Portal hypertension syndrome

Portal hypertension is a condition in which increased pressure in the veins is common in many diseases. Portal hypertension causes many dangerous complications and can lead to death if not diagnosed and treated promptly, including gastrointestinal bleeding complications.

In the human body, arteries carry blood from the heart to the organs and veins carry blood from the organs back to the heart. In particular, unlike normal veins, the portal vein carries out the task of transporting blood from organs including the stomach, small intestine, large intestine, pancreas, spleen to the liver. After receiving blood from the portal vein, the liver performs the function of filtering and eliminating other toxins in the blood from the body.
Portal hypertension is a condition in which portal blood pressure is elevated, >10 mmHg, while it's normally between 3 and 6 mmHg.

There are many causes of portal hypertension, depending on the location of the portal vein injury relative to the liver, the causes are classified as follows:
Anterior hepatic portal hypertension: venous stenosis congenital portal (common in young children), occlusion of the portal vein or splenic vein (common in pregnant women, postpartum women, the elderly, critically ill patients who have to lie down for a long time) , ...), tumor in the abdomen causing compression due to pancreatic cancer, stomach cancer, colon cancer. Portal hypertension in the liver: metastatic cancer to the liver, cirrhosis, primary cholestatic cirrhosis, alcoholic hepatitis, fatty liver. In which, cirrhosis is thought to be the main cause. Increased pressure in the posterior portal vein of the liver: constrictive pericarditis, diseases that increase right heart pressure such as right heart failure, tricuspid regurgitation, myocardium.

Usually patients with portal hypertension have no symptoms until complications develop. However, some of the following manifestations are common in portal hypertension:
Abdominal distension, ascites Enlarged spleen Varicose veins of the abdominal wall

Increased portal pressure can cause many dangerous complications, especially portal hypertension due to cirrhosis. Complications are:
Esophageal vein dilation and rupture Gastrointestinal bleeding caused by dilated or ruptured esophageal veins Anemia due to gastrointestinal bleeding Coagulation disorder due to liver failure to synthesize clotting factors Hyperaldosteronism Impaired liver and kidney function Encephalopathy

Most patients with portal hypertension are detected on admission with complications such as: gastrointestinal bleeding, acute abdominal pain, little urination, decreased consciousness.
To diagnose portal hypertension, include the following techniques:
Blood tests: blood albumin levels decrease, globulin levels increase, AST, ALT are slightly increased, bilirubin levels, alkaline phosphatase are normal or increased, anemia, white blood cells and platelets decreased. Ultrasound: Ultrasound to screen for cirrhosis and Doppler ultrasound to evaluate portal vein blood flow with flat flow wave imaging. Computed tomography and magnetic resonance imaging: This method is indicated when ultrasound does not give clear results. Esophagogastroduodenoscopy: This method is indicated when the patient is suspected of having portal hypertension with esophageal varices. X-ray of the visceral artery: This method is performed before the surgery to create a portal vein - vena cava shunt because it allows the assessment of the anatomical structure of the portal vein. In addition, the diagnosis of portal hypertension can also be by direct measurement of portal and suprahepatic portal pressure, liver scintigraphy, liver biopsy.

Treatment of portal hypertension includes the following treatments: treatment to reduce portal pressure, treatment of complications (gastrointestinal bleeding, ascites), liver transplantation.
Treatment to reduce portal pressure: There are treatment methods such as surgery to drain the portal-aortic blood system (indicated in case the patient has obvious symptoms of portal hypertension, a history of gastrointestinal bleeding and frequent recurrence, dilated esophageal veins but normal liver function), surgery to create adhesions of the portal-aortic system (indicated when there is no possibility or indication for angioplasty) blood), surgery to reduce blood flow to the portal vein such as splenectomy, ligation of the splenic artery, liver, vasectomy. Treatment of complications: Gastrointestinal bleeding is a common complication of portal hypertension. Treatment of gastrointestinal bleeding due to rupture of esophageal varices includes medical and surgical treatment. When the patient does not respond to medical treatment, surgical treatment is carried out with surgery to reduce portal pressure, direct intervention of dilated esophageal veins, surgery to block blood flow. The transition between the portal vein and the host is through the esophagus. Another complication of portal hypertension is ascites, which is usually treated surgically. Liver transplantation: Liver transplantation is indicated in some cases to completely treat portal hypertension. However, this is a technique that depends on many factors such as the source of the liver to be transplanted, the rejection reaction, immunity, biochemistry, etc. Portal hypertension syndrome is a condition that can be seen in many diseases. liver disease, mainly cirrhosis. Patients should be treated with prophylactic treatment of portal hypertension to avoid dangerous and fatal complications.
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