Portal hypertension and the treatment of this disease

Portal hypertension is a disease in which pressure in the portal vein system increases, which leads to blood flow problems. This syndrome is not fixed as a separate disease, it manifests itself during pathologies of internal organs, in particular, when blood flow in portal vessels, inferior hollow and hepatic veins is disturbed, most often the portal hypertension syndrome manifests itself in cirrhosis( a condition in which the normal functioning tissue of an organ is replacedconnective - after inflammation or trauma).

About 85% of cases of the disease occur varicose veins of the stomach and esophagus, which can lead to internal bleeding, which will have a detrimental effect on the general condition of the body.

Types of portal hypertension

Portal hypertension, depending on the pattern of the disease, is divided into several types:

• Hyperendricular hypertension develops against the background of congenital portal vein pathologies.
• Intrahepatic hypertension accompanies cirrhosis of the liver, less often it can be associated with sclerotic processes in the liver tissues.
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• Superhepatic - is caused by problems of outflow of blood from the veins of the liver.
• Mixed hypertension is accompanied by portal vein thrombosis and liver cirrhosis.
• Extrahepatic portal hypertension develops mainly in children and is a congenital pathology of the portal vein that disrupts its functioning. This extremely rare disease only in recent years is treatable due to the latest developments in the therapy of liver diseases.

Symptoms and Diagnosis

Portal hypertension of the liver is manifested by such symptoms:

• During the course of the disease, the abdomen increases in size, a swelling and a feeling of pressure under the ribs on the right side.
• Because of the frequent occurrence of bleeding from varicose veins in the digestive system, feces sometimes acquire a dark, almost black color.
• The development of encephalopathy is associated with malfunctioning of the liver, resulting in residues of toxins not filtered in the body, enter the bloodstream and further into the brain, leading to the death of nerve cells. Due to stagnation of blood, the spleen begins to increase in size and press on nearby organs.
• As in the portal system with hypertension, the pressure rises and sweat of the liquid part of the blood from the vascular bed begins, fluid accumulates in the abdominal cavity, which leads to ascites. At this stage, patients complain of shortness of breath, abdominal pain and loss of appetite.

If there is a suspicion that portal hypertension has begun to develop, it is important to visit a physician for examination as soon as possible and to clarify the diagnosis. During the diagnosis, the doctor first conducts a patient interview and an external examination. To clarify the diagnosis, an X-ray is performed to identify the dilated veins in the organs, splenometry is used to clarify the portal pressure( the normal pressure is at the level of up to 150 mm of water column, during the disease it rises to 500 mm of water column.) If necessary, radioisotope scanning and ultrasound of the liver,as well as other procedures aimed at analyzing the quality of blood circulation in the liver. Only after detailed diagnosis and establishment of an accurate diagnosis - portal hypertension, the patientTreatment of portal hypertension can be both conservative and surgical, it all depends on the type and stage of the disease. The conservative methods of treating hypertension include treatment with vasoactive drugs that reduce the pressure of the portal vein. If the bleedingis observed in the veins of the esophagus, the Sengshtaken-Blackmore probe is used, which is inserted into the esophagus and stomach, with which the affected veins are pressed. In case of permanent bleeding, a more radical method is used - sclerosing the esophagus, repeated procedure is performed every few days until the bleeding ceases completely.

For severe forms of the disease, surgical treatment of portal hypertension is necessary in the shortest time, since any delay can result in a relapse of the disease.

In surgery, several types of operations are distinguished depending on the illness clinic and the use of certain equipment and operating principles:

• New ways of blood outflow from the portal zone are being created.
• Methods are used to reduce the amount of blood that enters the portal area.
• Special equipment is used for drainage of fluid accumulated in the abdominal cavity.
• Operations aimed at restoring liver health( regeneration at the cellular level and restoration of blood circulation in the tissues of the kidneys).
• Operations, the main purpose of which is to create a connection between the veins of the esophagus and stomach( these vessels belong to different venous basins).

In some cases after surgical treatment there are complications of portal hypertension associated with the continuation of bleeding in the digestive system of the body. In addition, against the background of this disease often develops hepatic encephalopathy - a pathology affecting the nervous system( this condition often causes the death of the patient).Also, for the use of surgical treatment there are contraindications: old age, pregnancy, unstable condition of nearby organs, malignant tumors and tuberculosis. Despite contraindications it is important at the first symptoms to seek advice from a gastroenterologist or surgeon.