Portal Hypertension

Portal hypertension: causes, symptoms and treatment

Portal hypertension is a condition in which there is increased pressure in the portal vein, the main vein that collects blood from the digestive system and carries it to the liver. This condition can occur either as a result of an intrahepatic block associated with cirrhosis of the liver or as a result of an extrahepatic block caused by thrombophlebitis of the splenic vein or congenital portal vein pathology. Extrahepatic block is more common in children.

Portal hypertension has a variety of clinical manifestations. Patients may experience massive bleeding from the esophagus, stomach or intestines, as well as develop liver failure, ascites (accumulation of fluid in the abdominal cavity), abdominal pain, enlarged liver and spleen, vomiting, fever, headaches, loss of appetite, sleep disturbances, weight loss, jaundice and dilation of the venous network on the skin of the chest and abdomen, sometimes resembling the appearance of a “jellyfish head”. However, the course of the disease may be latent and not cause significant symptoms.

Various research methods are used to diagnose portal hypertension. This includes splenoid orthography (X-ray examination using a contrast agent), contrast examination of the esophagus, esophagoscopy (examination of the esophagus using an endoscope), and determination of liver activity, including biopsy.

Differential diagnosis is carried out to identify the cause of hypertension.

Initial treatment of portal hypertension is usually conservative. Includes diet, the use of choleretic agents, lipotropic substances and antispasmodics. Patients may also be prescribed intravenous vitamin complexes, fasting glucose, and detoxification therapy using various drugs. If the process in the liver is highly active, prednisone therapy can be used.

In case of bleeding, it is recommended to carry out an infusion of fresh frozen plasma and red blood cells, in parallel with the administration of calcium chloride, aminocaproic acid, glucose with B vitamins, ascorbic acid and other drugs. If liver failure develops, drip administration of a 4% sodium bicarbonate solution can be performed. If edema and ascites occur, spironolactone, an antialdosterone drug, can be used in combination with other diuretics. Internal administration of cooled plasma can be used to coat the mucous membrane of the esophagus, and regular cleansing enemas are recommended.

If symptoms of portal hypertension, hypersplenism (accompanied by anemia, thrombocytopenia and leukopenia) or recurrent severe gastrointestinal bleeding worsen, surgery may be required.

The prognosis of portal hypertension depends on the cause of this condition. In the case of liver cirrhosis, the prognosis is most often unfavorable.

Prevention of portal hypertension consists of preventing infection during childbirth and in the early neonatal period, as well as timely treatment of liver diseases.

In conclusion, portal hypertension is a serious condition that requires a comprehensive approach to diagnosis and treatment. Early detection of the cause of hypertension and timely initiation of conservative or surgical therapy can significantly improve the patient's prognosis and quality of life.