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Portal Hypertension

One of the most common discussions I have with patients is regarding portal hypertension, which is a complication of cirrhosis of the liver.  Portal hypertension develops in the liver regardless of the cause of cirrhosis.  Strictly speaking, portal hypertension is defined as an increase in the pressure within the portal vein.  The portal vein is the main vein that carries blood from the abdomen, small intestine, and colon to the liver.  This increase in pressure within the portal vein is caused by obstruction of the blood flow through the liver.

As a result of this elevated pressure in the portal vein, a series of veins enlarge in the abdomen in an effort to bypass the reduced flow of blood through the liver.  These enlarged veins in the esophagus and stomach are called varices.  In patients that have cirrhosis with portal hypertension and esophageal varices, the risk of bleeding from these varices increases significantly.  Bleeding esophageal varices have a high risk of complication.

Patients that have portal hypertension may not necessarily have any specific complaints.  Most of the symptoms may be related to their underlying liver disease, be it hepatitis B, hepatitis C, or alcoholic cirrhosis.  If you have cirrhosis, the chance of developing portal hypertension is high and increases over the years.

The complications of portal hypertension include the increased risk of gastrointestinal bleeding from esophageal or gastric varicies.  Patients may also develop ascites, which is the accumulation of fluid within the abdomen.  Due to the shunting of blood away from the liver and thus reducing the ability of the liver to detoxify the blood, a confusion state called hepatic encephalopathy develops due to a build up of toxins in the blood that can affect how the brain and nervous system functions.  Patients with portal hypertension will also have a low platelet count.  Platelets are cells in the blood that are responsible for clotting.  Because of the abnormal blood flow away from the liver with portal hypertension, more blood is shunted to the spleen.  The spleen, unfortunately, traps the platelets and the measured platelet count in the blood is reduced.  It should be kept in mind that the body is producing the normal amount of platelets from the bone marrow but due to the abnormal blood flow, platelets are simply being trapped in the spleen.  A low platelet count may be associated with an increase chance of bleeding. 

Portal hypertension is typically diagnosed based on several factors.  Ultrasound, CAT scan, or MRI may detect abnormally enlarged veins within the abdomen as well as an enlarged spleen in the proper setting of liver disease and cirrhosis.  Because patients with portal hypertension develop esophageal or gastric varices, it is the standard of care to perform an upper endoscopy screening for these enlarged veins.  Depending on the size of the veins, we can determine the risk of bleeding. Dr. Galati performs most of his endoscopic procedures at the Texas International Endoscopy Center, located next-door to his central office.