Portal hypertension refers to increased pressure in the portal vein, the vein that goes from the gastrointestinal tract to the liver. The most common cause is cirrhosis of the liver. Other causes include certain types of heart disease, which reduce blood flow out of the liver and thus slow the blood flow into the liver and lead to portal hypertension.
Esophageal Varices
Esophageal varices are dilated veins in the lower esophagus that are prone to rupture. According to "Harrison's Principles of Internal Medicine," most patients with cirrhosis will eventually develop varices, and about one-third of these patients will suffer from bleeding. Symptoms include black stools, when the blood trickles into the lower gastrointestinal tract, and vomiting of blood. Rupture of these varices and the subsequent vomiting of blood is an emergency. Untreated, the patient will go into shock and die.
Ascites
Ascites refers to accumulation of fluid in the abdomen. As explained in "Harrison's Principles of Internal Medicine," portal hypertension, secondary to cirrhosis, is the most common cause. The abdomen gradually grows in girth, often out of proportion to the rest of the body. The accumulation of fluid is so gradual that patients often don't notice it till they've accumulated one to two liters of fluid. Symptoms include shortness of breath, caused by pressure on the diaphragm that leaves the lungs less room to expand. Other symptoms include fatigue, weakness and malnourishment.
Splenomegaly
Enlargement of the spleen is another common complication of portal hypertension, caused by the decreased blood flow out of the spleen and into the liver. Splenomegaly can be asymptomatic. It can cause pain in the upper left abdomen and a feeling of satiety after consuming even a small meal. An enlarged spleen can lead to increased destruction of blood cells, causing anemia, bleeding and an increased tendency towards infections. The spleen is a soft organ and when enlarged is prone to rupture. Rupture of the spleen leads to massive bleeding and is a life threatening condition that requires emergency surgery.
References
- "Harrison's Principles of Internal Medicine, 17th edition"; Anthony Fauci et al.; 2008
- MyClevelandClinic.org: Portal Hypertension
- Mayoclinic.com: Esophageal Varices
