In the blood flow system, one of the largest vessels is the portal vein. With increasing hydrostatic pressure, portal hypertension develops in it. This condition is not considered an independent disease, as it occurs against the background of other pathologies associated with blood circulation disorders of different localization and origin.
Classification of portal hypertension syndrome
There are 4 main forms of the ailment in question:
- prehepatic;
- intrahepatic;
- superhepatic;
- mixed.
Prehepatic or subhepatic portal hypertension is considered the most difficult for disease therapy, as it develops as a result of congenital anomalies of the portal vein.
Intrahepatic type of syndrome in 95% of cases is associated with a severe stage of cirrhosis of the liver or is its complication. Less common pathology occurs due to sclerotic processes in the parenchyma and internal tissue of the organ.
Superhepatic or extrahepatic portal hypertension is caused by a complicated outflow of biological fluids from the veins of the liver. This may be due to increased blood viscosity, the presence of cholesterol plaques, endocrine and hepatological diseases.
Mixed form of hypertension is a consequence of chronic portal vein thrombosis in severe liver cirrhosis.
As can be seen, the main causes of the development of pathology are circulatory disorders, hepatological diseases, compression of the portal vein, tumors and cysts of the liver. Also provoking factors can act autoimmune, endocrine, vascular diseases.
Symptoms of portal hypertension
The clinic of the syndrome described includes the following complaints:
- bloating, an increase in its size;
- feeling of squeezing in the right hypochondrium, severity;
- sometimes - a chair very dark, almost black;
- encephalopathy;
- absent-mindedness, forgetfulness;
- drowsiness, constant fatigue;
- icterus of the skin;
- ascites ;
- pain in the epigastric region;
- nausea and vomiting;
- shortness of breath, swelling;
- esophageal-gastric bleeding;
- loss of appetite;
- apathy.
In many respects, the symptoms are similar to manifestations of hepatitis, but develop much faster and more intensively.
Signs of portal hypertension on ultrasound
During ultrasound examination, it is found:
- an increase in the size of the liver and spleen;
- presence of clearly visible blood clots in the blood vessels;
- expansion of the lumens of the splenic and portal veins.
In addition, for accurate diagnosis of hypertension you will need to perform laboratory tests:
- blood (general, biochemical );
- urine and feces.
Also used X-ray, rheogepatografiya, splenomanometry, liver scanning, splenoportografiya, soft tissue biopsy.
Treatment of portal hypertension
The initial stages of pathology assume conservative therapy through vasoactive drugs, in particular - Vasopressin or its analogues.
In the presence of bleeding or complications, compression of the vein with a Sengshtaken-Blackmore probe or sclerotherapy is used for 2-3 days.
If conservative treatment methods do not have efficacy, an operation is prescribed. Depending on the purposes of surgical intervention, the following types are distinguished:
- Removal of ascites from the abdominal cavity.
- Creating new ways to remove blood.
- Improvement of hepatic blood flow and regenerative processes in the organ.
- Reduction of the flow of biological fluid into the portal vein.
- Exclusion of the connection between the veins of the stomach and esophagus.