Portal hypertension is one of the serious complications of an advanced liver disease. The scar tissue formed by the damaged liver cells, which has lost its function, leads to the development of liver cirrhosis. This tissue compresses the blood vessels in it, causing a decrease in blood flow. This problem that occurs in the region can also affect other organs and tissues in the body, leading to serious internal bleeding and some other problems in the later stages. For this reason, it is important for your health to understand the type and effects of all kinds of diseases that develop in the liver and to start the treatment process without losing time. It is called portal hypertension. This vein, also known as the hepatic portal vein, is responsible for carrying the blood with reduced oxygen content from the small intestine, stomach, large intestine, pancreas, gallbladder and spleen to the liver. Therefore, it has a key role in the gastrointestinal system (digestive system). Liver; It filters the blood, purifying it of harmful components and then sending it back to the heart and the general circulation throughout the body. The pressure in the portal system increases directly when any condition blocks or slows the blood flow in the portal vein. In order to manage this situation, the human body directs the blood flow to other vessels and thus tries to balance the intravascular pressure. However, the higher than normal intravascular pressure and the flow rate of blood cause these other vessels to dilate. As a result, the vessel walls are stretched and weakened, and fluid leakage into the abdomen may develop in the thinned and damaged wall regions. There may even be ruptures and bleedings in the veins. Due to this serious effect on the vessels, portal hypertension is a serious disease that can be life-threatening. However, if it is diagnosed in a timely manner, it is possible to successfully treat portal hypertension when the portal venous system blood pressure is under control. Diagnosing the disease is not always easy. Because it can often be diagnosed after symptoms appear, early treatment may be missed. For this reason, especially liver diseases&nbs It is important to have regular health screenings in people with p;p>
Symptoms of Portal Hypertension
No symptoms may appear until complications of portal hypertension develop. Researches made; found that up to ninety percent of patients with cirrhosis developed portal hypertension before symptoms appeared. Large varicose veins (enlarged veins) were observed in approximately forty percent of the patients (4). The first and most obvious signs of portal hypertension are usually related to enlarged, bleeding, and leaky vessels. During this process, the following symptoms may be seen:
• Blood in the vomit or blood in the vomit,• Blood in the stool (black colored stool),• Ascites caused by the fluid leaking into the abdomen and rapid weight gain and abdominal swelling due to this ascites,• Swelling in feet or legs due to edema, • Mental confusion and difficulty in making decisions, changes in consciousness and mood, tremors in hands.
The patient's weight gain is not related to overeating. Fluid leaking into the abdomen causes edema. This leads to the loss of appetite of the patient. In severe cases, the edema extends into the chest cavity and makes it difficult for the patient to breathe. In addition, this fluid accumulating in the peritoneal cavity, which is the space between the peritoneal membrane covering the abdominal wall and the peritoneal membrane covering the internal organs, can also bring infections. Decreased blood flow in the spleen can cause the spleen to swell with dense blood and form new vessels called shunts. The enlarged spleen works harder than it should and retains too many blood cells from the circulation. This can lead to disorders related to blood coagulation and weakening of immunity due to the decrease in the number of cells in the circulation. Narrowing of the blood vessels in other parts of the body may also occur as a reaction to the enlargement of the blood vessels in the spleen. The narrowing of the vessels in the kidneys triggers kidney failure. Among the most common symptoms seen are these; however, it is possible to have different symptoms due to the patient's condition and changes in the affected vessels.
