Overview

The portal vein carries blood from your stomach, pancreas, and other digestive organs to your liver. It differs from other veins, which all carry blood to your heart.

The liver plays an important role in your circulation. It filters out toxins and other waste matter that the digestive organs have deposited in your bloodstream. When the blood pressure in the portal vein is too high, you have portal hypertension.

Portal hypertension can be quite serious, though it’s treatable if diagnosed in time. It’s not always easy to diagnose, however. Typically, you become alerted to the condition when you start experiencing symptoms.

Fast fact

Arteries carry oxygen-rich blood from your heart to your organs, muscles, and other tissue. Veins carry blood back to your heart, except for the portal vein, which carries blood to your liver.

Symptoms

Gastrointestinal bleeding is often the first sign of portal hypertension. Black, tarry stools can be a sign of gastrointestinal bleeding. You may also actually see blood in your stools.

Another symptom is ascites, which is a buildup of fluid in your belly. You may notice that your belly is getting bigger because of ascites. The condition can also cause cramps, bloating, and shortness of breath.

As well, becoming forgetful or confused could be a result of a circulation problem related to your liver.

Causes

The main cause of portal hypertension is cirrhosis. This is a scarring of the liver. It can result from alcohol abuse or a disease, such as hepatitis. Whenever your liver is harmed, it attempts to heal itself. This causes scar tissue to form. Too much scarring makes it harder for your liver to do its job.

Other cirrhosis causes include:

  • nonalcoholic fatty liver disease
  • iron buildup in your body
  • cystic fibrosis
  • poorly developed bile ducts
  • liver infections
  • reaction to certain medications, such as methotrexate

Cirrhosis can cause the normally smooth inner walls of the portal vein to become irregular. This can increase resistance to blood flow. As a result, blood pressure in the portal vein increases.

A blood clot can also form in the portal vein. This can increase the pressure of blood flow against the walls of the blood vessel.

Risk factors

People at an increased risk for cirrhosis are at an increased risk for portal hypertension. If you have a long history of alcohol abuse, you face a higher risk of cirrhosis. You’re at a higher risk of hepatitis if any of the following apply to you:

  • You use needles to inject drugs.
  • You received tattoos or piercings in unsanitary conditions.
  • You work in a place where you may have had contact with infected needles or infected blood.
  • You received a blood transfusion before 1992.
  • Your mother had hepatitis.
  • You have unprotected sex with multiple partners.

Diagnosis

Portal hypertension is difficult to diagnose if symptoms aren’t obvious. Screenings such as a doppler ultrasound are helpful. An ultrasound can reveal the condition of the portal vein and how blood is flowing through it. If an ultrasound is inconclusive, a CT scan may be helpful.

Another screening method that’s becoming more widely used is a measurement of the elasticity of your liver and surrounding tissue. Elastography measures how tissue responds when it’s pushed or probed. Poor elasticity suggests the presence of disease.

If gastrointestinal bleeding has occurred, you’ll likely undergo an endoscopic examination. This involves the use of a thin, flexible device with a camera at one end that allows your doctor to see internal organs.

Portal vein blood pressure can be determined by inserting a catheter fitted with a blood pressure monitor into a vein in your liver and taking a measurement.

Treatment

Lifestyle changes such as these can help treat portal hypertension:

  • improving your diet
  • avoiding alcohol consumption
  • exercising regularly
  • quitting smoking if you smoke

Medications such as beta-blockers are also important to help reduce your blood pressure and relax your blood vessels. Other medications, such as propranolol and isosorbide, may help lower the pressure in the portal vein, too. They can also reduce the risk of more internal bleeding.

If you’re experiencing ascites, your doctor may prescribe a diuretic to help reduce fluid levels in your body. Sodium must also be severely restricted to help reduce fluid retention.

A treatment called sclerotherapy or banding uses a solution that can help stop bleeding in the blood vessels of your liver. Banding involves the placement of rubber bands to block unhealthy blood flow to enlarged veins, known as varices or varicose veins, in your digestive system.

Another increasingly popular therapy is called nonsurgical transjugular intrahepatic portal-systemic shunt (TIPSS). This therapy helps control acute bleeding. It creates new pathways for blood to flow from the portal vein into other blood vessels.

Complications

One of the more common complications associated with portal hypertension is portal hypertensive gastropathy. The condition affects the mucus membrane of your stomach and enlarges blood vessels.

The pathways created between blood vessels in TIPSS can become blocked. This can lead to further bleeding. If liver problems continue, you could have further cognitive problems as well.

Outlook

You can’t reverse damage caused by cirrhosis, but you can treat portal hypertension. It may take a combination of a healthy lifestyle, medications, and interventions. Follow-up ultrasounds will be necessary to monitor the health of your liver and the results of a TIPSS procedure.

It will be up to you to avoid alcohol and live a healthier life if you have portal hypertension. You’ll also need to follow your doctor’s instructions. This goes for medications and follow-up appointments.

Tips for prevention

Drink alcohol moderately, if at all. And take steps to avoid hepatitis. Talk with your doctor about hepatitis vaccinations and whether you should have them. You may also want to be screened for hepatitis if you’re in an at-risk group.

Portal hypertension is caused by declining liver health, but you may be able to avoid this challenging vascular disease through healthy lifestyle choices.

Q&A: Portal hypertension without cirrhosis

Q:

Can you develop portal hypertension without cirrhosis?

A:

It’s possible, though rare. Portal hypertension without cirrhosis is called idiopathic non-cirrhotic portal hypertension (INCPH). There are five broad categories of causes of INCPH: immunological disorders, chronic infections, exposure to toxins or certain medications, genetic disorders, and prothrombotic conditions. Many of these categories can alter normal clotting and cause tiny clots to form, leading to INCPH. People with INCPH usually have a better outlook because they have a normally functioning liver.

Carissa Stephens, pediatric ICU nurseAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.