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.
In the US, they are graded on a scale of 1 to 4. (Esophageal 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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Hi Clint,
I am 52 years old and have just had the TIPS procedure due to cirrhosis of the liver leading to scarring and ascites. This is due to hard living when l was younger so it was self-inflicted and all my own doing.
What l’d like to know is if l can get a low salt diet on the net, l go to the Alfred Hospital in Melbourne, Australia which is excellent apart from the fact l can’t seem to get a diet that is ideal for me or a list of low salt foods that are the best for me. l spend a lot of time at the supermarket reading sodium quantities in food l buy but don’t fully understand what l should be eating.
l need a list of foods that are the best for me. l know processed foods are bad but sometimes there is no other choice.
sincerely, Dave Dawson
Hi Dave,
Thanks for your inquiry. Sorry to hear of your health situation. Sounds like you had a successful TIPS operation, and if you have a chance I would not mind hearing how long ago this took place and what kind of stabilizing meds you are on right now.
As far as a low sodium diet is concerned I have asked this question more than a few times in the last 10 years to see what may helpful to the specifics of portal hypertension. The last time I asked was at the beginning of this month (Jan. 2012) and was told exactly that there was nothing specific, because of the rarity of our condition. My problem with Portal Hypertension is all the related bowel issues due to the arteries in the lower part of the bowel being engorged with blood from the portal and spleenic vein clots. There are certain foods I abstain from, but as yet I have not been able to pinpoint what sets me off and causes severe pain at times. All being said, I know you have educated yourself in foods with low salt and at this point that is a good start until someone comes up with something specific to the condition. To help you and others who may be reading this I have done “some” research that may elighten you further (see links below). Before I do that though I want to point out that the DASH diet below is something that I have heard may be helpful to anyone (especially those with hypertension) who need to be on a low sodium diet.
http://heartfunction.ktp.utoronto.ca/modules/UHNsalt.pdf (More simple guidelines for what to eat)
http://dashdiet.org/ (The DASH diet)
http://www.ehow.com/how_5045419_create-low-sodium-diet-plan.html (Creating a low sodium diet plan)
Keep fighting,
Clint
Clint
I have been diagnosis with portal vein hypertension over 30 years ago and recently learned it was caused by thrombosis. I do not qualifiy for a liver transplant because my liver and liver function tests are fine. However, I have had 2 bandings and numerous bleeding episodes since first being diagnosis. I am currently on proponol and also take lasix for the ascetis. My hepatologist informed me that if the bleeding starts is just to keep having the bandings. I should explain that the bleeds are massive requiring 2-4 units of blood being transfused. Is there any other procedures are surgeries that you can suggest to help stop the bleeds? The bleeds are becomming more frequent at least 1time a year.
Hi Rachel,
Thanks for your post. I am truly sorry to hear of your bleeding episodes and my heart goes out to you. The Rex Shunt and a few other shunt procedures seem to be successful for children in particular as atrophy of the veins is an issue when one gets older. I had heard that over the age of 5 it is harder for doctors to do the Rex Shunt procedure, but one has to be the ideal candidate before consideration is made in all cases and if there are other complications of course this would play into the process. Now there is a procedure called the Sugiura procedure which was developed by the University of Tokyo and has showed some success to date. See: http://www.ncbi.nlm.nih.gov/pubmed/8042326 I have been meaning to write an article on this for my blog, but can’t seem to get information that is understandable for me to digest and re-write for the benefit of anyone needing a layperson’s view of it. The procedure was talked about in my case, and I would have easily forwarded my imaging to the doctor in Chicago who I believe has attempted a few of these, however my condition is considered to precarious to tamper with as I have to be so highly anti-coagulated for fear of further clotting. In your case it may be different so I am going to suggest that you contact Dr. Riccardo Superina at The Childrens Memorial Hospital in Chicago so maybe he will consider your case or refer you to another hospital/doctor who could at least review your situation and go from there. I would also suggest to contact Dr. Jean Emond at New York Presbyterian Hospital as I have been told by others that he is a good surgeon and may have some ideas for you? See contact information posted below. Please keep me informed if you hear of anything – hopefully this helps? Thanks again for your post! Regards, Clint
Dr.Riccardo Superina
2300 Children’s Plaza
(707 W. Fullerton Ave.)
Chicago, IL 60614-3363
Call 1.800.543.7362 (1.800.KIDS DOC)
Phone 773.880.4000
Dr. Jean Emond
NewYork-Presbyterian Hospital/Columbia
PH Room 14C
622 West 168th St
New York, NY 10032
Phone 212.305.9691
Clint
I’m very thankful you had a site like this.It helps me a lot better understand the health condition of one of our inmates.Unfortunately here in the Philippines from Brooke’s Point Palawan we do not have such kind of medical management like Rex Shunt.All I can do to help him is prayers.
liza
Jail nurse
Thank you Liza for your kind comments. I am only too happy to offer dome people some understanding and prayer for their condition.
