Portal Hypertension … Ascites and Splenomegaly

by Clint on March 15, 2011

There are several complications of Portal Hypertension(PH), including one of the most precarious side effects called Esophageal Varices (covered in a previous post), and of lesser degrees are the conditions of  ascites, and splenomegaly.  

Ascites takes place when excess fluid accumulates between the lining of the abdomen and abdominal organs.  This area is referred to as the  peritoneal cavity.

Low albumin levels in the blood as associated with portal hypertension is also a contributing factor.  Albumin is a protein made by the liver and is measured in the clear liquid portion of the blood by a special blood test.

Beyond portal hypertension there are other causes of ascites and they are cirrhosis, congestive heart failure, hepatitis, and cancers such as pancreatic, ovarian, or liver.  Kidney dialysis can also cause ascites.

Upon examination the obvious signs of ascites are a swollen belly (abdomen).  At that point evaluation tests on the liver may be performed which include urinalysis, and kidney function testing.

Common treatment includes diuretics (water pills), limiting salt in the diet, antibiotics (if infection is present), not to mention the avoidance of alcohol.  If the patient does not respond to the common treatments, then the placement of a tube in the abdomen may be used to drain large amounts of fluid from the area.  Lastly a transjugular intrahepatic portosystemic shunt (TIPS) is a radiology technique that reduces portal pressure and may be the most effective treatment for patients with ascites that are resistant to diuretics. The procedure is performed with the patient under conscious sedation or general anaesthesia.  A radiologist places a stint through the skin from the right jugular vein into the hepatic vein.  A connection is made between the portal and systemic circulations.   This treatment from what I have been reading seems to be the norm in the treatment of ascites for patients resistant to diuretics.

Now on to the topic of splenomegaly or simply put an enlarged spleen.     The spleen is an organ that is part of the lymph system.  The spleen’s role is to filter blood and to maintain healthy red and white blood cells and platelets.  To clarify, your spleen acts like a spongy filter for your blood. As blood circulates through your body, some of the cells (in the form of platelets and red blood cells) get damaged or worn down.  The function of the spleen is to remove these damaged cells from circulation. The spleen also acts as a storage location for extra red blood cells and platelets newly formed by your bone marrow.  There are several other causes to splenomegaly which include diseases of the blood, liver, cancers, and infections but in the case of PH sufferers the cause is clotting to the portal and splenic veins.

From a personal standpoint I have been fortunate enough to not have any pain as related to the enlargement of my spleen, however the possibility does exist from what I have read and been told.  When first diagnosed with portal vein thrombosis(PVT), the first gastroenterologist I had wanted to remove my spleen (splenectomy).  Being only a few months since the discovery of PVT in 2002, I felt uneasy about a possible splenectomy so I consulted with my haematologist who practised at another city hospital.  His exact words at that time were, “anyone can remove your spleen, but ‘he’ is not touching it – come and see me”!  Looking back I realize this was a good decision, and it may have saved me from added or more serious complications.  All being stated, a person can live without their spleen, but from what I have learned recently is that the spleen is very helpful in maintaining one’s immune system especially when the liver and artery function is compromised by a clot.   Without the spleen a person’s vulnerability to infection does increase, so it is important to get regular vaccinations to prevent bacteria such as influenza and pneumonia from taking its toll on one’s health.  I might also add that even though a person still has their spleen, but has portal hypertension, it is important to be inoculated against influenza and pneumonia as either can cause varices (if present) to rupture and bleed with serious consequences.  Like seniors and small children, our immune systems are compromised and health care professionals consider PH sufferers as being “high risk”.

Lastly I want to say that if you or a person you know is experiencing symptoms such as mentioned above, you are more than welcome to comment or post your questions below.  There is so much more one can learn, and each of us has a story… maybe you can shed some light on the subject for the benefit of someone else?

Until next time,

Clint

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{ 9 comments… read them below or add one }

barbara decristofaro December 9, 2012 at 1:20 pm

Hi Clint or anybody who can help me,

I have portal hypertension also but the doctors don’t seem to know what’s causing it. All the common causes have been ruled out.
Orginally I was diagnosed with cirrohsis and that was 6yrs. ago and just about a year ago they finally did a biopsy and other tests and ruled that out!

So now it’s PH that’s causing my ascities and I can’t find anything on the internet about other causes or any further testing or treatment. I am on high blood meds and diuretics but still need a paracetisis every 2 mon.

So, what I need is a good website with more info or if you can provide any I’d appreciate it.

I asked my gastro about TIPS and was told not in my case cause I don’t have cirrohsis or a blockage. Do you know if that’s true cause it sounds like it could help me. I was seeing a hepatologist, he’s one who diagnosed my PH but my insurance no longer covers him so I was told to find another one but he has to be good cause further testing if there is any could be very risky and that scares me.

