Portal hypertension

Hypertensio PORTALIS

Introduction

Portal hypertension is abnormally high blood pressure in the portal vein, large vein that carries blood from the intestines to the liver.

The portal vein receives blood flowing out of the whole intestine and the spleen, pancreas and gall bladder. After entering the liver, blood, forming a small ducts circulating liver. When blood leaves the liver, flows back through the hepatic vein into the general circulation.

In the portal blood vessels can increase blood pressure, two factors: the volume of blood flowing through blood vessels and increased resistance to blood flow through the liver. In Western countries, the most common cause of portal hypertension is increased resistance to blood flow caused by cirrhosis.

Portal hypertension leads to the development of venous blood vessels (called collateral vessels) that connect the portal system to the general bloodstream, thus bypassing the liver. Because of this detour, the substances that are normally removed by the liver from the blood can enter the general circulation. Collateral vessels develop in special places, most of which is the lower end of the esophagus. There vessels become swollen and sinuous, ie.become varicose veins (called esophageal varices). These swollen veins are very fragile and sometimes prone to bleeding. The other collateral vessels can develop around the navel and the rectum.

Symptoms and diagnosis

When portal hypertension is often an enlarged spleen. The liquid can escape from the liver and expand the abdominal cavity, and that the free fluid in the abdomen called ascites. Varicose veins in the lower end of the esophagus and gastric mucosa bleed easily, sometimes a lot. Varicose veins in the rectum may also bleed, although this is much rarer.

The doctor can usually palpable spleen increased through the abdominal wall. The fluid in the abdominal cavity can be detected by observing and listening to the abdomen nateknutog muklih sounds during tapping (percussion) of the abdomen. Rtg UZ and provide considerable information on the portal hypertension. UZ can be used to examine blood flow in the portal blood vessels and can detect the presence of fluid in the abdomen.

To test the increased vein can be used, and CT. The pressure in the portal system can be directly measured with a needle which pierces the abdominal wall to the liver or spleen.

Treatment

In order to reduce the risk of bleeding from esophageal varices, the doctor tries to reduce the pressure in the portal vein. One way is by giving propranolol, a drug used to treat high blood pressure.

Bleeding from esophageal varices is a medical emergency. Drugs such as vasopressin or octreotide can be given intravenously to constrict the veins that bleed, and blood transfusions are given to replace blood lost.

Endoscopic examination is usually done to confirm bleeding varices. Veins can clog rubber bands or giving chemical substances through the endoscope. If bleeding continues, through the person's nose and down into the esophagus can be brought into the catheter with a balloon on the end. Balloon inflation pressures are varicose veins and usually stops the bleeding.

If bleeding continues or occurs again, we can make a surgical bypass procedure (called a shunt) between the portal venous system and the general (systemic) venous system. This lowers the pressure in the portal vein, because the pressure in the general venous circulation is much lower. There are different types of operations portal-systemic shunt, including those that can be done in the radiological department using special devices under the control of X-rays. Shunt surgery is usually successful in stopping the bleeding, but are relatively dangerous. They also increase the risk of disruption of brain function due to liver failure (hepatic encephalopathy).