Portal Hypertension: What you need to know

We all know about high blood pressure, or "pressure." But have you ever heard of a condition where the pressure in a special blood vessel in our liver increases? In medicine, we call this 'Portal Hypertension.' Although the name is a bit complicated, this is a condition that can seriously affect the health of our liver. So don't worry, today we will talk about this very simply, in a way that you can understand.

What exactly is Portal Hypertension?

To understand this, let's first look at an amazing thing that happens in our bodies. All the nutrient-rich blood from your stomach, intestines, and spleen collects and goes to the liver through one large vein. This main vein is called the "portal vein." To be precise, this is the main blood supply to the liver.

Now imagine that there is a big "traffic jam" somewhere in this main artery, that is, inside the liver. If something is damaged in the liver and the small blood vessels inside it are blocked, the incoming blood cannot flow properly. What happens then? The blood pressure in that main portal vein and the other veins connected to it increases excessively. That is what we call Portal Hypertension .

When this pressure increases, the blood tries to flow through other, smaller, weaker veins. Then those veins (especially those in the esophagus and stomach) swell, become balloon-like, and can easily burst and bleed. We call these swollen veins varicose veins . This is the most dangerous complication of this disease.

What are the reasons for this situation?

The main and most common cause of Portal Hypertension is cirrhosis of the liver . Simply put, cirrhosis is a condition in which the liver is continuously damaged for some reason and the liver becomes stiff due to the scars that form as the wounds heal. Just like a scar forms on our skin when a wound heals. This scar tissue obstructs the blood flow within the liver.

There are several main reasons why the liver can be damaged:

• Excessive alcohol consumption.
• Viral infections such as Hepatitis B and C.
• Fatty Liver Disease.

Apart from this, this condition can also be caused by blood clots in the portal vein, some parasitic infections (e.g. Schistosomiasis), and other rare causes. Sometimes, no specific cause can be found.

What are the symptoms of Portal Hypertension?

In most cases, there are no specific symptoms in the early stages of this disease. Symptoms only appear when the complications we discussed develop. If a doctor has told you that you have liver disease, it is very important to be aware of these symptoms.

What are the treatments?

Unfortunately, the underlying cause of Portal Hypertension cannot always be completely cured. Therefore, the main goal of treatment is to prevent and manage complications, especially bleeding from varices.

1. Endoscopic Therapy

This is the first one used to treat varicose veins.

• Banding: An endoscope, a tube with a camera, is inserted through the mouth and a small rubber band is placed around the blood vessel, closing the vein.
• Sclerotherapy:This involves injecting a blood-clotting solution into the vein.

2. Medications

• Beta-blockers: Medications like Propranolol reduce pressure in the portal vein system and reduce the risk of bleeding.
• Diuretics: If the abdomen is filled with fluid (ascites), these medications are given to remove excess fluid from the body.
• Lactulose: This medicine helps control encephalopathy.

3. Lifestyle changes

This is a very important part.

• Stop drinking alcohol completely.
• Do not take any painkillers, other medications, or herbal teas without first consulting your doctor. Some medications can be harmful to the liver.
• Reduce your salt (sodium) intake. Eat according to your doctor's instructions.
• If you have mental confusion, you may be asked to limit protein-rich foods.

Other specific treatments

If the above treatments fail to control bleeding or abdominal distention, doctors may resort to more complex treatments. These work by reducing pressure in the portal vein system.

• TIPS (Transjugular Intrahepatic Portosystemic Shunt): This is not a surgery. In this, a small tube (stent) is inserted through the liver under X-ray guidance, creating a new path between the portal vein and another vein that leaves the liver. This changes the flow of blood and reduces pressure in the veins. This is a more than 90% successful treatment.
• DSRS (Distal Splenorenal Shunt): This is a surgery. In this, the splenic vein is connected to the vein of the left kidney. This also reduces pressure and controls blood flow. However, this is not commonly used anymore.
• Liver Transplant: This may be the only solution for patients with end-stage liver disease.

After such treatments, it is very important for your well-being to follow the doctor's instructions and follow-up appointments exactly . Scans and blood tests performed at that time can help determine the success of the treatment.