Waiting to hear from you.

Barb

Reply

Clint December 13, 2012 at 1:01 am

Hi Barbara,

Thank you for your post. I am sorry to hear about your condition, but happy you have found this site as hopefully you can glean further information from the information I have posted and also from others who have responded.

To my knowledge there are lots of pages on the internet with information regarding Portal Hypertension (PH), however none that I know of that is written from a personal perspective except for this one. One of the reasons I started this blog was to reach out to others with the same condition, plus provide a more comprehensive resource for fellow sufferers.

By what you have stated, it sounds to me like you have non-cirrhotic PH like I do, but you need to verify that with your doctor first. In my case, they have been unable to detect an actual genetic cause after every known one has been ruled out. I am highly susceptible to clotting anywhere, so any kind of operation or procedure has been ruled out for that reason, plus the fact that I have to be so highly anti-coagulated to prevent clotting. Maybe in your case this could be true also?

You are fortunate that you do not have cirrhosis on top of PH, as cirrhosis can cause PH to begin with. It is complicated enough having PH without the added concern of cirrhosis. Ascites is definitely related to PH, and I know of people who have dealt with this in the past, but are now doing better overall. The meds you are on, and assuming they are in the Nadolol family, are commonly used to keep your blood pressure down in order to prevent a bleed – especially from the varices that commonly form in the esophogas due to the portal vein being clotted. I am on 160mg per day, and thankfully I have not had a bleed from the varices there, however I had a bleed from the varices in the upper part of my stomach back in 2004.

If you subscribe to Facebook – there is a good site that I and many of the people who have written on this blog are members of. The site is called Portal Vein Thrombosis and Portal Hypertension in Children and Adults. Here is the link: https://www.facebook.com/groups/4496581222/

I completely understand how you feel about PH, and let me encourage by saying that you are not alone in your journey. On the Facebook site above you will find many parents whose children have PH, and also you will find other adults on the site who are dealing with the same condition. I know it will be helpful for you to join the FB site, but also to read what you can on this site as there are lots of people who have shared their individual journeys with PH. I pray you will get a better understand of your own condition and also that you will find a good specialist to look after you. Thanks again for your message. Please let me know if there is any other way I can help you? Sincerely – with prayer, Clint

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Elizabeth March 20, 2013 at 10:29 am

My husband has PVT. It is totally blocked and has been for a year since he got ill. Because of the clot he had 3 feet of his intestine removed and obviously some liver damage that has not yet righted itself. However, the liver function blood tests are ok. The reason for his PVT is because they found he had a bone marrow disorder, Myleoproliferative Neoplasm, which means his blood is sticky, hence clot formation. (he is on long term Warfarin for this) My worry now is that although collaterals have formed (and he only has stage one varicies) his ascites is building up. He has always had some since this happened that has made his tummy a little more rounded, but it seems to be getting a little worse and they have put him on another diuretic. He feels full and bloaty and vomits. Another scan next week and back to the specialist. The awful thing about all this is that his underlying condition is a blood disorder which whilst dangerous on its own, is manageable, the things that are the most life threatening are the symptoms of that condition ie PVT, ascites etc. Its all so rare and complicated and I have found this site so useful, thank you, Clint.

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Clint March 21, 2013 at 2:37 am

Elizabeth,

Thank you for sharing your husband’s story. I am sorry to learn of yet another person suffering from this most disconcerting disease!

One never knows who may benefit from your comments, and that being said I am no exception. I am especially intrigued by the underlying clotting condition (myleoproliferative neoplasm), as I also have sticky blood, but no known genetic cause as to the reason for this.

I am thankful he is able to at least manage and his liver function is good, but the ascites is not a great side effect, neither are esophageal varices if they develop. Besides hosting this blog, about the only other thing I can provide is encouragement and prayer of which I do for everyone who has shared stories on here. Maybe someday they will be able to better manage the side effects, or come up with a cure, but until we just have to carry on in faith that things will improve over time.

If you have any updates please feel free to share them on this blog anytime.

