| Category | Best Portal Hypertension Treatment in Indore |
What is portal hypertension?
Portal hypertension is characterized by an increase in the blood pressure within the portal venous system, which is a system of veins that includes those coming from the stomach, intestine, spleen, and pancreas. The portal vein branches into smaller vessels and travels through the liver. However, if the vessels in the liver are blocked due to liver damage, blood cannot flow properly through the liver. As a result, high pressure in the portal system develops, which may lead to the development of varices - large, swollen veins within the esophagus, stomach, rectum, or umbilical area (belly button). These varices can rupture and bleed, leading to potentially life-threatening complications.
What Causes Portal Hypertension?
The most common cause of portal hypertension is cirrhosis of the liver. Cirrhosis is scarring which accompanies the healing of liver injury caused by hepatitis, alcohol, or other less common causes of liver damage. In cirrhosis, the scar tissue blocks the flow of blood through the liver.
Other causes of portal hypertension include blood clots in the portal vein, blockages of the veins that carry the blood from the liver to the heart, a parasitic infection called schistosomiasis, and focal nodular hyperplasia, a disease seen in people infected with HIV, the virus that may lead to AIDS. Sometimes the cause is unknown.
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What Are the Symptoms of Portal Hypertension?
The main symptoms and complications of portal hypertension include:
How Is Portal Hypertension Diagnosed?
Usually, doctors make the diagnosis of portal hypertension based on the presence of ascites or of dilated veins or varices as seen during a physical exam of the abdomen or the anus. Various lab tests, X-ray tests, and endoscopic exams may also be used.
How Is Portal Hypertension Treated?
Treatment for portal hypertension depending upon the complications, particularly bleeding from varices, as most causes of portal hypertension cannot be treated. But at early-stage various approaches are available, including diet, medications, endoscopic therapy, surgery, and radiology procedures.
Treatment may include:
Endoscopic therapy. The first line of treatment for variceal bleeding usually involves either banding or sclerotherapy. Banding is a procedure in which a gastroenterologist uses rubber bands to block off the blood vessel and stop the bleeding. When banding is not an option, sclerotherapy may be used. This involves injecting a blood-clotting solution into the bleeding varices to stop the bleeding.
Medications. Nonselective beta-blockers such as nadolol or propranolol may be prescribed alone or in combination with endoscopic therapy to reduce the pressure in varices and minimize the risk of bleeding. In patients with varices that are at risk for bleeding, nonselective beta-blockers are also prescribed to prevent a first variceal hemorrhage. If a patient cannot tolerate beta-blockers, esophageal variceal banding may be used instead. Additionally, lactulose is a drug that can be used to manage confusion and other mental changes associated with encephalopathy.
What Lifestyle Changes Should Be Made for Portal Hypertension?
Maintaining good nutritional habits and keeping a healthy lifestyle may help you avoid portal hypertension. Some of the things you can do to improve the function of your liver include the following:
What are the other treatment options for portal hypertension?
If endoscopic therapy, drug therapy, and/or dietary changes don't successfully control variceal bleeding, you may require one of the following procedures to reduce the pressure in these veins. Decompression procedures include:
Transjugular intrahepatic portosystemic shunt (TIPS): This procedure involves placing a stent (a tubular device) in the middle of the liver. The stent connects the hepatic vein with the portal vein, which reroutes blood flow in the liver and helps relieve pressure in abnormal veins.
Distal splenorenal shunt (DSRS): This procedure connects the vein from your spleen to the vein from the left kidney in order to reduce pressure in the varices and control bleeding.
Liver transplant: This is done in cases of end-stage liver disease.
Devascularization: A surgical procedure that removes the bleeding varices; this procedure is done when a TIPS or a surgical shunt is not possible or is unsuccessful in controlling the bleeding.
Paracentesis: This is a procedure in which the accumulation of fluid in the abdomen (ascites) is directly removed. The results are usually temporary and the procedure will need to be repeated as needed.
What Happens During the TIPS Procedure?
The TIPS procedure involves a radiologist creating a tunnel through the liver using a needle to connect the portal vein to one of the hepatic veins. A metal stent is then placed in the tunnel to maintain its openness. By rerouting blood flow in the liver, this procedure reduces pressure in abnormal veins not only in the stomach and esophagus but also in the bowel and the liver. It is not a surgical procedure and is performed by the radiologist within the vessels under X-ray guidance. Although the process typically lasts between one to three hours, patients should expect to stay in the hospital overnight following the procedure.
How Successful Is the TIPS Procedure?
The TIPS procedure controls bleeding immediately in more than 90% of patients with portal hypertension. However, in about 20% of patients, the shunt may narrow, causing varices to re-bleed at a later time.
What Complications Are Associated With TIPS?
Shunt narrowing or blockage can occur within the first year after the TIPS procedure. Follow-up ultrasound exams are performed frequently after the TIPS procedure to detect these complications. The signs of a blockage include increased ascites (accumulation of fluid in the abdomen) and re-bleeding. This condition can be treated by a radiologist who re-expands the shunt with a balloon or repeats the procedure to place a new stent.
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