What's the treatment for portal hypertension?
Treatment is directed at the cause of portal hypertension. Gastroesophageal variceal hemorrhage is the most dramatic and lethal complication of portal hypertension; therefore, most of the following discussion focuses on the treatment of variceal
hemorrhage. Medical care includes emergent treatment, primary prophylaxis, and elective treatment.
To reduce the risk of bleeding from esophageal varices, a doctor may try to reduce the pressure in the portal vein. One way is to give propranolol. Bleeding from esophageal varices is a medical emergency. Drugs such as vasopressin or octreotide may be given intravenously to constrict the bleeding veins, and blood transfusions are given to replace lost blood. An endoscopic examination is usually done to confirm that the bleeding is from varices. The veins can then be blocked off with rubber bands or with injections of a chemical given through the endoscope.
Portal hypertension can be accompanied by good liver function with good production of all necessary proteins. In such instances liver transplantation is not indicated. For long-term management an operation called portal vein shunting can be considered. During this operation the surgical connection between the portal vein or its branches and the vena cava (low-pressure vein caring blood from lower extremities and kidneys to the heart) or its branches is created. This allows blood from the portal vein to be redirected into the vena cava resolving the portal hypertension. This operation can be performed in selected patients with excellent long-term results. |
