Portal hypertension is high blood pressure in the portal system, which is the circulation system where the blood circulation from the intestines to the liver and spleen to the liver takes place. From the liver it joins the systemic circulation, which is the main circulation of the body, from limbs to the heart to the inferior vena cava, which is the vein that carries de-oxygenated blood from the lower part of the body into the heart. So if there is a blockage of the blood drainage from intestines or spleen to the inferior vena cava, pressure inside the portal system increases and causes portal hypertension. The problem is that the blood finds an alternative path to reach the heart. This path is usually through the food pipe or through the upper part of the stomach where the blood vessels dilate. This can bleed and lead to torrential blood vomiting.
Liver disease is the main cause of the blockage in the blood vessels coming from the intestine to the inferior vena cava.
- Vomiting blood
- A large spleen where a large mass can be felt in the abdomen
- Recurrent infection
- Low hemoglobin
- Low WBC count
- Bleeding gums
- Black colored motion
- Proximus spleno renal shunt
If there is an extrahepatic portal vein obstruction or blockage of hepatic vein which carries the blood from the liver, a shunt or proximus spleno renal shunt is done. If surgery is to be avoided then one can go for endoscopic correcting like banding or sclerotherapy and keep doing it till the varices or the distended veins are eradicated. It can recur and the patient has to come back again so it’s a long term treatment where one has to keep coming back to the doctor.
Banding is an endoscopic procedure where the enlarged veins are sucked into the endoscope and a tight rubber band is applied at the neck of the enlarged vein so that these blood vessels are squeezed in the rubber band and they fall.
Sclerotherapy is injecting an irritant fluid into these veins because of which they thrombose and fibrose, and are destroyed. In other words, the fluid irritates the lining of the blood vessels, due to which they swell and stick together, and the blood clots. Gradually, the vessel turns into scar tissue that fades away. This is a local treatment, not a treatment for the entire disease but for a manifestation of the disease. One has to keep doing it once a week or once in 2 weeks or once in a month depending on the severity.
Now a days banding is preferred over sclerotherapy as sclero is done for smaller varices.
Prognosis depends on the primary disease and not on the varices. If the liver is destroyed then the patient will die. There is no way to arrest the damage of the liver except transplant.