Hepatic Portal Hypertension

By: Medic 1

A large, perfectly round, soft, and jiggly belly is very desirable in some parts of the world. It can also be a precursor to an extremely quick and bloody death. Hepatic portal hypertension is a syndrome that is linked to diseases that effect the liver. In the following paragraphs, we’ll talk about how people get hepatic portal hypertension, how those people are effected, and what exactly is going on inside of the body when it develops. We’ll also explore what treatment options are available, and what can be done to prevent the problem. Finally, we’ll talk about how hepatic portal hypertension can lead to that big, round belly, and end your life in a scene bloody enough for a horror film.

Let’s go over some basics, and breakdown what hepatic portal hypertension means. The word hepatic, simply means anything referring to the liver. Portal, is referring to the portal vein (also referred to as the hepatic portal vein). It is one of the major blood vessels in the body, and it essentially carries blood from many of our organs and intestines back to the liver for filtration. Hypertension refers to a high amount of pressure found inside our blood vessels. In this case, we are talking about having a high degree of pressure, inside our hepatic portal vein.

Hepatic portal hypertension develops when we have problems with our liver. The most common cause is cirrhosis. Hepatitis, cancer, and anything else that causes the liver to function poorly can lead to hepatic portal hypertension. Problems can develop with our liver in several ways, but the most common are through lifestyle choices. The liver is our bodies major filtration system. Anything we put into our bodies must pass through the liver. When we drink alcohol or take drugs (either illicit or medications), the liver works hard to remove these products from our blood stream, so we can eventually get them out of our body. People who use alcohol or drugs for long periods of time, eventually overwork the liver, and disease develops. For this reason, alcoholics and drug addicts often have liver failure. People who share needles are also susceptible because they are at a high risk of contracting hepatitis, which literally translates to inflammation of the liver. Infections, parasites, and cancers can also debilitate the liver and lead hepatic portal hypertension.

As we mentioned earlier, the liver takes care of filtering the bodies blood. If we think of all of the blood vessels in the body as water pipes, the liver would be the water treatment plant. When the liver is not functioning properly, it either slows down or stops the filtration process. Just as you would expect if the water treatment plant was running slowly or stopped all together, there is a backup in the system. Water backing up would put additional pressure on the pipes, and could eventually cause one to burst. The same thing happens in the portal vein. The backup exerts more pressure on not only the portal vein, but all of the veins that are offshoots of it. This leads to swollen veins, also known as varices. Too much pressure on these veins can eventually lead to them bursting, which can be an extremely life threatening situation.

Remember that large, perfectly round, soft, and jiggly belly we talked about earlier. This is one of the symptoms of hepatic portal hypertension. In addition to the liver being the bodies water treatment plant, it’s also the bodies protein factory. When the liver fails, it’s ability to manufacture proteins suffers. A very key protein related to our topic is albumin. Albumin plays a major role in regulating the pressure inside of our blood vessels. As the force of blood pushes against the walls of our blood vessels, albumin regulates the pressure that pushes back, and keeps the blood inside of the vessels. Our blood vessels actually have little, tiny holes in them, so without this pressure, blood will leak out. This is what happens with a symptom called ascites. Our liver is not functioning properly so blood has backed up into the hepatic portal vein, increasing its pressure. Because the liver isn’t working properly, we don’t have the albumins we need to create enough pressure to push back against the additional pressure caused by the backup, and the portal vein and associated vessel begin to leak blood. This blood builds up in the abdomen, and creates a large, perfectly round, soft, jiggly belly.

As some of the associated vessels become engorged, they can provide us with additional signs of hepatic portal hypertension. They can become visible in the abdomen, anus, and even in the throat. When they burst, blood can make its way into our intestines and show up as black tarry stools. Blood vessels in the anus can burst presenting as blood in our stool. Blood vessels in the esophagus can burst and cause us to vomit blood. This brings us to that bloody scene worthy of a horror movie I described earlier. An esophageal varices, which is a direct result of hepatic portal hypertension, blood vessels is the lower esophagus burst. If the vessels are large enough, we can rapidly lose blood. People have been known to vomit up to 1 liter of blood at a time, which is approximately 15% of the bodies total blood volume. If something isn’t done to stop the broken vessel from bleeding, death can occur within a matter of minutes.

Unfortunately, there is no cure for hepatic portal hypertension. Most of the treatments revolve around managing the effects that it has on your body. The best treatment is to prevent yourself from getting it in the first place. Prevention means taking good care of your liver, which means making healthy lifestyle choices. Eat healthy, exercise, don’t smoke, don’t do drugs, and most importantly, avoid excessive alcohol consumption. There’s no guarantee that you can completely avoid hepatic portal hypertension, but healthy lifestyle choices will certainly increase your odds of prevention.

References Cited

"What Is Portal Hypertension?" WebMd.com. Ed. Malinda Ratini. N.p., 16 Dec. 2014. Web. <http://www.webmd.com/digestive-disorders/digestive-diseases-portal>.

Herrine, Steven K., MD. "Portal Hypertension - Liver and Gallbladder Disorders." Merck Manuals Consumer Version. N.p., July 2014. Web. <https://www.merckmanuals.com/home/liver-and-gallbladder-disorders/manifestations-of-liver-disease/portal-hypertension>.

Bosch, Jaume, MD, Pilar Pizcueta, PhD, Faust Feu, MD, Mercedes Frernandez, PhD, and Juan C. Garcia-Pagan, MD. "Pathophysiology of Portal Hypertension." Gastroenterolgy Clinics of North America (1992): n. pag. Researchgate.net. Web. <https://www.researchgate.net/profile/Mercedes_Fernandez2/publication/21586497_Pathophysiology_of_portal_hypertension/links/553e31480cf20184050ddc8b.pdf>.

"Liver and Intrahepatic Bile Ducts-nontumor - Ascites." Pathologyoutlines.com. Ed. Komal Arora. N.p., Oct. 2014. Web. <http://www.pathologyoutlines.com/topic/liverascites.html>.