Portal Hypertension
Care for a Serious Liver Disease
In people with portal hypertension, there is increased pressure in the portal vein — the major vein transporting blood through your liver. At NewYork-Presbyterian, our liver disease specialists have the skills and expertise to care for people with portal hypertension and are leaders in the development of innovative treatments for this disease.
Causes of portal hypertension
Cirrhosis is the most common cause of portal hypertension. The scar tissue caused by cirrhosis obstructs the flow of blood through the liver. Portal hypertension may also develop in people with blood clots in the veins leading into the liver (portal vein) or out of the liver (hepatic veins) or other rare conditions that do not involve liver damage or cirrhosis.
Signs & Symptoms of Portal Hypertension
Portal hypertension may cause you to experience:
- Blood in the stool
- Accumulation of fluid in the abdomen ("ascites")
- Confusion/disorientation (encephalopathy) due to poor liver function
- Enlargement of the spleen
- Low levels of platelets (blood-clotting cells) or white blood cells
Tests & Diagnosis
Portal hypertension may cause you to experience:
- Blood in the stool
- Accumulation of fluid in the abdomen ("ascites")
- Confusion/disorientation (encephalopathy) due to poor liver function
- Enlargement of the spleen
- Low levels of platelets (blood-clotting cells) or white blood cells
Our Approach to Care
Your care team includes hepatologists (liver specialists), gastroenterologists, interventional radiologists, surgeons, nurses, physician assistants, registered dietitians, social workers, and others with experience caring for people with portal hypertension and other liver diseases. If you develop complications such as varices (enlarged blood vessels in the esophagus, stomach, and rectum, which can rupture), encephalopathy, or ascites, our experts can treat those conditions as well.
How we treat portal hypertension
Our teams offer medication, nutritional guidance, endoscopic and interventional radiologic procedures, surgery, and liver transplantation for people with portal hypertension.
Medical treatment. Your doctor may first treat you using medications such as beta blockers (which lower blood pressure) to prevent bleeding from varices, and diuretics to reduce fluid accumulation due to ascites. You may also receive an antibiotic such as rifaximin and/or lactulose, a type of laxative, to reduce confusion and other mental changes resulting from encephalopathy.
Dietary education. Our registered dietitians will work with you to tailor a nutrition plan to support your health, including a low-salt diet and avoidance of alcohol.
Endoscopic and surgical procedures. The doctors at NewYork-Presbyterian offer a range of procedures to treat portal hypertension and its complications if medications are not sufficient.
- Band ligation of varices. A gastroenterologist uses rubber bands to tie off varices (dilated blood vessels that may cause internal bleeding), reducing blood flow and pressure and lowering the likelihood that the varices will rupture.
- Injection and embolization of varices. Your doctor injects a special liquid or metallic coil into the varices to address bleeding by blocking off blood flow in the problematic blood vessel. It is usually only performed if you are bleeding and band ligation is not an option for you.
- Transjugular intrahepatic portosystemic shunt (TIPS). You may have this procedure if band ligation and/or injections cannot stop bleeding from varices or when diuretic medication is not effective for controlling ascites. Guided by x-ray and ultrasound imaging, an interventional radiologist creates a small hole in the portal vein and inserts a stent (a small tube) into it, creating a shunt. This shunt is then connected to one of the hepatic veins, creating another pathway or bypass that reduces pressure in your portal vein as well as other abdominal veins, including varices.
- Balloon-occluded retrograde transvenous obliteration (BRTO). This procedure is used in addition to or instead of TIPS to manage certain varices (gastric varices, which come from the stomach). The procedure involves blocking the dilated vessels with a balloon, reducing bleeding and the risk of rupture.
- Distal splenorenal shunt (DSRS). A surgeon connects the splenic vein to the left kidney vein to lower pressure in varices and control bleeding. DSRS is a surgery that requires a longer hospital stay when compared to TIPS or other treatments. It is typically performed when other options are not possible.
Liver transplantation. If your portal hypertension cannot be effectively treated through other means and becomes life-threatening, you may need a liver transplant. At NewYork-Presbyterian, we have exceptional expertise in liver transplantation and use a variety of approaches, including living donor liver transplantation.
Why Choose Us
Portal hypertension is a serious illness and requires the expertise of a team of specialists to provide the most effective care. This is the approach we take at NewYork-Presbyterian, where we offer all available treatments for portal hypertension, including liver transplantation. Weill Cornell Medicine and Columbia University researchers have also led many clinical trials studying new devices, techniques, and medications to improve outcomes in patients with portal hypertension. You may have the opportunity to participate in a clinical trial of a promising new treatment. Whatever care you need, you can receive it all through one medical center. Make an appointment today to see what we can do for you.