The portal vein transports blood from the intestines to the liver. Increased pressure within this blood vessel is termed portal hypertension. Cirrhosis most commonly causes portal hypertension. Other causes of portal hypertension include a blood clot in the portal vein, heart failure, pancreatitis, cancer and decreased blood proteins. Portal hypertension often leads to severe and potentially life-threatening complications.
Ascites
Portal hypertension frequently leads to ascites, an accumulation of fluid in the abdominal cavity. Symptoms of ascites include rapid weight gain, abdominal distention and pain, and an early sense of fullness with eating. Severe ascites may encroach on the lungs, causing breathing difficulty and shortness of breath. Drainage of ascitic fluid can provide temporary symptom relief in patients with extreme ascites. Reaccumulation of the fluid frequently occurs. The American College of Gastroenterology notes that people with ascites are at risk for bacterial infection of the ascitic fluid, a condition known as spontaneous bacterial peritonitis. The sudden onset of fever, abdominal tenderness and nausea typically points to the development of this infection, which can readily spread to the bloodstream. The development of ascites in a person with cirrhosis proves an ominous sign. The Cleveland Clinic reports that 50 percent of people with cirrhotic ascites die within two years of developing this complication.
Variceal Bleeding
Portal hypertension causes concomitantly increased pressure in the venous circulation of the digestive tract, which drains into the portal vein. Pressure within the veins may cause areas of focal dilation, wherein the vessel wall thins and balloons outward. Varices is the medical term for thinned, dilated veins. In a review article on the complications of cirrhosis published in "American Family Physician," Drs. Joel Heidelbaugh and Maryann Sherbondy report that varices develop in approximately 50 percent of patients with cirrhosis and portal hypertension. Varices most commonly occur in the esophagus; they may also develop in the stomach and intestines. Varices can spontaneously rupture, causing profound and potentially life-threatening bleeding.
Hepatic Encephalopathy
Hepatic encephalopathy is a frequent complication of portal hypertension. The liver serves as the primary site for detoxification of harmful chemicals in the bloodstream. Decreased blood flow through the liver leads to a buildup of ammonia and other toxins in the blood. These toxins adversely affect the brain, causing the condition known as hepatic encephalopathy. The National Institute of Diabetes and Digestive and Kidney Diseases reports that symptoms of hepatic encephalopathy include memory loss, poor concentration, confusion, drowsiness, personality changes, tremors and slurred speech. Untreated hepatic encephalopathy can lead to seizures, coma and death.
References
- Cleveland Clinic: Portal Hypertension
- National Institute of Diabetes and Digestive and Kidney Diseases: What Are the Complications of Cirrhosis?
- Cleveland Clinic Center for Continuing Education: Complications of Cirrhosis: Ascites
- American College of Gastroenterology: Ascites--A Common Problem in People with Cirrhosis
- American Family Physician; "Cirrhosis and Chronic Liver Failure: Part II. Complications and Treatment"; Joel J. Heidelbaugh, M.D., Maryann Sherbondy, M.D.; September 2006
