Cirrhosis and Portal Hypertension

Cirrhosis Overview

Portal hypertension is increased pressure in the portal vein — the main vein that receives blood from the:

• Stomach
• Small intestines
• Spleen

The increased pressure is most often a symptom of liver disease and is most commonly caused by scarring in the liver (cirrhosis).

It can occur when the veins leading in to or out of the liver are blocked, or as a result of chronic pancreatitis.

In newborns, portal hypertension can result from umbilical infection. In cases of chronic pancreatitis and umbilical infection, the liver is usually normal.

Variceal bleeding

Pressure on the portal vein causes blood flow to be restricted or pushed backward.

This causes enlargement and lengthening of the veins in the stomach and esophagus. Enlarged veins are called varices.

Excessive bleeding (hemorrhage) from the varices is a potentially life-threatening condition that must be treated because hemorrhage often recurs and is associated with a high risk of death.

Other complications

Portal hypertension may cause the spleen to become enlarged. This can cause abdominal discomfort and, because the enlarged spleen holds blood cells, reduce circulating platelets and white blood cells.

Other conditions that may develop as a result of portal hypertension include:

• Ascites — the buildup of fluid in the abdomen. This results from leakage of abdominal fluid out of the liver and the lining of the intestines. When the volume of leaking fluid exce eds the ability of the abdominal lining to absorb it, the fluid accumulates and causes abdominal stretching and expansion.
• Encephalopathy — the abnormal functioning of the brain. Encephalopathy caused by liver disease is characterized by mental changes that result from toxic substances reaching the brai n without first being metabolized by the liver.