What Exactly is Portal Hypertension?

Portal hypertension is an increase in pressure within the portal vein.  The portal vein is the main vein that extends from the digestive organ to the liver.

The increased pressure is caused by a blockage (clot)  in the blood flow from the digestive organs to the liver.

The increased pressure in the portal vein causes large veins (varices) to develop across the esophagus and stomach to bypass the blockage. The varices become very fragile and can bleed easily.

If the varices are discovered through a gastroscopy they are usually graded on a scale of 1 to 3, with 3 being the most dangerous to bleed.

Portal HypertensionIn the US, they are graded on a scale of 1 to 4. (Esophogeal varices will be discussed in greater detail on another article).

In my particular case,  portal hypertension was caused by thrombosis or clotting of the portal vein due to an apparently unknown genetic defect, which was thought to be some kind of protein deficiency.

This cause often termed non-cirrhotic is not the most common cause of this condition, as is cirrhosis of the liver.

Cirrhosis results from the healing of a liver injury caused by hepatitis, alcohol abuse, or other causes of liver damage.

In cirrhosis, the scar tissue blocks the flow of blood through the liver and will slow it’s processing function.

Read more about my own personal Portal Hypertension Journey.

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Born without a Portal Vein!
March 26, 2012 at 1:10 am

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Clint August 13, 2013 at 11:39 pm

Mbm,

Thanks for your post. Sorry to hear of your fiancées complications! You have come to the right place (I say this humbly), as PH is a distressing condition, and I and the few others I have met along the way have great empathy for what he and you are facing right now.

Please bear with me as I bring you some background in order to hopefully ease your mind …

I have all the same clots which are common to most sufferers, although I have had only one bleed from the upper part of the varices in my stomach, way back in late 2004, in which I came close to being transfused but thankfully the bleeding stopped. I am classified in the less common bracket of non-cirrhotic portal hypertension with an unknown genetic cause. Not comforting but only relaying the realities of this condition to you, that bleeding from the esophagus is the most dangerous side effect to deal with. I am no longer on Coumadin as it does not work on me, however I am on Fragmin injections (heparin) which I have taken now for since 2004, and the dose was increased in early 2005 to 2 injections from one. All being said, the most common treatment worldwide for this condition is to lower the heart rate by using Nadolol (beta blockers) to keep the pressure down in the varices that have formed due to the blood clots in the portal vein that normally affect the spleen and the mesenteric vein. If you find the time I would encourage you to read the various posts on this blog, and with that are some personal stories from others as related to me, and of course many comments.

On Coumadin a person should be monitored to some degree, but I have found for the most part that people, whether they take this thinner for PH or other clotting conditions, come to a point where they would adjust the dosage according to the I/R levels indicated. Be insistent with your doctor that you want to monitor this condition closely and if not that you learn how to adjust according to the blood results. I remember when I was first diagnosed I was initially put on Coumadin and was on it for over 2 years and with that I saw my doctor on a more regular basis, so he would adjust it accordingly. I started with blood work every week, then moved to every 2 weeks until I was placed on Fragmin, in which my levels no longer have to be monitored. There are newer oral meds with less of a history than Coumadin, and you may want to ask you doctor about those also. Whether or not they would work for you your fiancée is the big question, and at this point they may just want to play it safe with him given what he has just been through.

I asked my gastroenterologist just yesterday as it was my annual check-up with her, if there was any new information on the condition, and she unfortunately said no. Most of the research on portal hypertension comes out of the University of Barcelonia in Spain, and she herself spent a half a year there 2 years ago studying the condition, so I feel that I have first hand information in that respect. She has not provided me with all the information on this blog, but much has come through my own research and that of others who have provided me with articles, and stories of their own personal journey’s.

There is so much more I can say, and I want to be careful as to what I say due to the fact that you are still learning about this. It is great to have a support system around you especially at a time like this and I also want to say to you that because I am a person of faith, I will pray for your fiancée, yourself, and your family as you deal with this. Again I encourage you to research the information provided here – most of the main points have been covered, however it is a work in progress as I try to keep up with any new findings. I asked my gastroenterologist just yesterday as it was my annual check-up with her, if there was any new information on the condition, and she unfortunately said no. Each one of us are different for sure, but I have lived 11 years beyond my original diagnosis, and I attribute this to the doctors who have really gone to bat for me, the meds, and for my family and friends who have supported me with their prayers and love along the way. The most important medications to be is the blood thinner and a beta blocker to keep the pressure down. I do not live my life in fear, but have felt times of despair as that is a normal human reaction, however I do live a relatively normal life. Hope this helps?

