Portal hypertension - a disruption of blood flow in vessels of portal, hepatic vein and inferior vena cava, which results in an increased hydrostatic pressure in the portal vein. This disease occurs in both adults and children, and occurs most often due to liver cirrhosis. It may be accompanied by varicose veins in the stomach and esophagus, splenomegaly, ascites, bleeding disorders toward anticoagulation and other symptoms and syndromes.
Gastrointestinal bleeding and hepatic coma - the most dangerous complications of portal hypertension, liver.
The etiology of portal hypertension
Syndrome of portal hypertension - is not an independent disease, and clinical manifestations of various pathologies, according to the nature of which distinguish dopechenochny, intrahepatic and postpechenochny types of portal hypertension.
By predpechenochnoy form include:
- Congenital malformation of the portal vein;
- Overgrown lumen throughout the vein or its parts;
- Pressure on the veins or inflammatory infiltrate tumor and cysts;
- Mechanical damage to the portal vein;
- Operations on the liver.
The reasons for the internal portal hypertension liver can be almost all the existing acute and chronic diseases affecting this organ:
- Primary biliary cirrhosis;
- Sclerotic scarring of the liver tissue;
- rheumatoid arthritis;
- Acute alcoholic hepatitis;
- Felty's syndrome;
- Congenital hepatic fibrosis;
- Wilson disease;
- Caroli's disease;
- Gaucher disease;
- Polycystic liver;
- Myeloproliferative disorders;
- Intoxication with vitamin A;
- Intoxication vinyl chloride, arsenic, copper.
Portal hypertension caused postpechenochnogo type blocking blood in the veins of the liver for the following reasons:
- Chiari disease - a complete or partial obstruction of the veins;
- Thrombosis of the inferior vena cava - tumors and cysts;
- Heart disorders - tricuspid valve insufficiency, constrictive pericarditis.
Symptoms of portal hypertension
Symptoms of portal hypertension associated with primary disease cause high pressure in the portal vein.
Predpechenochnaya form usually occurs in childhood and generally has a favorable prognosis. Most often it is accompanied by bleeding from esophageal veins, splenomegaly, hypersplenism, portal vein thrombosis. Some patients gate Vienna is replaced by a network of small veins.
For the type of intrahepatic portal hypertension characterized by signs of cirrhosis
. Course of the disease depends on what species relates cirrhosis (atrophic, Postnecrotic, or biliary pigment), and the degree of compensation of liver dysfunction and pathological process activity
. Patients occur hemorrhagic complications, splenomegaly, veins of the anterior abdominal wall, ascites
. Varicose veins are subject to rupture, leading to bleeding
. Thus there is vomiting blood without pain epigastric
. If the blood flow into the stomach, then the vomiting is the color of coffee grounds
. Quickly developing hemorrhagic anemia
. First bleeding from esophageal varices in 30% of cases leads to death
. When running cirrhosis of the liver parenchymal disease it causes ascites and Gospel
. In these cases, both conservative and surgical treatment of portal hypertension may not succeed
Postpechenochnaya form of the syndrome in the acute phase is accompanied by severe pain in the right upper quadrant and epigastric region. Rapidly increasing hyperthermia, hepatomegaly and ascites. Death occurs as a result of baked-renal failure and profuse bleeding from esophageal veins. In the chronic stage of the disease hepatomegaly and splenomegaly develops gradually. On the front of the abdominal wall appears collateral venous network. There exhaustion and hypoalbuminemia (violation of protein metabolism).
Diagnosis and treatment of portal hypertension
Diagnosis of the syndrome of portal hypertension is carried hepatologist, gastroenterologist or an oncologist using abdominal ultrasound. It shows an enlarged spleen and liver, and also reveals the accumulation of fluid and changing the diameter of the portal and splenic vein.
If you suspect that portal hypertension is necessary to conduct fibrogastroduodenoscopy (EGD) to assess the condition of the veins of the esophagus and detect gastrointestinal bleeding. Varicose veins gastrointestinal adjusted with contrast radiography. In addition to the research conducted urinalysis and blood chemistry.
Treatment of portal hypertension can be conservative or surgical. It is aimed primarily at removing the initial disease and the prevention of bleeding in the gastrointestinal tract.
Some doctors use nitrates and beta-blockers, but often resorted to operations, especially in the ascites, severe liver disease and the rapid expansion of the gastric veins. Surgical intervention is to provide new ways for the outflow of the blood and the withdrawn liquid from the abdominal cavity. It is important to adjust the speed of the process, since the explosive dehydration may develop hepatic coma. In some cases, a liver transplant is needed.
Portal hypertension can not be cured completely. Any methods give only a temporary effect, and in most cases, the disease returns. But without treatment the life of patients is sharply reduced to an average of 1, 5 years. Therefore it is extremely important the correct treatment of liver diseases and timely diagnosis of portal hypertension.