Portal hypertensia

Portal hypertensia is a disturbance of a normal blood flow in portal vessels, a hepatic and lower vena cava which leads to the increased hydrostatic pressure in a portal vein. This disease occurs both at adults, and at children, and arises most often because of cirrhosis. It can be followed by a varicosity of a stomach and gullet, a splenomegaly, ascites, disturbances of coagulability of blood towards hypocoagulation and other symptoms and syndromes.

Gastrointestinal bleedings and hepatic coma – the most dangerous complications of portal hypertensia of a liver.

Etiology of portal hypertensia

The syndrome of portal hypertensia is not an independent disease, but clinical displays of various pathologies according to which nature distinguish dopechenochny, intra hepatic and post-hepatic types of portal hypertensia.

Treat a prehepatic form:

• Congenital anomaly of development of a portal vein;
• Fusion of a gleam of all vein or its certain site;
• Pressure upon veins tumorous or inflammatory infiltrate and cysts;
• Mechanical injuries of a portal vein;
• Liver operations.

Practically all existing acute and chronic diseases affecting this body can be the reasons of internal portal hypertensia of a liver:

• Primary biliary cirrhosis;
• Sclerous scarring of hepatic fabric;
• Pseudorheumatism;
• Acute alcoholic hepatitis;
• Felti's syndrome;
• Inborn fibrosis of a liver;
• Wilson's disease;
• Karoli's disease;
• Disease to Gosha;
• Alveococcosis;
• Hemochromatosis;
• Schistosomiasis;
• Sarcoidosis;
• Liver polycystosis;
• Tumors;
• Myeloproliferative diseases;
• Intoxication vitamin A;
• Reception of medicines;
• Intoxication vinyl chloride, arsenic, copper.

Portal hypertensia of post-hepatic type is caused by blocking of blood in liver veins for the following reasons:

• Kiari's disease – full or partial obstruction of veins;
• Thrombosis of the lower vena cava – a tumor and a cyst;
• Disturbances of cordial activity – insufficiency of the tricuspid valve, chronic cardial compression.

Symptoms of portal hypertensia

Symptoms of portal hypertensia are connected with primary disease which served as the reason of high pressure in system of a portal vein.

The prehepatic form arises in the childhood more often and in general has the favorable forecast. Most often it is followed by bleedings from esophageal veins, a splenomegaly, a hypersplenism, thrombosis of a portal vein. At some patients the portal vein is replaced with network of small expanded veins.

Symptoms of cirrhosis are characteristic of intra hepatic type of portal hypertensia. The course of a disease depends on to what look cirrhosis (atrophic, postnecrotic, biliary or pigmental), and also from extent of compensation of dysfunctions of a liver and activity of pathological process belongs. Patients have hemorrhagic complications, a splenomegaly, a phlebectasia of a front abdominal wall, ascites. Expanded veins are subject to the gaps leading to bleeding. At the same time there is vomiting blood without pain in epigastriums. If blood flows into a stomach, then vomiting has color of a coffee thick. Quickly posthemorrhagic anemia develops. The first bleeding from gullet veins in 30% of cases terminates in a lethal outcome. At the started cirrhosis damage to a parenchyma of a liver is caused by ascites and a disease of the Gospel. In these cases both conservative, and operational treatment of portal hypertensia can not be crowned with success.

The post-hepatic form of a syndrome in an acute stage is followed by severe pain in right hypochondrium and epigastric area. Quickly the hyperthermia, a hepatomegalia and ascites accrues. Death is caused by a baked renal failure and profuse bleedings from esophageal veins. In a chronic stage of a disease the hepatomegalia and a splenomegaly develop gradually. On a front abdominal wall the collateral venous network appears. Exhaustion and a hypoalbuminemia (disturbance of protein metabolism) is observed.

Diagnosis and treatment of portal hypertensia

Diagnosis of a syndrome of portal hypertensia is carried out by the hepatologist, the gastroenterologist or the oncologist by means of ultrasound examination of an abdominal cavity. It shows increase in a spleen and liver, and also reveals accumulation of liquid and change of diameter of a portal and splenic vein.

At suspicions of portal hypertensia carrying out a fibrogastroduodenoskopiya (FGDS) is necessary for assessment of a condition of veins of a gullet and detection of gastrointestinal bleeding. The varicosity of digestive tract is established by means of a contrast X-ray analysis. Except the specified researches the general analysis of urine and biochemical analysis of blood is carried out.

Treatment of portal hypertensia can be conservative or surgical. It is directed, first of all, to elimination of an initial disease and prevention of bleeding in digestive tract.

Some doctors use nitrates and beta-blockers, but most often resort to operations, especially at ascites, the expressed liver failure and rapid expansion of gastric veins. Surgical intervention consists in creation of new ways for outflow of blood and in removal of liquid of an abdominal cavity. At the same time it is important to regulate the process speed as at intensive dehydration the hepatic coma can develop. In some cases liver transplantation is necessary.

Portal hypertensia does not recover completely. Any methods give only temporary effect, and the disease in most cases is returned. But without treatment the term of life of patients is sharply reduced and averages 1,5 years. Therefore the correct therapy of diseases of a liver and timely diagnosis of portal hypertensia is extremely important.