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Portal hypertension

  1. Symptoms
  2. Reasons
  3. Diagnosis
  4. Treatment


Portal hypertension

a stable set of symptoms that are a complication of cirrhosis. The cause of portal hypertension is the increased pressure in the vein (the portal vein), which develops as a result of obstructions of blood flow in the area. Portal vein this is one of the major vein that brings blood from the stomach to the liver.

Symptoms

Symptoms of portal hypertension

  • increased spleen
  • appears varicose veins
  • appear the diseases of cardial gastric Department
  • disease the anorectal area
  • diseases of the umbilical region
  • increases the amount of free fluid in the abdominal cavity of a patient man
  • occurs portal gastropathy
  • decreased appetite
  • appears bloating
  • vomiting, nausea
  • pain is felt in the umbilical region.

Form

There are several forms of portal hypertension

  • prepecenica appears when there are obstacles in the blood flow of the portal vein before it enters the liver
  • intrahepatic appears when obstacles in the blood flow of the portal vein is directly in the liver. Sometimes presinusoidal, sinusoidal and postsinusoidal.

To distinguish between these forms of the disease is possible only after a biopsy of the liver.

Clinical stage

  • the initial stage. Patients have the first symptoms of the disease, such as flatulence, heaviness in the side, General malaise
  • reasonable stage, when there are pronounced symptoms of the disease. Is characterized by symptoms such as heaviness in the side and upper abdomen, epigastric pain, abdominal epigastric pain, feeling of fullness stomach, nausea, vomiting, enlarged spleen and liver
  • severe stage. Appear pronounced clinical symptoms of the disease. Begins to appear ascites (when there is fluid in abdominal cavity)
  • complicated stage. Begin to develop complications of the disease (ascites that is difficult to treat, varicose veins on the internal organs).

Reasons

Causes of portal hypertension are

  • the disease develops when thrombosis of the portal vein
  • the disease develops when the thrombosis of the splenic vein
  • in ARTESIA or stenosis of portal vein
  • when compressed vein tumor
  • by increasing blood flow in the vein, occurs in diseases of the blood.

Causes of intrahepatic hypertension

  • biliary cirrhosis
  • the initial stage of portal hypertension
  • regenerative hyperplasia
  • in the presence of diseases of the bone marrow, which produces many blood cells
  • polycystic
  • metastases
  • alcoholic hepatitis
  • pelisky hepatitis
  • congenital

  • at a late stage of shistosomozy
  • in biliary cirrhosis
  • at a late stage of portal hypertension
  • in vein-occlusive diseases
  • when nezirroticski portal fibrosis.

Causes of hypertension postpectoral

  • thrombosis of hepatic veins
  • the obstruction of the lower vein
  • with the right

    which is caused by constrictive pericarditis

  • at arterial-portal venous fistula
  • by increasing blood flow in Vienna
  • by increasing blood flow in the spleen.

Causes of mixed hypertension

  • cirrhosis of the liver
  • in chronic active hepatitis
  • primary biliary cirrhosis.

Diagnosis

  • Analysis of diseases and complaints (when the first symptoms increases the size of the liver and spleen, abdominal pain, vomiting, abdominal enlargement, bloody stool, etc.)
  • the history of life. Sick patient with some chronic diseases, whether hereditary diseases, bad habits, took the patient for a long time any medications, if the patient tumor had contact with toxic substances
  • inspection. On examination, the doctor determines skin color, looks, whether on the skin, spider veins, enlarged belly of whether whether the expansion of blood vessels of the abdomen. During palpation the doctor evaluates pain in the abdomen. While rapping at the size of the liver and spleen
  • a blood test helps to identify the decrease of platelets in the blood
  • coagulation
  • biochemical analysis of blood
  • definition of viral hepatitis
  • the analysis of urine.

Treatment

It is necessary to determine the cause of the disease and taken for treatment.

Diet should reduce salt intake to prevent water stagnation in the body. Also, the patient is recommended to reduce the consumption of protein foods, to reduce the risk of hepatic encephalopathy.

Treatment is carried out in stationary conditions under the supervision of a physician. For treatment of the disease are used as surgical methods and conservative treatment.

Conservative treatment

  • prescribe drugs with the pituitary hormone. They reduce the blood flow in the liver and reduces pressure in Vienna
  • prescribed nitrates. These medications dilate the veins and lead to the accumulation of blood in the vessels and reduce blood flow in the liver
  • beta-blockers drugs that lower heart rate
  • synthetic analogues of somatostatin. It is a drug that lowers the arterioles of the abdominal cavity
  • prescribe diuretics to bring unnecessary fluid from the body
  • antibiotic therapy is carried out. To remove the causative agent of the disease.

Surgical treatment of portal hypertension is carried out in such cases

  • in the presence of varicose veins of the stomach or

  • if splenomegaly
  • in the ascites.

There are methods of surgical treatment of portal hypertension

  • portosystemic
  • splenorenal shunting
  • devascularization of the lower esophagus
  • ligation of some of the arteries and veins of the esophagus and stomach
  • transplantation (liver transplant).

Complications

Hypersplenism the spleen destruction of red blood cells. Is the reason

  • anemia
  • bleeding due to thrombocytopenia
  • bleeding from varicose veins
  • hidden gastrointestinal bleeding
  • hepatic encephalopathy
  • the appearance of hernias
  • disorders of the kidneys
  • various infectious diseases
  • bacterial

  • hepatorenal syndrome.

The prognosis of portal hypertension depends on the stage of the disease, the presence of bleeding and of their volume.