Portal Hypertension Treatment

A rise in the pressure inside the portal vein, which transports blood from the digestive system to the liver, is known as portal hypertension. Cirrhosis of the liver is the most frequent cause, however, thrombosis (clotting) may also be to cause.

A rise in the pressure inside the portal vein is referred to as portal hypertension (the vein that carries blood from the digestive organs to the liver). An obstruction in the blood flow through the liver is the root cause of the rise in pressure.

To circumvent the blockage, big veins (varices) grow across the oesophagus and stomach as a result of increased pressure in the portal vein. The varices deteriorate and become more prone to bleeding.

Causes:

The liver scarring condition known as cirrhosis is the most frequent cause of portal hypertension. The healing of a liver injury brought on by hepatitis, alcoholism, or other causes of liver damage leads in cirrhosis. Scar tissue inhibits the liver’s metabolic processes and limits blood flow through the liver in cirrhosis.

A blood clot that forms in the portal vein, or thrombosis, may also be the cause of portal hypertension.

Symptoms: It’s possible that specific symptoms that indicate what’s going on in the liver are not always present when portal hypertension first appears. But your risk of having portal hypertension is higher if you have liver disease that results in cirrhosis. The following are the primary signs and effects of portal hypertension:
  • Gastrointestinal bleeding: Black, tarry stools or blood in the stools; or blood vomiting as a result of varices that spontaneously rupture and hemorrhage.
  • Ascites: A buildup of fluid in the abdomen
  • Encephalopathy: Poor liver function and blood flow being diverted away from the liver produce confusion and forgetfulness.
  • Decreased white blood cell count or decreased platelet counts.
Portal Hypertension
Diagnosis: You can get a diagnosis of variceal hemorrhage by an endoscopic examination, X-ray research, and laboratory tests. To lower the possibility of recurrent bleeding, further treatment is required. Before the TIPS and DSRS procedures, testing is necessary. You will undergo the following tests to assess the degree and severity of your portal hypertension prior to either of these procedures:
  • a review of your medical background
  • a physical assessment.
  • a blood test.
  • Angiogram
  • Ultrasound
  • Endoscopy
Your doctor could ask you to have additional pre-operative tests before TIPS or DSRS, including as an electrocardiogram (commonly known as an EKG), a chest X-ray, or more blood tests. Additional blood products, such as plasma, will be ordered now if your doctor believes you will need them.
Portal Hypertension

Treatment:

Diet, medication, endoscopic therapy, surgery, or imaging can all be used to treat the symptoms of portal hypertension. Treatment alternatives are suggested when the bleeding episode has been managed based on the severity of the symptoms and how well your liver is working. To understand more book your appointment with the portal hypertension and best liver specialist in Noida, Ghaziabad.

The first level of treatment:

When variceal bleeding is initially discovered, you could receive medication or endoscopic therapy. Alterations to one’s diet and way of life are also crucial.

Sclerotherapy or banding are the two types of endoscopic therapy. A gastroenterologist can stop or reduce the danger of bleeding by injecting a solution into the bleeding varices during sclerotherapy. A gastroenterologist performs a treatment called “banding” in which rubber bands are used to cut off the blood flow to each varix (enlarged vein).

To relieve the pressure in your varices and further lower the risk of recurrent bleeding, doctors may prescribe medications like beta blockers or nitrates alone or in conjunction with endoscopic therapy.

Propranolol and isosorbide are two drugs that may be used to lower portal vein pressure and lower the risk of recurrent bleeding.

Confusion and other mental alterations brought on by encephalopathy can be treated with the medication lactulose. It is possible for this drug to increase the number of bowel motions you have each day.

Lifestyle Changes: Your liver will work normally if you continue to eat healthily and lead a healthy lifestyle. The following are some actions you can do to enhance the function of your liver:
  • Use neither alcohol nor hard drugs.
  • Never take any medication—prescription or OTC—without first speaking to your doctor or nurse. Some drugs may exacerbate liver illness and may counteract the beneficial benefits of your other prescription drugs.
  • Observe the dietary recommendations that your doctor or nurse has given you. Consume food low in sodium (salt). You’ll probably need to limit your daily sodium intake to no more than 2 grams. Only if confusion is a symptom is a reduction in protein intake necessary. You can follow these dietary recommendations by developing a meal plan with the assistance of your nutritionist.
You could need one of the following decompression procedures to lessen the pressure in these veins if the initial level of treatment fails to stop your variceal bleeding. A stent (a tubular device) is inserted into the liver’s center during a radiological technique known as a transjugular intrahepatic portosystemic shunt (TIPS). A surgical operation known as a distal splenorenal shunt (DSRS) joins the splenic vein to the left kidney vein to relieve pressure in varicose veins and regulate bleeding.

Treatment Procedures:

TIPS

The portal vein, which transports blood from the digestive system to the liver, is connected to one of the hepatic veins during the TIPS operation by a radiologist creating a tunnel through the liver with a needle (the 3 veins that carry blood from the liver). This tunnel is given a metal stent to keep it open. The TIPS surgery relieves pressure in all aberrant veins, including those in the liver, colon, and stomach, and reroutes blood flow through the liver.

The TIPS procedure does not involve surgery. Under X-ray supervision, the radiologist performs the surgery inside the vessels. A one to three-hour process is required. After the procedure, you should prepare to stay in the hospital for 1 to 2 days.

In almost 90% of patients, TIPS surgery rapidly stops bleeding. However, the shunt may constrict in roughly 30% of individuals, leading to varices bleeding later on.

DSRS Procedure:

Surgery is required for the DSRS. The splenic vein, also known as the splenic vein, is connected to the left kidney’s renal vein during surgery after being severed from the portal vein. Your varices’ pressure is selectively decreased by this procedure, and the bleeding is also controlled.

You receive general anesthesia before the procedure. The procedure takes roughly four hours. An average hospital stay lasts between seven and ten days.

Over 90% of people with DSRS have their bleeding under control; the first month carries the largest risk of any recurrent bleeding. However, the DSRS technique offers effective long-term bleeding control.

Ascites is a potential side effect of DSRS surgery (an accumulation of fluid in the abdomen). Treatment options include sodium restriction and diuretics.

Other Treatments:
  • The end-stage liver disease requires a liver transplant.
  • The bleeding varices is removed surgically through a process called devascularization. When a surgical shunt or TIPS is not an option or are unable to stop bleeding, this treatment is used.
  • Ascites, a buildup of fluid in the belly, occasionally require surgical removal. The term “paracentesis” refers to this process.

To know more consult to the best Portal hypertension treatment doctor in Noida, Ghaziabad.

Dr. Sushrut Singh

Dr. Sushrut Singh is an Additional Director in the Department of Liver and Digestive Sciences at Fortis Hospital, Sector-62, Noida. . Having pursued both his M.B.B.S. and M.D. from the King George’s Medical College, Lucknow, he went on to complete his postgraduate super-speciality in Hepatology from the only Liver University in Asia under the guidance of most renowned Prof. Dr. Shiv Kumar Sarin from the Institute of Liver and Biliary Sciences (ILBS), New Delhi.

  • Speciality : Liver Specialist, Hepatologist, Gastroenterologist
  • Degree : M.B.B.S., M.D., D.M.
  • Experience : 12+ Years
  • Phone : +91 93153 54431

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