Portal Hypertension.

Portal hypertension: causes, symptoms, diagnosis and treatment

Portal hypertension is a condition in which there is an obstruction in the flow of blood from the portal system, resulting in increased pressure within the portal vein. This condition can be caused by both intrahepatic and extrahepatic causes.

Etiology and pathogenesis of portal hypertension

Intrahepatic portal hypertension is observed in liver cirrhosis, which is an irreversible process of replacing healthy liver tissue with connective tissue. As a result, intrahepatic vessels are disrupted with impaired blood outflow from the portal system.

Extrahepatic portal hypertension can be caused by thrombophlebitis of the splenic vein or congenital pathology of the portal vein. Extrahepatic block in children is more common and can be caused by umbilical sepsis suffered during the neonatal period.

Clinical picture of portal hypertension

Symptoms of portal hypertension can vary depending on the cause of its occurrence. However, in most cases, it is possible to identify the main symptoms characteristic of this condition.

One of the main symptoms is massive esophagogastric and intestinal bleeding. In this case, it is possible to develop liver failure, increasing ascites, abdominal pain, hepatosplenomegaly, vomiting, fever, headache, poor appetite, sleep disturbances, weight loss, jaundice, dilated venous network on the skin of the chest and abdomen, sometimes in the form of a “jellyfish head” . The course of the disease may be latent.

Diagnosis of portal hypertension

To establish the diagnosis of portal hypertension, splenoportography, contrast study of the esophagus, esophagoscopy, and determination of the activity of the process in the liver, including by biopsy, are used. Differential diagnosis is carried out to clarify the cause of hypertension.

Treatment of portal hypertension

Initially, treatment of portal hypertension is carried out with conservative methods, such as diet, choleretic drugs, lipotropic substances, antispasmodics, parenteral vitamin complex, fasting glucose, detoxification therapy such as IV hemodez or neocompensan, 5% glucose solution and others. If ALT and AST activity is high, a course of prednisone therapy can be prescribed for 45-50 days at an optimal dose of 0.5-0.75 mg/kg per day.

In case of bleeding, an infusion of fresh frozen plasma and red blood cells is carried out simultaneously by drip with the simultaneous administration of calcium chloride, 5% aminocaproic acid solution, 5% glucose solution with B vitamins, ascorbic acid, cocarboxylase, calcium glutamate, infusion of polyglucin, neocompensan, Ringer's solution, also prescribed routine If liver failure develops, a 4% sodium bicarbonate solution is injected drip-wise.

When edema and ascites occur, spironolactone (an antialdosterone drug) is prescribed in combination with other diuretics. To envelop the mucous membrane of the esophagus, cooled plasma is used internally. Cleansing enemas are carried out systematically.

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