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Friday, February 8, 2008

Portal Hypertension Surgery

The liver filters venous blood from abdominal organs. Portal hypertension is increased blood pressure in the veins of abdominal organs. The primary vein that carries blood from the abdominal organs to the liver is called the portal vein. When this vein clots or when the liver develops scar tissue from disease and compresses the vein, the blood pressure in the vein goes up and portal hypertension develops. Blood backing up in the veins of abdominal organs causes typical signs of portal hypertension such as ascites to develop. Ascites is free fluid in the abdomen caused by blood being under high pressure and some of its liquid portion squeezing through the vessels and settling in the abdomen.

Hypersplenism is an enlarged spleen caused by blood congestion and increased destruction of blood cells due to spleen hyperactivity. Gastrointestinal bleeding (bleeding into the stomach) results from rupture of varicose veins in the stomach and esophagus (swallowing tube). Varicose veins form a collateral venous network for the blood to escape into an area of lower pressure.

Portal hypertension can be accompanied by good liver function with good production of all necessary proteins. In such instances liver transplantation is not indicated (see liver transplantation). 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.

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