Liver Diseases and Transplantation

Portal Hypertension

Portal hypertension is a type of liver disease characterized by elevated blood pressure in the portal vein - a major vein that transports blood from the stomach to the liver, large and small intestines, spleen, gallbladder, and pancreas. High blood pressure or hypertension in this vein is most often caused by cirrhosis of the liver. Other causes include blood clots in the vein and schistosomiasis - a parasitic infection common in Africa, sub-Saharan Africa, southern China, the Middle East, Southeast Asia, South America, and a few countries in the Caribbean.

Doctors at the Center for Advanced Digestive Care (CADC) at NewYork-Presbyterian/Weill Cornell Medical Center are leaders in the care of patients with all types of liver diseases, and have pioneered innovative treatments. The team includes all of the medical and surgical specialists required to care for patients with portal hypertension, offering comprehensive and personalized care customized to each patient's needs. Care for portal hypertension is often led by physicians at the Center for Liver Disease and Transplantation, the world-renowned liver center based at NYP

Symptoms of Portal Hypertension

Portal hypertension can cause symptoms including but not limited to:

• Blood in vomit or stools
• Confusion or forgetfulness
• Jaundice
• Low white blood cell counts
• Swelling of legs and feet

Portal hypertension can cause a life-threatening condition known as esophageal varices, where blood vessels in the esophagus (and sometimes in the stomach or rectum) become enlarged and can rupture, causing internal bleeding. Patients with varices often have black, tarry or bloody stools. They also may vomit blood.

Another condition caused by portal hypertension is ascites formation, when fluid accumulates in the abdomen. Patients with ascites may have abdominal swelling and pain, which can lead to loss of appetite from the swollen abdomen pressing on the stomach and shortness of breath from the swollen abdomen pressing on the lungs. In some cases, patients with ascites also develop swelling in their ankles.

A third condition caused by portal hypertension is hepatic encephalopathy, in which the damaged liver can no longer successfully remove toxins such as ammonia from the blood. These toxins travel to the brain and impair the function of brain cells. Patients with hepatic encephalopathy generally become forgetful or easily confused. In its most severe form, hepatic encephalopathy can cause significant lethargy or even coma.

To learn more about portal hypertension, visit our Health Library.

Diagnosis of Portal Hypertension

If portal hypertension is suspected, the CADC's liver experts may use several different techniques to diagnose:

• Upper GI endoscopy
• Ultrasound
• Various other imaging techniques including x-rays, CT scans, or an MRI.
• Blood tests

Treatment of Portal Hypertension

Medication

CADC doctors may prescribe medication to treat portal hypertension. Physicians may employ nonselective beta blockers - medications for hypertension which reduce blood pressure - to prevent bleeding from esophageal varices. They may prescribe diuretic pills to reduce fluid due to ascites. They may also prescribe an antibiotic and/or lactulose, a type of laxative, which help reduce the confusion and other mental changes caused by hepatic encephalopathy.

Procedures

Doctors at the CADC and the Center for Liver Disease and Transplantation can use several different types of procedures to treat portal hypertension. c

• With banding, a gastroenterologist uses rubber bands to tie off varices. This reduces blood flow and pressure and the likelihood that the varices will rupture.
• With sclerotherapy, physicians inject a liquid into the varices, which creates scar tissue. This treatment does not reduce pressure in the varices, but it does create a stronger protective "covering" to contain blood. Sclerotherapy is only done if banding cannot be performed.
• CADC doctors sometimes treat severe portal hypertension with a procedure known as "transjugular intrahepatic portosystemic shunt," or TIPS. Before undergoing TIPS, patients have a number of tests to assess the function of their liver, heart, and kidney and to help determine the extent and severity of the portal hypertension. These tests may include echocardiography (the use of ultrasound to evaluate heart function), endoscopy, blood tests, and angiography. TIPS is typically used in patients where neither banding nor sclerotherapy can stop bleeding from varices or and when diuretic medication cannot control ascites fluid.