Cirrhosis and Portal Hypertension

In people who have cirrhosis, the cells of the liver are damaged and can’t repair themselves. As liver cells die, scar tissue forms. When this scar tissue builds up, blood can’t flow through the liver properly.

Normally, poisons and wastes in the blood get filtered (cleaned) out when blood passes through the liver. If scar tissue keeps blood from flowing normally through the liver, the blood doesn’t get filtered. Poisons and wastes can build up in the body. This can cause symptoms such as mental confusion, agitation or tremors (shaking). In serious cases it can even lead to coma and death.

Cirrhosis is sometimes caused by hepatitis (an infection of the liver), or by eating or drinking harmful chemicals. The most common cause of cirrhosis is drinking too much alcohol. This is called alcoholic cirrhosis.

Women who drink too much alcohol may be at greater risk of developing alcoholic cirrhosis than men who drink too much. If you drink alcohol, you need to tell your family doctor so he or she can check for signs of cirrhosis, especially if you have any of the symptoms listed below.

Your doctor will ask if you have any of the following symptoms of cirrhosis:

If you have some or all of these symptoms and you are a regular or binge alcohol drinker (if you drink lots of alcohol at one time), you may have cirrhosis.

Your doctor will examine you and may order tests to see how your liver is working. Your doctor may also arrange for a biopsy of your liver. In a biopsy, a very thin needle is put into your liver to take out a small bit of tissue for testing. Your doctor may use Doppler ultrasound (sound waves used to make a picture) to look at your liver.

Normally, blood is carried to the liver by a major blood vessel called the portal vein. If blood can’t flow easily through the liver because of cirrhosis, the blood gets slowed down in this vein and the pressure inside the vein increases. This higher blood pressure in the portal vein is called portal hypertension.

If blood can’t flow normally through the portal vein, it must return to the heart using other blood vessels. These vessels become swollen because of the increased amount of blood flowing through them. They are called varices. Varices have thin walls and can easily break open because they aren’t meant to handle such high-pressure blood flow. Bleeding from a broken blood vessel is serious and can even be fatal.

Once liver cells have been damaged, nothing can be done to repair the liver or cure cirrhosis. Treatment is aimed at avoiding further damage to the liver, and preventing and treating complications such as bleeding from broken blood vessels. Your doctor may prescribe a medicine to help prevent your blood vessels from breaking open. Drugs that prevent broken blood vessels have some side effects. Not everyone can take them.

If medicine isn’t enough, surgery may help stop the bleeding from broken blood vessels. One option is to interrupt the flow of blood to swollen varices in the area where the esophagus (the tube leading to the stomach) attaches to the stomach. A long lighted tube is passed through the mouth to the stomach. Then rubber bands or hardening chemicals are placed on the swollen blood vessels to block them off.

If this procedure isn’t successful, a person with portal hypertension may need to have a surgeon connect the blood vessels in such a way that the blood doesn’t flow through the liver. Another kind of procedure, called TIPS (transjugular intrahepatic portosystemic shunt), may be done in some cases.

If you drink alcohol, the most important way to help yourself is to stop. Alcohol just keeps damaging your liver. Some medicines, vitamins and herbal remedies can also damage your liver. Talk with your doctor before you take any medicines, including antibiotics, birth control pills, and even over-the-counter drugs such as acetaminophen (one brand name: Tylenol).

It’s also important for you to take good care of yourself. When resting, be sure to raise your feet and legs, especially if they are swollen. Eat a balanced diet. You may need to watch how much protein and sugar you eat. Ask your doctor if you should follow a special diet.