Treatment of Portal Hypertension

Tess Thompson

When we talk of high blood pressure or hypertension, we generally refer to the arteries and veins and rarely does the mention of the pulmonary system surface. Pulmonary hypertension is a different field of study, and diagnosis and treatment refers to the pulmonary circulatory system. Portal hypertension is primarily high blood pressure in the portal system.

Veins are blood vessels that carry blood from the abdominal organs to the heart. A small vein known as the portal vein carries blood from the liver. The portal circulatory system also has blood vessels that branch out into smaller vessels that spread out through the liver. Any obstruction in the portal venous system causes portal hypertension, which forces the blood to find alternate routes to flow to the heart. The search for an alternate route can make the blood travel through the esophagus, the skin of the abdomen and even the veins of the rectum. This unusual transmission can cause any of the following complications

  1. Ascites - an accumulation of serous fluid in peritoneal cavity
  2. Hepatic encephalopathy - enlargement of the spleen
  3. Esophageal varices - a condition of extremely dilated sub-mucosal veins in the esophagus.

Varices may also form in the stomach, duodenum and rectum. There is also an increased risk of bacterial peritonitis, problems associated with the liver and kidneys with esophageal varices that pose a major and continuous risk of hemorrhages that can be fatal at times.

The treatment for portal hypertension depends mostly on the cause and the severity of the condition. Mostly medication, semi-surgical and surgical procedures are used depending upon the efficiency levels of the liver. Beta blockers which are used as high blood pressure medication are often the first line of treatment for portal hypertension. If esophageal variceal bleeding is suspected then a nitrate is added to propanolol, the first beta blocker or nadolol, a beta-adrenergic blocking agent. This combination therapy is often more effective than using beta blockers alone.

In instances of severe conditions of bleeding, analogues of growth hormones and anti-diuretic hormones are injected intravenously to decrease portal pressure. If variceal bleeding has been diagnosed and medications do not work, endoscopic banding may be resorted to, which is blocking off the blood vessel using rubber bands.

There are other procedures through which a passage is created to divert blood from one channel to another to relieve pressure. Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure that involves placing of a tubular device called a stent in the middle of the liver to connect the hepatic vein with the portal vein. Distal splenorenal shunt (DSRS) is another procedure that connects the vein from the left kidney to the vein from the spleen.

Paracentesis is another semi-surgical procedure that involves puncturing with a hollow needle in order to draw out fluid that accumulates in the peritoneal cavity. Liver transplantation is indicated only when portal hypertension is accompanied by disorders of the liver and in situations where the liver is unable to produce proteins.

Natural remedies for high blood pressure like dietary and lifestyle changes play an important role in managing symptoms of portal hypertension, which is usually caused by cirrhosis of the liver. Avoid alcohol and recreational drugs. Do not consume more than 2 grams of sodium (salt) per day and reduce protein intake if there are signs of confusion. Better still, consult a dietician for a diet plan and stick to it religiously.


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