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Portal Hypertension and Varices

Hypertension usually means abnormally high blood pressure in the systemic circulation – arteries which carry blood from the lungs to all other parts of the body.

Portal hypertension refers to abnormally high blood pressure in the portal circulation – where blood from the heart goes through the digestive system, absorbing nutrients from digested food and carries them into the liver via the portal vein.

Portal hypertension is caused by obstruction of the blood flow into, through or out of the liver.

What are the symptoms to look out for?

The degree of portal hypertension is assessed by the symptoms it causes. These may include any, or all of the following:
  • An enlarged spleen
  • Abdominal swelling
  • Prominent veins under the skin of the abdomen
  • Varices or enlarged veins in the lining of the gut, especially the oesophagus and stomach
  • Signs of bleeding
  • Diarrhoea, poor weight gain

How is a diagnosis made?

A range of tests can be carried out to make a diagnosis:
  • General physical examination
  • Blood tests
  • Ultrasound scan
  • Endoscopy
  • Sigmoidoscopy

Portal Hypertension treatment options

If the symptoms are mild, no treatment is needed, but if the condition leads to bleeding, this will require treatment. If portal hypertension causes diarrhoea or poor weight gain, the dietitian will advise you on changes to your child’s diet to ensure they absorb adequate nutrients and calories.

Treatment for varices

If the varices have inflamed the lining of the oesophagus or stomach, a medicine may be given to protect the lining and help it to heal.

Treatment for active bleeding

If a child is vomiting blood or passing blood in their stools they must be taken to the nearest hospital immediately. If possible take a sample of the vomit or stool with you to hospital and remember to tell doctors about your child’s portal hypertension as well as the present symptoms.

While in hospital some of the following will be done:

  • Monitoring your child’s pulse and blood pressure
  • Observation of vomiting and colour of stools
  • Blood test to indicate how much blood has been lost
  • Giving special fluids/blood intravenously to maintain blood volume
  • Giving medicines intravenously to actively stop the bleeding.

Once stable, your child may be given an endoscopy to look at the varices that are bleeding and this may require a transfer to a specialist centre. Treatment options will be considered at this point, which might include injecting the varices to prevent the small veins bleeding (sclerotherapy) or placing special rubber bands around them (banding) to remove the varices . Repeated treatments may be necessary to reduce the chance of the varices bleeding again

To find out more about Portal Hypertension please download our leaflet.

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