• View your medical records with: Weill Cornell CONNECT
  • Access health records from your hospital visits online with: mynyp.org

NewYork-Presbyterian/Weill Cornell Medical Center - Center for Advanced Digestive Care

NewYork-Presbyterian/Weill Cornell Medical Center - Center for Advanced Digestive Care

Portal Hypertension

Portal hypertension is increased blood pressure in the liver's 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. 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.

Symptoms

Portal hypertension can cause a life-threatening condition known as varices where blood vessels in the esophagus, 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 encephalopathy, in which the damaged liver can no longer successfully screen toxins from the blood. These toxins travel to the brain and impair the function of brain cells. Patients with encephalopathy generally become forgetful or easily confused.

A third condition caused by portal hypertension is ascites. With ascites, fluid leaks from the portal artery (due to the high pressure) and 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 experience swelling in their ankles.

Diagnosis

If portal hypertension is suspected, Center liver experts will perform either an upper endoscopy or ultrasound.

Treatment

Surgical Procedure

Portal hypertension is often treated with a surgical procedure known as transjugular intrahepatic portosystemic shunt, or TIPS. Before undergoing TIPS, patients will have a number of tests to pinpoint the severity of the condition. These tests check the heart's function and help determine the extent and severity of portal hypertension.

Pre-procedure tests check the heart's function and help determine the extent and severity of portal hypertension. These include:

  • Cardiac echography
  • Endoscopy
  • Blood tests
  • Ultrasound or angiogram

Other procedures

Other procedures used to treat portal hypertension include banding or sclerotherapy when banding cannot be performed.

Medication

Medication may also be used to treat portal hypertension. Physicians may prescribe nonselective beta blockers, medication for hypertension, which reduces blood pressure, with or instead of TIPS. They may also prescribe Lactulose, a drug which helps reduce confusion and other mental changes caused by encephalopathy.