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What Is Portal Hypertension?

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Introduction to Portal Hypertension

Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Normally, the veins come from the stomach, intestine, spleen, and pancreas, merge into the portal vein, which then branches into smaller vessels and travels through the liver. If the vessels in the liver are blocked, it is hard for the blood to flow causing high pressure in the portal system.

When the pressure becomes too high, the blood backs up and finds other ways to flow back to the heart, where it is pumped to the lungs, where it gets rid of waste products and picks up oxygen. The blood can travel to the veins in the esophagus (esophageal varices), in the skin of the abdomen, and the veins of the rectum and anus (hemorrhoids) to get around the blockages in the liver.

What Causes Portal Hypertension?

The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis results from scarring of a liver injury caused by hepatitis, alcohol abuse, or other causes of liver damage. In cirrhosis, scar tissue blocks the flow of blood through the liver.

Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, and a parasitic infection called schistosomiasis. Sometimes the cause is unknown.

What Are the Symptoms of Portal Hypertension?

The onset of portal hypertension may not always be associated with specific symptoms that identify what is happening in the liver. But if you have liver disease that leads to cirrhosis, the chance of developing portal hypertension is high.

The main symptoms and complications of portal hypertension include:

• Gastrointestinal bleeding: Black, tarry stools or blood in the stools; or vomiting of blood due to the spontaneous rupture and hemorrhage from varices.
• Ascites (an accumulation of fluid in the abdomen).
• Encephalopathy or confusion and forgetfulness caused by poor liver function.
• Reduced levels of platelets, blood cells that help form blood clots, or white blood cells, the cells that fight infection.