Portal Hypertension

In the earliest stages of cirrhosis, you may not notice symptoms. When signs and symptoms do become apparent, they may include the following:

• Appetite loss
• Fatigue or weakness
• Itchiness
• Mild discomfort over your liver
• Muscle cramps
• Nausea and vomiting
• Unexplained weight loss

As your liver function gets worse, other problems may occur:

• Abdominal bloating or swelling
• Ankle swelling
• Jaundice (yellowing of your skins and the whites of your eyes)
• Confusion or trouble thinking
• Dark urine
• Internal bleeding
• Bruising and bleeding easily

Doctors may use a physical exam, along with blood tests, imaging studies, and in some cases, a biopsy to diagnose cirrhosis. A biopsy involves removing tissue and examining it under a microscope. Along with these tests, doctors may also perform an upper endoscopy. This test involves passing a thin, flexible tube with a light on the end into your mouth and down your esophagus. Doctors can also place tools through the endoscope. The test may help your doctors diagnose portal hypertension.

We carefully evaluate your condition to determine which treatment or treatments will be best for you.

Endoscopy

Portal hypertension can sometimes lead to bleeding from the varicose veins in the esophagus or the stomach. Your physician can use endoscopic treatments to treat bleeding vessels and prevent further bleeding.

Medication

A number of medications may be used to reduce portal pressure. Your physician will work with you determine what is the appropriate medication and dosing for you. If you have abdominal distention or ankle swelling, your physicians will usually prescribe a low-sodium diet and additional diuretics to help you eliminate the additional fluid.

Transjugular Intrahepatic Portosystemic Shunt (TIPS)

TIPS is an interventional radiology procedure. It involves inserting a metal stent (a tiny wire mesh tube) into your liver, going through the jugular vein in your neck. The stent creates a passageway between your portal vein and your hepatic veins (the veins that drain blood from your liver into the large vein that carries blood back to your heart). This makes it possible for blood to bypass the blockage caused by the scarring of cirrhosis and relieve the high blood pressure in your liver.

There are several treatments that may help manage complications of portal hypertension linked to cirrhosis.

Dietary Changes

It’s important to follow a low-sodium diet (typically 2 grams/day) to prevent fluid collection and minimize swelling (edema). Our nutritionists can teach you about foods that are high in sodium, which alternatives and substitutes to consider, and how to read food labels.

To help prevent the confusion, drowsiness and behavioral changes (encephalopathy) that liver problems can cause, it’s important to take your medications exactly as directed by your doctor. You don’t have to restrict protein. But it is important to pay attention to the type of protein you eat. Our nutritionists may advise you to eat a mix of protein foods from meat and vegetable sources such as eggs, dairy products, nuts, lentils and beans, but to consume less red meat. Also, you may be able to better tolerate protein-rich foods if you eat them throughout the day rather than all at once.

Endoscopic Treatment

If you have bleeding varices, doctors may rely on endoscopy to treat them. The doctors may recommend:

• Banding: placing special rubber bands to block the vessels and stop your bleeding.
• Sclerotherapy: injecting a solution into the veins that causes scarring and ultimately stops bleeding.

Medication

We may use medication to lower the pressure in varices and reduce the chances for bleeding. Sometimes we use medication together with endoscopic treatment.

Specialized Portal Decompressive Surgery

If we’re not able to control your varices with medication, an endoscopic procedure, or a TIPS surgery, then surgery may be an option. Surgeons with the Transplant Institute at BIDMC use special procedures to reroute blood flow through your liver. The procedures involve sewing a vein that’s under high pressure, such as your portal vein or splenic vein (the vein that drains blood from your spleen, the upper part of your stomach and part of your pancreas) to a vein under low pressure. This can help decrease swelling in your veins. With less swelling, bleeding may stop and the risk that a vein will rupture goes down.