) diet with no more than 2 grams of sodium per day. Reduced protein intake will also help avoid confusion (encephalopathy). Medical treatment also include the use of water pills (diuretics). The most common medications used are furosemide (Lacix) and spironolactone (Aldactone). To further reduce the pressure in the portal vein, patients are also started on medications to lower blood pressure. The most common medications are "beta blockers", these include propanolol, nadolol, or atenolol. Patients that fail medical management maybe eligible for a "shunt" procedure.
Normal Esophagus compared to Esophagus with varices
Life threatening bleeding can occur from esophageal varices. Patients diagnosed portal hypertension should have an endoscopy to determine if varices are present. Patients with significant varices can be treated with "banding" or "sclerotherapy". To further reduce the pressure in the portal vein, patients are also started on medications to lower blood pressure. The most common medications are "beta blockers", these include propanolol, nadolol, or atenolol. Patients that fail endoscopic management maybe eligible for a "shunt" procedure.
A TIPS procedure is usually performed by an interventional radiologist. A hollow needle is used to access the internal jugular vein in the neck. A wire is passed through the needle into the vein, down to the liver. A ) The wire is passed usually through the right hepatic vein, and a connection is made with the portal vein. B) Through the connection a wire mess tube is placed. C) The wire mesh tube expanded to allow blood to flow directly from the portal vein to the hepatic vein.
There are several types of shunts to treat patients with portal hypertension. Since a TIPS procedure has become the leading treatment for portal hypertension, surgical shunts are used in those patients who have failed TIPS or have a completely blocked portal vein. Most patients in need of a surgical shunt are those that have a blood disorder where clot forms in the portal vein. In situations where patients go on to suffer complications from bleeding varices or ascites, a surgical shunt can be relieve these complications.
Cirrhosis is the leading cause of portal hypertension. Historically a surgical procedure called a mesocaval shunt was performed to relieve increased pressure to lower the risk of bleeding. With advances in intervention radiology, a procedure called a Transjugular-Intrahepatic-Portalsystemic-Shunt or TIPS procedure is now used in most patients with portal hypertension. In patients with a completely blocked portal vein, TIPS is usually not possible. In these patients a surgical shunt is usually the procedure of choice. The most common shunt used is called a mesocaval shunt. Patients who have a completely blocked portal vein commonly have an abnormally high tendency to form blood clots, otherwise known as a hypercoagulable state. These patients also need to take blood thinners to prevent future blood clots in their TIPS or surgical shunt.
Ascites
Initial treatment for ascites is a low-sodium (salt) diet with no more than 2 grams of sodium per day. Reduced protein intake will also help avoid confusion (encephalopathy). Medical treatment also include the use of water pills (diuretics). The most common medications used are furosemide (Lacix) and spironolactone (Aldactone). To further reduce the pressure in the portal vein, patients are also started on medications to lower blood pressure. The most common medications are "beta blockers", these include propanolol, nadolol, or atenolol. Patients that fail medical management maybe eligible for a "shunt" procedure.
Esophageal Varices
Normal Esophagus compared to Esophagus with varices
Life threatening bleeding can occur from esophageal varices. Patients diagnosed portal hypertension should have an endoscopy to determine if varices are present. Patients with significant varices can be treated with "banding" or "sclerotherapy". To further reduce the pressure in the portal vein, patients are also started on medications to lower blood pressure. The most common medications are "beta blockers", these include propanolol, nadolol, or atenolol. Patients that fail endoscopic management maybe eligible for a "shunt" procedure.
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
A TIPS procedure is usually performed by an interventional radiologist. A hollow needle is used to access the internal jugular vein in the neck. A wire is passed through the needle into the vein, down to the liver. A ) The wire is passed usually through the right hepatic vein, and a connection is made with the portal vein. B) Through the connection a wire mess tube is placed. C) The wire mesh tube expanded to allow blood to flow directly from the portal vein to the hepatic vein.
Surgical Shunt
There are several types of shunts to treat patients with portal hypertension. Since a TIPS procedure has become the leading treatment for portal hypertension, surgical shunts are used in those patients who have failed TIPS or have a completely blocked portal vein. Most patients in need of a surgical shunt are those that have a blood disorder where clot forms in the portal vein. In situations where patients go on to suffer complications from bleeding varices or ascites, a surgical shunt can be relieve these complications.