Increase in portal vein pressure above the normal level of 5-10 mm Hg or greater.
Portal hypertension is due to obstruction.
Causes can be divided into:
Prehepatic: portal vein thrombosis , congenital atresia , hypo plasia of umbilical vein,trauma, tumor.
Intrahepatic: liver cirrhosis hepatic fibrosis ( Wilson's disease, hemochromatosis, or congenital fibrosis)
post hepatic: obstruction occur at any level between liver and right heart, including hepatic vein thrombosis, inferior vena cava thrombosis, right side heart failure,Budd-Chiari syndrome.
Symptoms and signs:
Symptoms:
Blood in vomit
esophageal varices
Blood in stool
Dark stool
Abdominal swelling
Enlarged spleen
Pancytopenia
Gastrointestinal bleeding
Ascites
Pruritus
Abdominal pain and fever
Signs
Dilated veins in the anterior abdominal wall (umbilical epigastric vein shunts)
Caput medusa (tortuous collaterals around the umbilicus)
Rectal hemorrhoids
Ascites - Shifting dullness and fluid wave (if significant amount of ascitic fluid is present)
Paraumbilical hernia
Jaundice
Spider angiomas
Gynecomastia
Dupuytren contracture
Muscle wasting
Palmar erythema
Asterixis
Testicular atrophy
Splenomegaly
Bounding pulses
Warm, well-perfused extremities
Arterial hypotension
Complications
Variceal bleeding
Oesophageal, gastric, other
Congestive gastropathy
Hyperpleenism
Ascites
Renal failure
Hepatic encephalopathy
Diagnosis of Portal Hypertension
Liver function test (LFT)
Raised LFT indicates active liver damage.
Low albumin level indicates established cirrhosis.
Elevated prothrombin time indicates end stage liver disease with poor prognosis.
Endoscopy- Helps document esophago-gastric varices.
USG of liver and portal venous system helps diagnosis of PHT by demonstration of dilated collaterals around gastro-esophageal junction and dilated portal vein.
Liver biopsy- to differentiate early cirrhosis
Portovenography- percutaneous splenoportography (SPG) is commonly done for visualization of portal vein and its main tributaries.
Homeopathic management :
It is based on the symptoms and signs elicited.
1. Dolichos pruriens
Syndrome of portal hypertension of first degree. intensive, unbearable, "terrible" itch of skin , intensive pains in both hypochondriac regions dull pain under the angle of right scapula, constant yellow colour of the eyes, bitterness in the mouth , Stool constipated. cirrhosis of liver & hepatocellular insufficiency
2. Carduus Marianus
chief action is centered in the liver, and portal system, causing soreness, pain, jaundice. Has specific relation to the vascular system.Pain in region of liver especially Left lobe very sensitive. Fullness and soreness, with moist skin. Constipation; stools hard, difficult, knotty; alternates with diarrha. Hypermia of liver, with jaundice.
3. Magnesium Muriaticum
characteristic constipation. It has chronic liver affections like cirrhosis with tenderness and pain, extending to spine and epigastrium ad the pain is worse after food. Pressing pain in liver; worse lying on right side. Liver is enlarged with bloating of abdomen; yellow tongue.
4. Ptelea Trifoliata
aching and heaviness in the region of the liver is greatly aggravated by lying on the left side. Liver sore, swollen, sensitive to pressure. Indicated in end stages of cirrhosis.
5. Nux Vomica
The liver is swollen hard and sensitive to the touch and pressure of clothing is uncomfortable. The first remedy in cirrhosis of the liver. Colic may be present.
6. Lycopodium
The region of the liver is sensitive to the touch, and there is a feeling of tension in it, a feeling as if a cord were tied about the waist. Cirrhosis of liver. The pains are dull and aching .Fullness in the stomach after eating a small quantity.
Portal hypertension is due to obstruction.
Causes can be divided into:
Prehepatic: portal vein thrombosis , congenital atresia , hypo plasia of umbilical vein,trauma, tumor.
Intrahepatic: liver cirrhosis hepatic fibrosis ( Wilson's disease, hemochromatosis, or congenital fibrosis)
post hepatic: obstruction occur at any level between liver and right heart, including hepatic vein thrombosis, inferior vena cava thrombosis, right side heart failure,Budd-Chiari syndrome.
Symptoms and signs:
Symptoms:
Blood in vomit
esophageal varices
Blood in stool
Dark stool
Abdominal swelling
Enlarged spleen
Pancytopenia
Gastrointestinal bleeding
Ascites
Pruritus
Abdominal pain and fever
Signs
Dilated veins in the anterior abdominal wall (umbilical epigastric vein shunts)
Caput medusa (tortuous collaterals around the umbilicus)
Rectal hemorrhoids
Ascites - Shifting dullness and fluid wave (if significant amount of ascitic fluid is present)
Paraumbilical hernia
Jaundice
Spider angiomas
Gynecomastia
Dupuytren contracture
Muscle wasting
Palmar erythema
Asterixis
Testicular atrophy
Splenomegaly
Bounding pulses
Warm, well-perfused extremities
Arterial hypotension
Complications
Variceal bleeding
Oesophageal, gastric, other
Congestive gastropathy
Hyperpleenism
Ascites
Renal failure
Hepatic encephalopathy
Diagnosis of Portal Hypertension
Liver function test (LFT)
Raised LFT indicates active liver damage.
Low albumin level indicates established cirrhosis.
Elevated prothrombin time indicates end stage liver disease with poor prognosis.
Endoscopy- Helps document esophago-gastric varices.
USG of liver and portal venous system helps diagnosis of PHT by demonstration of dilated collaterals around gastro-esophageal junction and dilated portal vein.
Liver biopsy- to differentiate early cirrhosis
Portovenography- percutaneous splenoportography (SPG) is commonly done for visualization of portal vein and its main tributaries.
Homeopathic management :
It is based on the symptoms and signs elicited.
1. Dolichos pruriens
Syndrome of portal hypertension of first degree. intensive, unbearable, "terrible" itch of skin , intensive pains in both hypochondriac regions dull pain under the angle of right scapula, constant yellow colour of the eyes, bitterness in the mouth , Stool constipated. cirrhosis of liver & hepatocellular insufficiency
2. Carduus Marianus
chief action is centered in the liver, and portal system, causing soreness, pain, jaundice. Has specific relation to the vascular system.Pain in region of liver especially Left lobe very sensitive. Fullness and soreness, with moist skin. Constipation; stools hard, difficult, knotty; alternates with diarrha. Hypermia of liver, with jaundice.
3. Magnesium Muriaticum
characteristic constipation. It has chronic liver affections like cirrhosis with tenderness and pain, extending to spine and epigastrium ad the pain is worse after food. Pressing pain in liver; worse lying on right side. Liver is enlarged with bloating of abdomen; yellow tongue.
4. Ptelea Trifoliata
aching and heaviness in the region of the liver is greatly aggravated by lying on the left side. Liver sore, swollen, sensitive to pressure. Indicated in end stages of cirrhosis.
5. Nux Vomica
The liver is swollen hard and sensitive to the touch and pressure of clothing is uncomfortable. The first remedy in cirrhosis of the liver. Colic may be present.
6. Lycopodium
The region of the liver is sensitive to the touch, and there is a feeling of tension in it, a feeling as if a cord were tied about the waist. Cirrhosis of liver. The pains are dull and aching .Fullness in the stomach after eating a small quantity.
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