Portal hypertension is one of the most serious complications of advanced liver disease. Scar tissue in your liver (cirrhosis) compresses the blood vessels running through it and reduces their blood flow. This affects many other organs throughout your body. It can cause serious internal bleeding and other problems.
Portal hypertension is elevated blood pressure in your portal vein and the smaller veins that branch off from it — your portal venous system. The portal venous system drains blood from your stomach, intestines, pancreas and spleen into your liver through the portal vein. Your liver filters the blood and then sends it back to your heart and into general circulation in your body.
When something blocks or slows the blood flow through your portal vein, it causes increased pressure throughout your portal venous system. Your body attempts to compensate for this pressure by diverting the blood flow into other veins. The extra blood flow makes these veins expand and makes their walls stretch and weaken. They may leak fluids into your abdomen, and they can also break and bleed.
In Western nations, portal hypertension is most commonly caused by cirrhosis of the liver. That’s when long-term liver disease causes scarring of your liver tissues. Scar tissue obstructs the flow of blood through the portal vein running through your liver. In other areas of the world, a parasite infection called schistosomiasis is the more common cause. Over 230 million people worldwide have this infection.
The complications of portal hypertension can be life-threatening, especially internal bleeding. Not everyone will have these complications, but the risk increases as portal hypertension increases. The greater the pressure, the more enlarged your veins become and the more likely they are to rupture. Portal hypertension is the most common cause of hospitalization and death in people with cirrhosis.
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You may not have any symptoms until complications develop. Up to 90% of people with cirrhosis already have portal hypertension before they have symptoms. Up to 40% already have large varices (enlarged veins). The first noticeable symptoms of portal hypertension are usually related to new, enlarged, leaky and bleeding veins, such as:
The most direct way to diagnose portal hypertension is to measure the pressure in your liver veins, which involves inserting a tiny catheter into a vein. But this is a difficult procedure and not usually necessary. Healthcare providers can recognize portal hypertension by its clinical signs and symptoms. Imaging tests and blood tests can help confirm their suspicions.
Your healthcare provider will suspect portal hypertension if you have:
Portal hypertension itself may or may not be reversible, depending on its cause. If there’s an infection or a blood clot that your healthcare provider can treat with medication, portal hypertension can improve and sometimes resolve over time. However, significant scar tissue, such as in the case of cirrhosis, usually won’t reverse and leads to persistent portal hypertension. Most treatment is aimed at managing the complications of portal hypertension. Your healthcare provider will address emergencies first, then move on to longer-term solutions.
First-line treatments to stop gastrointestinal bleeding include:
Other first-line treatments for complicated portal hypertension may include:
When bleeding or other complications persist, healthcare providers may move on to second-line treatments.
Two different shunt procedures are sometimes performed to help redirect blood flow through your portal venous system and relieve pressure.
Finally, some people with advanced liver disease may be candidates for a liver transplant.
All of these treatments require extensive follow-up care to keep an eye on your condition. You’ll see your healthcare provider frequently in the first year after treatment to make sure the treatment is still working and that no new complications have developed. After that, you’ll continue to see them at least twice a year for imaging tests to look at your liver and blood tests to check your liver function.
The best way to prevent portal hypertension is to try and stop the progress of chronic liver disease when you can. Not all causes are in your control, but some of the most common ones are — if you discover them soon enough. Liver disease caused by alcohol use or by metabolic disease can often be improved by dietary and lifestyle changes. Hepatitis C can be cured with antivirals. Make sure to get screened at least once.
Your outlook depends on how severe your portal hypertension is and whether you have bleeding varices or other complications. The risk of death from your first episode of bleeding may be as high as 40%. If bleeding recurs after treatment, the risk of death from your next episode is close to 30%. Your risk is higher if you have more advanced cirrhosis. It’s lower if your liver disease is still early enough to control.
Keep in touch with your healthcare team. Make sure to make all of your checkup appointments and take your medications as directed. Check with your provider before taking new medications, and reduce or eliminate alcohol. You may need to maintain a low-sodium diet, or a more personalized diet plan. You may also have other related conditions that you can help control with diet and lifestyle changes.
A note from Cleveland Clinic
Portal hypertension affects so many different organs that treating it can feel like putting out multiple fires. It may come as an unpleasant surprise to learn that liver disease can affect veins in your stomach, esophagus, lungs and kidneys. This is especially true if you’ve had no symptoms or signs of liver disease until now. But catching it earlier will give you the advantage in controlling portal hypertension.
Last reviewed by a Cleveland Clinic medical professional on 10/02/2022.
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