Portal Hypertension (cont.)

Portal hypertension usually is diagnosed well after the process has begun in the body, and only after a complication occurs. When a patient develop ascites or has gastrointestinal bleeding, the health care professional will look for potential causes, including portal hypertension.

Once the diagnosis is a possibility, it can be confirmed by blood tests, X-rays, CT or MRI and endoscopy. Pressures within the portal vein are not routinely measured except in specific situations (see TIPS procedure)

Treatment for portal hypertension is often directed at preventing complications. This includes treating the underlying cause and avoidance of alcohol. Because of the risk of further liver damage, over-the-counter medications that contain acetaminophen (Tylenol, Panadol, etc.) should also be avoided.

Dietary restrictions include limiting salt to prevent further ascites fluid accumulation. Protein restriction may also be indicated, since increased protein load can overwhelm the liver's ability to synthesize it and may lead to hepatic encephalopathy.

Medications such as beta blockers and nitroglycerin may be appropriate to decrease pressure within the portal system. Lactulose may be prescribed as a treatment for hepatic encephalopathy.

Endoscopy may be required to band or tie off varices in the esophagus to prevent catastrophic and life threatening bleeding.

A TIPS procedure (transjugular intrahepatic portosystemic shunt) may be an option to decrease the pressure within the portal system. An interventional radiologist attempts to place a tube that connects the portal vein with the hepatic vein. This may decrease the pressure within the liver and may also reduce pressure within the veins of the stomach and esophagus, hopefully decreasing the risk of bleeding.

Source: MedicineNet.com
http://www.medicinenet.com/portal_hypertension/article.htm