Clint
My 15 year old son had islet cell transplant 2 1/2 years ago. In the past 10 months he has had 3 bleeds. He has esophageal varices and portal vein hypertension. We have been referred to Dr. Edmond for bypass. It was also mentioned we might want to visit Dr. Superina. Does anyone have any opinions or suggestions they would share with regard to these two doctors or their respective hospitals?
Hi Brenda,
Thanks for your comments. So sorry to hear of your son’s bleeding episodes – I can only imagine how scary that is for you and him and I pray that an answer will be found for him in short order!
I am familiar with Islet cell transplant as it was developed by a doctor (Dr. James Shapiro) here in my hometown of Edmonton, Canada. The same doctor previewed my case along with 4 other doctors for a rare multi organ transplant they were considering for me, but in the end decided it would compromise my life too much as I am doing relatively fine – but enough about me!
I can tell you that both doctors you mentioned above are very good and come with high recommendations. Dr. Superina is talked about quite a bit on my blog, and also a Facebook page called Portal Vein Thrombosis and Portal Hypertension in Adults and Children. Dr. Superina has performed over 130 successful Rex Shunt procedures on Children over the past 10 years and is very well thought of in the Portal Hypertension community – especially by the parents of these same kids. Dr.Emond, although is mentioned on this blog is also highly regarded in his field and I have heard from a few people that he is very compassionate to his patients and their families. There is a doctor in Russia, I think a few in the UK from what I know, and one in Mexico that has also performed the Rex Shunt procedure – so the technique is not limited to just the US.
Hope this is helpful? Please let me know if you would like to talk to another parent whose child has had been a patient of Dr. Superina’s or if you have any further questions. I will do my best to try to help direct you, but at the very least I will pray!
Thank you for the info. I appreciate the prayers. That is what has gotten him this far.
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Hello Clint,
Firstly I hope that you are well.
You may remember I wrote on here a while ago regarding my 15 year old son and portal hypertension due to liver damage from chemotherapy. He has had it now for 7 years. Today he has had an endoscopy, it was due last month but he had a chest infection. Their findings during the procedure this time were large gastric varices. I was sad to learn that there is not much treatment for these unless they actually bleed, am I right? He has a massive spleen, there was talk of him having it removed or splenic embolization, the Doctors have left this up to us his parents. they said this though before they found these veins. He could have a liver transplant at some stage but at the moment his liver function is still good despite the damage. We would not get a liver under these circumstances. I feel they think that at the moment his quality of life is ok, to start interfering may mess this up. It just feels like I am waiting for something bad to happen, I know I should have more faith, I do pray but I am just so worried. I now feel that knowing he has these veins, should he go to school everyday, what if a massive bleed happens there… The list could be endless of what if’s! Do you have any up to date information regarding the gastric varices that could help me for when I next see consultant. I like to go with some knowledge. I know if they found upper ones that beta blockers are effective in helping them not to bleed, but not stomach ones? Your reply would be much appreciated.
Hi Karen,
I certainly do remember you and the story of your son. Who could blame you for being worried – it is most natural and when it comes to your own child the intensity of anxiety would be high. We are human and sometimes even with a strong faith we can waiver from that when it comes to our kids.
On the subject of gastric varices you are right in saying that there is not much they can do for them, however beta blockers is still the standard preventative measure in this case. If it is any consolation to you, I had a bleed from the varices in my stomach back in 2004, and although I came close to be transfused, they stopped bleeding and it never came to that point. As far as varices being banded in the stomach I have never heard of this, and they only would do this for the esophogas. Like you son, my spleen is very enlarged also, and my liver function is good too. Shortly after doctors discovered my portal vein as being clotted, my gastroenterologist at that time ordered a follow up scope, and after that suggested removing my spleen. Fortunately we called the hematologist who I had seen initially and he said to me, “no one is touching your spleen”. At the point I switched over to another hospital and was referred to a gastroenterologist who agreed that removing my spleen was not in my best interests. A person can live without their spleen, however your immune system can be compromised without it, as I suppose it is anyways. If I were you I would get a second opinion if you can on this, and definitely do not take my word for it, as it may be better for your son not to have his spleen because of other complications I know nothing about. I know of a few people who really suffer with pain, and one person relates it as being spleen pain. You also mentioned that your son’s quality of life is good right now, and that is the same for me, so why compromise this by messing things up? About 5 years ago, under the suggestion of my current gastroenterolist she had a transplant team review my case for a multi organ transplant, which would have been an extremely rare operation. The complications of that would have been very serious, and if that would have not been an option then they were considering a shunting procedure – of which both were denied due to my current quality of life.
As I do for most people I encounter on this blog, I will continue to pray for your son and you as you consider what to do in the future. I suspect the treatment protocols between your country and ours are very much the same, but on the subject of the spleen – this is something that I would be questioning given what I had experienced in the past. Fortunately my gastroenterolist has had specilized training in portal hypertension in both Barcelona, Spain and also Yale Medical School in New Haven, CT so she is able to advise me well.
I hope this helps? May God hold your son and your family in the palm of His hands. From my childhood I learned scriptures at an early age, and although I fell away from God in my youth, today it is different as I know He has sustained me and many others in their journey with this most disconcerting condition. Take comfort from this if you can … “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus”. Phillipians 4:6, 7