Portal Hypertension (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
In this Article
- What is portal hypertension?
- What causes portal hypertension?
- What are the symptoms of portal hypertension?
- How is the diagnosis of portal hypertension made?
- What is the treatment for portal hypertension?
- What are the complications of portal hypertension?
- Can portal hypertension be prevented?
- What is the prognosis for portal hypertension?
- Find a local Gastroenterologist in your town
What are the symptoms of portal hypertension?
When blood cannot easily flow through the liver architecture (from portal vein to sinusoids to hepatic vein to Vena cava), it tries to bypass the portal system, using the systemic venous system to return to the heart. Symptoms of portal hypertension are due to the complications of decreased blood flow through the liver, and from increased pressure within the veins where blood is shunted.
- Varices describe enlarged veins. Blood meant for the portal system, is diverted to and gathers in other veins as it makes its way to the heart. These varices can occur in the esophagus, stomach, around the umbilicus and in the anus and rectum.
- Esophageal and gastric varices are at risk for life threatening bleeding and can have signs and symptoms with vomiting blood and blood in the stool. Melena describes black, tarry stool that is the result of upper gastrointestinal bleeding.
- Ascites describes abnormal fluid collection within the peritoneum (the sac that contains the intestines within the abdominal cavity) and is due to a combination of factors, including increased pressure in the portal system and decrease protein in the body. The liver produces the body's protein and portal hypertension and the underlying liver disease decreases its ability to function.
- Hepatic encephalopathy is another complication of liver disease, causing confusion and lethargy due to the buildup of waste products and the inability of the liver to adequately filter them.
- Splenomegaly or enlargement of the spleen. Because of portal hypertension, blood backs up, and this also can trap the components of blood (red blood cells, white blood cells and platelets) within the spleen causing anemia and thrombocytopenia (low platelet count in the bloodstream).
- Decreased white blood cell counts increase the risk of general infection. Spontaneous bacterial peritonitis is an infection within the peritoneal sac within the abdomen, and is seen as a consequence of long standing portal hypertension.
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