With kind regards and best wishes, Clint

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annette August 10, 2014 at 12:24 pm

Hi Clint just came across this site by sheer accident, so sorry to hear of your story, and everyone’s else’s , I was diagnosed in late November 2012 with well established cirrohiss of liver, I did feel very well, then ggastroenterolgist wanted me to have endoscopy to make sure no varices were there, had first endoscopy on Jan 24. 2013 Dr who performed it said no varices but had 2 lesions which he took 2 biopsys of, then exactly one month apart on Feb 24. 2013 went to bed knew nothing woke up 2 days later in intensive care, vomited 4 pints blood and had 5 varices banded, my life has changed dramatically, enlarged liver and spleen low platelets due to cirrohiss, I have regular endoscopys am on propranolol, had APC treatment very large vein in stomach can’t be touched I’m told, basically I am getting over the fear of the bleed although petrified of another one, as had the bleed in bed and knew nothing, my husband heard me chocking, so I was lucky, my only other concern is Ascites I honestly don’t want to get that, I may be living on another planet but that is my real concern, I don’t know how I would deal with that as well, I will always wonder about my first endoscopy though and the biopsys, even my heptologist was surprised, all drs were but they won’t commit to anything, just saying liver was not in the state it should have been in to have such a massive bleed, still still alive and I thank god for that, so sorry for going on a lot, nice to communicate with people who understand. Prayers also going out to you all. Annette

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Clint August 11, 2014 at 1:30 am

Hi Annette, Thank you for posting on my blog. I am glad you have found my site and now am connected to it. Sorry to hear of what has happened to you. It can be most disconcerting with what you have been through, and my heart and prayers go out to you. I want to encourage you by saying that the way doctors are treating you (ie. propranolol) is standard the world over, and that the key is to keep pressure down for the varicises in order to stave off further bleeding. So far there are shunting procedures that have proven to work, but are limited to younger children with no other complications. Shunting is rare for adults because of atrophy which tends to happen more in adults vs. children. The portal vein is a prime candidate for atrophy and I can only surmise because of the location. It is not that accessible.

Are you on blood thinners? What other medications are you on? What was the cause of your cirrhosis? These are a few questions I wondered about after reading your post.

There is another great resource for you if you are on Facebook. The page is called Portal Hypertension and Portal Vein Thrombosis in Children and Adults. The page was created by a Mom in Vancouver Canada about 3 years ago. I am a regular contributor and most people on this site have referenced mine in some form or another. Y
If you have any further questions or comments – they are most welcome. Take care, and God Bless, Prayerfully, Clint

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annette August 17, 2014 at 4:30 am

Hi Clint thanks you so much for your reply ,cirrohiss was caused by alcohol unfortunately, I wasn’t a massive drinker, binge drinker more likely, well I am suffering for it now, the only medications I am on are Propranolol, Lansomprozole for gastritas, and acid reflux, also have small hiatus hernia, all this found out on my first and second scope, oh yes iron tabs in case get another bleed, I have been told will have to be on them indefinitely, and thanks will look for that site on facebook, have been to see my heptologist since my last E-Mail and he said results of last scan was good, and blood work also good, the only thing he said, when I kept asking about the biopsys I had done at hospital in kent where I live, he said I must contact that hospital about it, then he asked did I ever get a photo of my Esophagus when first scope was done I said no, so he showed me one, and he said it was normal, and he really stared at me, that doctor from liver unit and my gastroenterolgist I feel are really trying to tell me something without coming right out with it, I don’t know what I should do next, I do know that endoscopist who performed first endoscopy would not look at me, when I was admitted last may 2013 due to internal bleed, did not know that was occurring either, just went in wwith severe abdominal pain, so I reallynget this uneasy feeling that’s my feelings, good luck with your problems hope you are feeling well, prayers for you and everyone else who suffers. Annette

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Robert Rabbitt August 15, 2016 at 3:30 pm

just been diagnosed with portal hypertension . doctor said cirrhosis. however I went to a homeopathic doctor and she disputes the findings of the doctor ant the ct scan. she says you have liver stone because cirrhosis goes to the right side of the liver. I have swelling on the left. she put me on a computer to follow my blood flow. what she says the blood flow is adequate but its being slowed from the liver because of the stones. is it possible. I have no symptoms of cirrhosis exept weight loss

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Clint August 15, 2016 at 4:11 pm

Hi Roger, If like you say you have been diagnosed with portal hypertension, I would put more faith in medical doctors than in any homeopathic doctor by far in treating the condition. Whether or not you have cirrhosis can still mean you have portal hypertension, and that should never be taken lightly. To actual dispute a CT scan and medical findings is really going out on a limb, and I would caution you to be careful. I would get a second opinion if you are unsure. I went to a homeopathic doctor a few years after my diagnosis and after what I thought to be a questionable test on all my medications, he put me on black cherry juice. He only told me that I should not take Vitamin C of all things. I ran into more people who had seen this very same homeopathic doctor, and was it coincidence that they too were sent to the health food store to purchase black cherry juice for their ailments? There is more science for portal hypertension and dare I say cirrhosis that what one of these doctors may tell you. Cirrhosis of the liver definitely is a larger cause for portal hypertension, but as in my case I have non-cirrhotic portal hypertension which is a much rarer cause. So all being said, again I would get a second opinion if you can and go from there. Keep me posted, Clint

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