Thoughts and prayers,

Clint

mbm August 14, 2013 at 6:52 am

Thank you so much for your reply, it really means a lot to me. Especially your thoughts and prayers, because it seems like at first, everyone (the doctors) were so concerned about this serious medical issue, now all of a sudden, nothing. I will definitely be reading through everything here, I’m so grateful to have found this site. Thank you for this, and everyone else too, who shares their experiences. Thoughts and prayers to you, and everyone else dealing with this.

kevin October 6, 2013 at 10:22 am

i suffer from ideopathic portal hpertension now since 1989 and have had several life threating bleeds but was fortunate to have had a mesocaval shunt preformed on me back in 1992 at the royal free hospital in london and hope i don’t need any thing else done

Clint October 6, 2013 at 10:10 pm

Thanks Kevin … wow what a journey you have had! Although you have had a rough time, it is encouraging that there are procedures like the mesocaval shunt which can extend one’s life!

May you enjoy many more years of great health! Best, Clint

Audra October 31, 2013 at 10:03 am

Hello,
A quick update on my condition. Further to my chronic anemia problem. After taking double doses of iron supplements (feramax) my hemoglobin and ferritin levels continued to drop. At the end of June my hemoglobin was 73 and ferritin was 3 so I was referred back to the haematologist. I saw the haematologist at the end of August. My hemoglobin and ferritin levels continued to drop so he arranged a blood transfusion as a quick fix first because I was to go on a 2 week
trip back east. I have had 5 iron infusions as well and am waiting to see the hemo again in mid November. He also referred me for another colonoscopy to check for small bleeds. The hemo suspects slow blood loss in the digestive tract. Clint, I see that you get iron infusions 4 times a year (in your management section). Is this because you have slow blood loss, can’t absorb iron or some other reason. I am debating on whether it is worth asking to be referred to a gastroenterlogist if nothing conclusive is found. Because I live in a small town in British Columbia, I would have to travel to Kelowna to see a gastro specialist. I know the iron infusions are working because I no longer chew or crave ice and my energy level is much better.

I hope you are as well as you can be and thank you again for this wonderful website.
Audra

Clint November 1, 2013 at 1:06 am

Hello Audra,

Its good to hear from you again. You are one of the veteran’s on my blog and I thank you for your contributions in the past. Sorry to hear your ferritin/hemoglobin levels are dropping and your subsequent transfusion. You asked whether or not you should see a gastroenterologist and I would highly recommend it! Portal hypertension falls under gastroenterology and to gain a better understanding of your symptoms and treatment you need to see a specialist of this nature as they will enlighten you more on the subject. Under emergency situations a gastroenterologist is the go to person for people such as us. The interconnection with the esophagus, liver, and spleen fall under the area of gastroenterology, and these specialists have a better handle on this as compared to hematologists who focus on the veins and arteries. When I had a bleed in 2004, I was bleeding from the varices in the upper part of my stomach – near the esophagus. In my case I do bleed slowly in my stomach (from the pressure) and my hematologist likes to keep my platelets on the higher side, therefore I have the infusions albeit less often (3 times per year instead of 4). That is interesting that you craved ice … do you know if that is common?

Keep me posted … I trust all will be better for you soon as goodness knows you have had quite the journey also!

Clint

Audra November 2, 2013 at 9:32 am

Hello again,
Thank you for the advise. I will ask to be referred to a gastroenterologist if nothing comes of the scopes and tests I am already scheduled to have.

The craving and chewing of ice comes under the umbrella of a condition called “PICA”. Pica is the craving and eating of non-nutritional substances such as paper, clay, dirt etc. Specifically, the chewing of ice is associated with iron deficiency anemia and is called pagophagia. I am continually amazed at what I have learned about the human body since my diagnosis 5 years ago.

Take Care and I will keep you posted on any new developments.
Audra

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