Causes of Portal Hypertension
Causes of portal hypertension, being more than one However, the most common cause is liver cirrhosis. Cirrhosis is the last stage of chronic liver disease and often occurs as a result of viral hepatitis C, alcoholic hepatitis, and nonalcoholic fatty liver disease. The liver is a self-repairing organ; however, when it is damaged, it starts working harder than it should to heal itself. Over time, this leads to the formation of scar tissue in the liver. As the amount of these formed tissues increases, the function of the liver begins to decrease over time. Also, due to cirrhosis, the normally smooth inner walls of the portal vein become irregular and a resistance to blood flow arises on the inner surface of the vein. As a result, the blood pressure in the portal vein increases. Even blood clots can occur in the portal vein due to this rough inner surface. Clot formation may also play a role in increasing the pressure. Any individual at risk for cirrhosis should be considered a potential candidate for portal hypertension. Some of the risk factors for portal hypertension are:
- Long-term alcohol use,
- Use of drugs by intravenous injection,
- Having tattoos or piercings in unsanitary conditions
- Contact with infected needles or infected blood,
- Unprotected sexual intercourse with multiple partners,
- Family history of hepatitis,
- Family- Predisposition to hereditary clot formation.
How to Diagnose Portal Hypertension?
Portal hypertension is a disease that is difficult to diagnose if the symptoms are not clear enough. Scans such as Doppler ultrasound give an idea about the disease. Doppler can provide information on issues such as the state of the portal vein and the way the blood progresses through the vein. In cases where this imaging method is not sufficient, it may be useful to perform a CT (computerized tomography) scan. Another method that has been widely used recently is the liver and surrounding tissue. measure of its elasticity. This technique, called elastography, measures how tissue responds to stimuli as it is pushed or moved. Weak elasticity can give an idea about the presence of the disease. Certain complications may also occur secondary to portal hypertension in the patient. One of them is bleeding in the digestive system. This condition, called gastrointestinal bleeding, usually requires the application of endoscopy. This examination is an application that allows the specialist to see the internal organs and is performed using a thin, flexible device with a camera at one end. Portal vein blood pressure can be determined by placing a catheter with a blood pressure monitor attached to a vein in the liver and measuring it. However, this method is often used as a last resort. In most cases, the diagnosis of the disease may be possible by evaluating blood tests and other tests together with the symptoms. Observing most of the common symptoms in portal hypertension will be sufficient for the diagnosis of the disease. These common symptoms that play a key role in the diagnosis can be listed as follows:
- Varces caused by enlarged blood vessels,
- Enlarged spleen,
- Gastrointestinal bleeding,
- Fluid accumulation in the abdomen,
- Cognitive impairment,
- Reduction in the number of blood cells,
- Easy bruising and bleeding.
Treatment of Portal Hypertension
Portal hypertension is a disease that is difficult to treat if it progresses and becomes severe. . For this reason, taking timely precautions against the complications seen in the patient and applying the treatments without delay have a direct effect on the success of the treatment. The main aim of treatment is to reduce the pressure in the portal vein as soon as possible. Portal hypertension The main complication is bleeding in varicose veins. Therefore, the aim of treatment is to manage bleeding. Applications such as drug therapy, endoscopic therapy, shunt procedures and liver transplantation can be among the treatment methods. Some of the procedures that may be included in the treatment applications can be listed as follows:
- If there are enlarged veins in the esophagus or stomach due to the disease, various pharmacological agents can be used to reduce the pressure in these veins and to prevent bleeding.
- Cirrhosis in the patient. there is; however, if there is no varicose veins, beta-blocker group drugs can be applied and treatment can be made. However, beta-blockers are not recommended to prevent the development of varicose veins; because it is known that the side effects of the drug outweigh the possible benefits for this patient group.
- Endoscopic methods can be used to treat gastrointestinal bleeding. An approach called endoscopic taping therapy can be used to manage the bleeding of varicose veins, especially in the digestive system. During endoscopy, small elastic loops are placed over the vessel. The rings block the blood flow to each varicose vein. Thus, the growth of varicose veins can be prevented.
- Balloon tamponade is applied to control severe varicose bleeding that compresses the veins. A small balloon is inflated in the stomach or esophagus to apply pressure to the bleeding vessels, which compresses and stops the bleeding.
- Another method is the shunt procedure. Shunt method can be used to prevent recurrent bleeding despite medical or endoscopic treatment.
- The last method is liver transplantation. It is the most effective treatment of cirrhosis and portal hypertension. It may be possible for the patient with liver transplantation to fully recover.
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