Cirrhosis is a long-term liver disease that results in scarring of the liver. Scarring blocks blood flow and filtration and can lead to a back-up of the portal vein, where blood that drains from the small intestine, spleen, and stomach meets the liver. This increased pressure is known as portal hypertension.
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What Is Cirrhosis and Portal Hypertension?
Cirrhosis is a long-term liver disease that causes scarring of the liver, damaging its ability to filter blood. This impaired liver function creates a backup of blood, which can lead to an increase in blood pressure. When pressure increases in the main vein that receives blood from the small intestine, spleen, and stomach — the portal vein — it is known as portal hypertension.
It can occur when the veins leading into or out of the liver are blocked, or as a result of chronic pancreatitis.
In extreme cases, this condition can lead to variceal bleeding. This is when the backed-up blood causes the veins of the esophagus and stomach to stretch and the blood to pool. These build-ups can then burst and result in internal bleeding.
In newborns, portal hypertension can result from umbilical infection. In cases of chronic pancreatitis and umbilical infection, the liver is usually normal.
How common is cirrhosis and portal hypertension?
About 4.5 million adults in the U.S. have liver disease, according to the Liver Foundation. Of the population that has liver disease, many might already be experiencing portal hypertension and not know it.
What causes cirrhosis and portal hypertension?
Cirrhosis is a long-term liver disease that can be contracted from hepatitis and other viruses, as well as long-term alcohol abuse and nonalcoholic fatty liver disease. If you have one or more of these conditions, your liver may be at risk of cirrhosis.
Cirrhosis and portal hypertension risk factors
Cirrhosis and portal hypertension are serious conditions that can have life-threatening effects. You could be at a heightened risk if you are a heavy smoker or drinker.
Many people who have cirrhosis will already have portal hypertension and not know it. The symptoms of portal hypertension often only show up as internal bleeding, which can lead to blood in the stool or vomit. If you already have liver disease or drink or smoke excessively, you are at a greater risk of cirrhosis and portal hypertension.
Complications of cirrhosis and portal hypertension
Cirrhosis is a serious liver disease that can lead to other serious complications. Left untreated, it can lead to liver failure, liver cancer, or death.
It can also cause:
- Pressure on the portal vein to restrict blood flow or push it backward. This causes the veins in the stomach and esophagus to enlarge and lengthen. Enlarged veins are called varices.
- Excessive bleeding (hemorrhage) from the varices. This is a potentially life-threatening condition that must be treated because hemorrhage often recurs and is associated with a high risk of death.
Portal hypertension may cause the spleen to become enlarged. This can cause abdominal discomfort and, because the enlarged spleen holds blood cells, reduce the levels of circulating platelets and white blood cells.
Other conditions that may develop as a result of portal hypertension include:
- Ascites — Buildup of fluid in the abdomen. This results from the leakage of abdominal fluid from the liver and the lining of the intestines. When the volume of leaking fluid exceeds the abdominal lining's ability to absorb it, the fluid accumulates, causing abdominal stretching and expansion.
- Encephalopathy — Abnormal functioning of the brain. Encephalopathy caused by liver disease is characterized by mental changes that result from toxic substances reaching the brain without first being metabolized by the liver.
How can I prevent cirrhosis and portal hypertension?
The best prevention for these conditions is to maintain proper liver care. Eliminating smoking or drinking can be the key change for some people. If you already have a long-term liver disease, then following your doctor’s plan is the best course of action to prevent your condition from worsening.
What Are the Signs and Symptoms of Cirrhosis and Portal Hypertension?
Common symptoms may include:
- Ascites (abdominal swelling).
- Blood in the stool or vomit.
- Easy bruising.
- Fatigue.
- Hepatic encephalopathy.
- Itching.
- Jaundice (yellowing of the eyes and skin).
- Loss of appetite.
- Weakness.
When should I see a doctor about my cirrhosis and portal hypertension symptoms?
If you already have a liver condition that could lead to cirrhosis, you may already be in regular contact with your doctor. If you notice the symptoms listed above, you should report them to your doctor as soon as possible. The symptoms of advanced portal hypertension are related to internal bleeding and might result in blood in the stool or vomit. If you experience these symptoms, go to an emergency room.
How Do You Diagnose Cirrhosis and Portal Hypertension?
Your doctor will need to get clear imaging of your liver to examine the extent of your condition. This will require a form of imaging procedure, such as a CT or MRI scan. These scans will give your doctor a visual understanding of your condition, but to know how the liver is functioning, your doctor may need to run blood tests. The liver’s primary function is to filter the blood, so any abnormalities in the blood can be a sign of a weakened liver.
Imaging tests to diagnose cirrhosis and portal hypertension
Blood tests and liver function tests
Your doctor might order one or more tests, including:
- Liver function tests — Measure various blood substances to determine the health of your liver.
- Platelet count — Looking for thrombocytopenia.
- Auto antibodies — To check for primary biliary cirrhosis (PBC).
- Liver biopsy — The best test for diagnosing and staging cirrhosis.
- Upper endoscopy — To look for esophageal varices, which are suggestive of cirrhosis.
- Paracentesis — To evaluate fluid that has accumulated in the abdominal cavity.
How Do You Treat Cirrhosis and Portal Hypertension?
The goals of cirrhosis treatment are to:
- Help you avoid substances (medicines, alcohol) that might cause further liver damage.
- Prevent liver cancer with surveillance.
- Treat the complications associated with cirrhosis.
Treatment options may include:
- Antiviral medicines used for treating Hepatitis B and Hepatitis C.
- Liver transplantation.
Other things that may aid in treatment include:
- Avoiding alcohol.
- Avoiding nonsteroidal anti-inflammatory drugs (NSAIDS).
- Eating a balanced diet.
How effective is treatment?
Treatment effectiveness is based on how far your condition has progressed. If your liver is reaching the point of failure, the only option is a transplant, the success of which is dependent on the body’s ability to accept the new liver.
How long does it take to recover after liver transplant for cirrhosis and portal hypertension?
A liver transplant surgery will require several days in the hospital. The first day is for preparing for and performing the surgery, followed by a day or two more to monitor you as you recover and your body adapts to the new liver.
