What is Cirrhosis and Portal Hypertension?

Cirrhosis is the irreversible damage done to the liver because of a variety of factors. The normal liver tissue gets damaged permanently and abnormal changes take place which damage the liver structurally and functionally.

Liver is the organ that detoxifies, helps in digestion, produces important proteins and factors important for blood clotting. All of these functions are compromised in liver cirrhosis.

Portal hypertension refers to the increased blood pressure in the portal vein which supplies the nutrients to the liver. Cirrhosis is one of the causes of this disorder.

How common is Cirrhosis and Portal Hypertension?

Every fifth Indian has a risk of suffering from cirrhosis. Most common age groups affected are 40-70 years. Every year about 10 lakh new patients are diagnosed with liver cirrhosis.

What are the causes of Cirrhosis and Portal Hypertension?

The causes of cirrhosis are:

  • Alcohol intake
  • Hepatitis B
  • Hepatitis C
  • Non-alcoholic fatty liver disease(NASH)
  • Autoimmune liver disease
  • Hemochromatosis
  • Wilson’s disease
  • Cystic fibrosis
  • Problems in the bile duct

The common causes of Portal Hypertension are:

  • Cirrhosis of liver (most common cause)
  • Parasitic infections like schistosomiasis, hydatid disease
  • Portal vein thrombosis (blood clot)
  • Portal Pyemia (Pus in portal vein)
  • Splenic vein thrombosis
  • Liver cancer
  • Polycystic liver disease
  • Medications
  • Congenital liver disease
  • Obstruction of hepatic veins

What are the risk factors for Cirrhosis and Portal Hypertension?

  • Alcohol: The main risk factor is alcohol abuse. Excessive alcohol is a direct toxin to the liver.
  • Unsafe sex: Hepatitis B and C are commonly transmitted through sexual intercourse and are also transmitted through blood. So multiple sexual relationships, unprotected sexual intercourse, intravenous drug abuse, multiple blood transfusion, infants born to mothers suffering from hepatitis are at a greater risk of developing cirrhosis than the normal population.
  • Positive family history: The genetic diseases like cystic fibrosis, hemochromatosis, Wilson’s disease may be transmitted from the parents to the children, exposing them to an increased risk.
  • Obstruction in the bile duct
  • Other autoimmune conditions

The risk factors of portal hypertension are same as that for Cirrhosis.

What are the symptoms of Cirrhosis and Portal Hypertension?

  • Liver enlargement which manifests as a feeling of a mass in the right side of abdomen is seen in all causes of portal hypertension except cirrhosis. In cirrhosis, the liver shrinks in size.
  • Jaundice or yellow discoloration of eyes and skin
  • Abdominal distension (due to the accumulation of fluid in abdomen)
  • Loss of hair of armpits and genitals
  • Menstrual abnormalities like irregular or no periods
  • Loss of sexual desire
  • Impotence
  • Growth of breasts in males
  • Bruises
  • Bleeding from nose
  • Easy fatiguability
  • Weakness

Portal hypertension is one of the consequences as well as a complication of cirrhosis and it manifests as:

  • Feeling of a mass in the left side of the abdomen due to enlargement of spleen
  • Blood in vomiting (haematemesis) due to increased pressure in the esophageal veins which are also called esophageal varices
  • Blood in stools
  • Abdominal distension

What are the complications of Cirrhosis and Portal Hypertension?

  1. Hepatic encephalopathy: This is a term referred to brain damage (semi-comatose stage) because of liver failure. There are sleep difficulties, confusion, and tremors in the patient.
  2. Renal failure which manifests as decreased frequency of urination
  3. Excessive blood in vomiting and stools

How is Cirrhosis and Portal Hypertension diagnosed?

The physician may conduct the following tests:

  • Complete blood count
  • Liver function tests
  • Blood urea
  • Serum creatinine
  • Hepatic venous pressure gradient measurement
  • Ultrasound of abdomen
  • CT scan
  • MRI
  • Liver biopsy
  • Assessment of the fluid accumulated in the abdomen
  • Esophagogastroscopy (done to understand the causes of blood in vomiting)

What is the treatment for Cirrhosis and Portal Hypertension?

Symptomatic treatment: Since cirrhosis itself leads to various other disorders it’s important to treat those first. The esophageal varices can be treated through a variety of medical, endoscopic and shunting procedures which are recommended by the treating doctor depending on the severity.

The fluid in the abdomen has to be periodically drained. Hepatic encephalopathy can be treated by enemas, restriction of dietary proteins, etc. Renal failure can be treated by dialysis, medications.

Surgery: The ultimate treatment is a surgery where the affected part of the liver is surgically removed or in severe cases entire liver has to be removed and the patient has to undergo liver transplant which has its own complications.

Portal hypertension due to cirrhosis also has the same line of treatment. The other causes like splenic vein obstruction can be treated by surgical removal of spleen. The treatment largely depends on the causes and severity.

What are the lifestyle changes required to prevent Cirrhosis and Portal Hypertension?

Alcohol is the most common culprit of cirrhosis and should be completely stopped.  It is important to have protected sexual intercourse to prevent hepatitis. Low-fat diets should be consumed.

The patient of cirrhosis should avoid alcohol and take a low protein diet. It is important to avoid injuries as the person is prone to bleeding and bruising easily.

In conclusion, cirrhosis is permanent damage and should be prevented as much as possible.

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