Portal hypertension treatment

List the treatment goals for a patient with portal hypertension and its complications. 

The aim of pharmacologic treatment in portal hypertension is to decrease portal pressure and reduce the effects of sympathetic activation. 

FIGURE 19-4. Treatment algorithm for active gastrointestinal bleeding resulting from portal hypertension. (From Schianotd, Bodenheimer HC. Complications of Chronic Liver Disease. In Friedman SL, McQuaid KR, Grendell JH (eds.)... 

Non-selective fi-blockers such as propranolol and nadolol are first-line treatments to reduce portal hypertension. This effect reduces bleeding and decreases mortality in patients with known varices. Use of (1-blockers to prevent variceal formation is controversial. 

Evidence-Based Table of Selected Treatment Recommendations Variceal Bleeding in Portal Hypertension... 

The treatment of ascites secondary to portal hypertension includes abstinence from alcohol, sodium restriction, and diuretics. Sodium chloride should be restricted to 2 g/day. 

Azizov KhA (1998) Surgical treatment of the patients with a liver cirrhosis in conditions portal hypertension decompensation with ascite syndrome. MD Thesis (in Russian) Tashkent, Uzbekistan, p 45... 

Amin LI, Anykin T (1988) Influence of surgical treatment of liver cirrhosis with portal hypertension on morphological changes of a liver. In Problems of surgical treatment of patients with hver cirrhosis with portal hypertension. Medicine Publ, Moscow, pp 18-19... 

Cl) = 0.30 - 0.92] was offset by an increased risk of death in remission (OR = 2.22, 95% Cl = 1.20 - 4.14), mainly due to infections. Strikingly, 11% of patients in the 6-TG arm compared to less than 2% in the 6-MP arm developed non-fatal hepatic toxicity with features of veno-occlusive disease (VOD) characterized by symptoms including tender hepatomegaly, hyperbilirubinaemia with elevated aminotransferases, thrombocytopenia out of proportion to neutropenia, and portal hypertension. In 85% of affected 6-TG recipients, these symptoms were observed during maintenance or interim maintenance. Of interest, in patients randomized to 6-MP, hepatic toxicity was associated with intensification elements in which both treatment arms received exclusively 6-TG. 

The American College of Gastroenterology recommends esophagogas-troduodenoscopy employing endoscopic injection sclerotherapy or EBL of varices as the primary diagnostic and treatment strategy for upper GI tract hemorrhage secondary to portal hypertension and varices. 

Hypertension of the portal vein, with its numerous intrinsic or acquired causes, may not display any symptoms for several years. Portal hypertension itself is very often a concomitant symptom in a number of liver diseases. (65) It can lead to severe or even fatal complications. For this reason, hepatological investigation frequently needs to explore (7.) the presence of portal hypertension, (2.) its aetiology, (i.) its severity, and (4.) potentially successful treatment of the underlying causes - in order to produce a favourable effect on portal hypertension. (22, 23, 33, 37, 38, 69, 158)... 

J.L., Piera, C., Abraldes, J.G., de Diego, A., Albillos, A., Bosch, J. Randomized comparison of long-term carvedilol and propranolol administration in the treatment of portal hypertension in cirrhosis. Hepatology 2002 36 1367-1373... 

Metoclopramide reduces the intravaricose pressure by restoring the normal tone to the lower oesophageal sphincter. The use of metoclopramide for the prevention and treatment of oesophageal varix bleeding is thus another pharmacological alternative. The haemodynamic effects of portal hypertension are not influenced. 

Knechtle, S.J., DnAlessandro, A.M., Armbrust, M.J., Musat, A., Kalay-oglu, M. Surgical portosystemic shunts for treatment of portal hypertensive bleeding outcome and effect on liver function. Surgery 1999 ... 

Shibata, D., Brophy, D.P., Gordon, F.D., Anastopoulos, H.T., Sentovich, S.M., Bleday, R. Transjugular intrahepatic portosystemic shunt for treatment of bleeding ectopic varices with portal hypertension. Dis. Colon Rect. 1999 42 1581-1585... 

TakahasM, T., Katoh, H., Dohke, M., Okushiba, S. A giant hepatic hemangioma with secondary portal hypertension. A case report of successful surgical treatment. Hepato-Gastroenterol. 1997 44 1212-1214... 

An 18-month-old boy who had regularly consumed a herbal tea mixture since the 3rd month of hfe developed veno-occlusive disease with portal hypertension and severe ascites (46). Histology of the liver showed centrilobular sinusoidal congestion with perivenular bleeding and parenchymal necrosis without cirrhosis. The child was given conservative treatment only and recovered completely within 2 months. 

Other histological features that have been described include lesions of the hepatic venous system (pehosis hepatis, sinusoidal dilatation, perivenous fibrosis, and nodular regenerative hyperplasia) and these can be associated with portal hypertension (SEDA-16,520) (SED-13, 1120) (21). Particularly severe and potentially fatal veno-occlusive liver disease has been reported in patients with renal and allogeneic bone marrow transplants taking chronic treatment (26) (SEDA-12, 386), but complete histological reversal can be observed (SEDA-20, 341). 

Conn HO. Propranolol in the treatment of portal hypertension a caution. Hepatology 1982 2(5) 641. ... 

Liver damage due to vitamin A is not always irreversible one patient, after prolonged intake of excessive amounts of vitamin A for treatment of psoriasis (90 000 micrograms RE/day), had not only reversible chronic intoxication, but reversible portal hypertension and deranged liver function tests without any histological signs of cirrhosis (44). In a similar case, portal hypertension disappeared after 6 months on a low vitamin A diet. The fact that there was no reduction in Ito cells either in size or number suggests that lipid venous obstruction is unlikely to be the only mechanism responsible for portal hypertension in vitamin A-induced liver disease (45). 

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