Cirrhosis and Portal Hypertension

Overview

What is cirrhosis?

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 out as 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. In serious cases, cirrhosis can even lead to coma and death.

What is portal hypertension?

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 in this vein slows down and the pressure inside the vein increases. This higher blood pressure in the portal vein is called portal hypertension.

Symptoms

What are the symptoms of cirrhosis?

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

  • Loss of appetite
  • Unintended weight loss
  • Weakness and fatigue
  • Nausea
  • Jaundice (which is the yellowing of the skin and eyes)
  • Dark brown urine
  • Red palms
  • Vomiting blood
  • Menstrual problems (in women)
  • Mental confusion (such as difficulty concentrating and forgetfulness)
  • Itchiness of the skin
  • Abdominal swelling (due to fluid that collects in the abdomen)

Causes & Risk Factors

What causes cirrhosis?

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 of cirrhosis. Both regular, long-term alcohol use and binge drinking (drinking large amounts of alcohol in a short time period) can contribute to cirrhosis.

What causes portal hypertension?

If blood can’t flow normally through the portal vein, it must return to the heart using other blood vessels, most often those found in the stomach, esophagus and intestines. 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. Also, because the portal vein is blocked, toxins in the blood are not cleaned by the liver and therefore remain in the body.

Diagnosis & Tests

How will my doctor know if I 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 also use an ultrasound (sound waves used to make a picture) to look at your liver.

Treatment

What are the treatment options for cirrhosis and portal hypertension?

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. Your doctor may also prescribe medicine to lower blood pressure if you have portal hypertension.

If medicine isn’t enough, surgery may help stop 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.

What can I do to help myself?

If you drink alcohol, the most important thing you can do is 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 prop up 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. Avoiding salt may also help with fluid retention and swelling. Ask your doctor if you should follow a special diet.

Questions to Ask Your Doctor

  • What treatment is best for me?
  • What lifestyle changes should I make?
  • Should I change my diet?
  • What exercises are good for me?
  • Are there any medicines I should avoid taking?
  • Can I drink any alcohol at all?
  • Will I need a liver transplant?
  • What caused my cirrhosis and portal hypertension?
  • Will I have to have surgery?
  • If my symptoms get worse, when should I call my doctor?