Portal hypertension

[nerd1]

Does anyone know if portal hypertension can be seen on imaging?

Thanks

[Ewife]

Hello, personally the only way I've heard of it being diagnosed is by evidence of oesophagael varices by Endsoscopy procedure.

Others on this forum may know more.

[YvonneM60 in reply to Ewife]

Mine was detected by ct scan . They then said I had ostophagus varacies and would do a endoscopy but no rush . Made me app for 12 week . No preventative medication . Like beeta blockers ! Whilst waiting I suffered a life threatening bleed . I am lucky to be here . I'd advice anyone to push for there treatment as a lot of specialist just don't give a seat!

[AyrshireK]

They can often tell direction and rate of portal veinous flow on ultrasound - certainly have on hubbies scans.

[Sammyjoe2]

How are you doing?. Don’t know if this helps but I was told when having my US that blood was flowing normally through the Liver and a measurement (which I’ve now forgotten) was noted re the flow pressure I think.

[nerd1]

Hi Sammyjoe, still freaking out unfortunately before seeing the consultant tomorrow. I'm asking about portal hypertension because of the apparent HE I'm experiencing with jerking & ammonia smell 😞

[Sammyjoe2 in reply to nerd1]

Hope the appointment goes well, at least you will hopefully be a big step nearer to finding out what is going on. Try not to worry too much, it’s better to know good or bad and get the help and support that you need. Let us know how you get on. Sam x

[Debs365 in reply to nerd1]

Good luck for tomorrow ,

[Tia2021 in reply to nerd1]

Hope all goes well for you tomorrow, I know it's hard but try not to worry , xx

[Sammyjoe2 in reply to nerd1]

Hi nerd1,

Just wondering how you are and how your appointment went?.

Sam

[nerd1 in reply to Sammyjoe2]

Hi Sammyjoe, the consultant said he didn't think it was my liver causing the symptoms based on the tests I've already had, but he did agree to a doppler ultrasound & said I should be tested for Wilson's disease, which was a bit of a surprise. So now I'm just waiting to see what those tests show..

[Sammyjoe2 in reply to nerd1]

Oh gosh really, well good that he is being thorough to try and get to the bottom of it. Hope you don’t have to wait too long for the tests.

[Ihavebigfeet]

Ultrasound shows it well

[jazzjam]

They can see the portal vein, yes. It is always mentioned on my scans. I have just read through all your posts and you have had a lot to worry about. Your liver results seem to be goid. Have you had a look at your normal food and drink intake. I know it sounds very basic but a lot of these issues you are having can very easily be put down to food and drink intake.

I am not sure what age you are but spider nevei and hair loss are very common side effect of changes in hormones as is pain in the joints.

[nerd1 in reply to jazzjam]

Hi jazzjam, thanks for replying. I turned 40 in November, but unfortunately it's clear that this is more than can be explained by any normal hormonal changes. I started eating better when the problems first started and as far as I know was not deficient in anything except vitamin d. I've been teetotal for nearly 11 months now but the symptoms keep recurring.

[YvonneM60 in reply to nerd1]

I have been teetotal for 18 yrs. However I was diagnosed with chirrosis . I'm angry ,frustrated and very scared .I have potol hypertension .

Had a massive bleed last August this is when I was diagnosed .

Originally it was put down to my chronic pancreatitis!

I've been told since that I don't have it. Then again I do .

I know a Tiny part of me is hoping that the other specialist is right !

I am positive in my attitude . Feeling better than I have for years ! Put on weight . Appetite really good .

I keep going x

[pushthrough in reply to YvonneM60]

Yvonne, did a varice pop or something? That's good that you have an appetite, so do I. Make sure you watch what you eat. I would see a dietician just in case. Almost everyone with Cirrhosis has a very specific and strict diet they need to stick to along with exercise. Mine is low fat high fiber, 2mg of salt max, and no beef, very little sugar.

[Fibro2021]

In my case, portal hypertension was identified only by liver biopsy (histological signs of non-cirrhotic portal hypertension to be precise). CT, ultrasound, MRI were not informative. Only the Doppler showed an acceleration of the linear blood flow in the portal system.

[Ubwa]

As others have said it can be seen easily via ultrasound and can be deduced via other imaging means too.

[pushthrough]

A CT with contrast looking for blockages can. That’s how they found mine at the ER. They thought it was thrombosis but was hypertension.

[YvonneM60 in reply to pushthrough]

I've had this mux up . I have chronic pancreatitis and my portal hypertension was put down to thrombosis with this! I then had a life threatening bleed and was diagnosed Chirrosis! My other specialist is adamant it's not Chirrosis !

[nerd1 in reply to YvonneM60]

Hi Yvonne, have you got anything else that has shown cirrhosis, e.g. fibroscan, ultrasound, biopsy?

[pushthrough in reply to YvonneM60]

Yvonne, typically they would need to run several tests to determine if you have cirrhosis. I had to have an ultrasound, MRE, Fibroscan and a lot of blood tests before I was diagnosed. Took around 8 months.

[pushthrough]

Hello nerd. I just realized I have commented on your other posts. I have portal hypertension and I’m fine for now and my specialist isn’t too concerned. I have probably had it for years and didn’t know. Yes, there’s always a chance of internal bleeding and varices rupturing if you have them. I would try to stay calm because you very well may not have it. I had no idea I did. I also didn’t know I had liver damage. Your kpa and blood results don’t seem that bad.

[vinylcollector]

I was told they could see it on ultra scan, but second one said looked like it was flowing in right direction, but I still have Portal Hypertension. It's all very vague.

[deanw41 in reply to vinylcollector]

Portal hypertension cause my ascites(I think),I’m on beta blockers,no varcies and patent directional flow. So do I have PH or not? Unsure?

[vinylcollector in reply to deanw41]

Well, as said, it's all very vague. If the PH is there, when blood is moving in correct direction, how can that be PH? Ascites, is fluid in the abdomen, because it isn't naturally draining away, it's not a blood leak. PH can cause varices due to back pressure as blood tries to find another route. The Portal artery isn't as I understand it, getting blood to the liver, pressure builds up, enlarging spleen and then tries to push blood via another route, if there is a weakness in any of the veins or anywhere in the system, the pressure will cause a bleed. Ascites and PH are two separate things going on, one is chemical within the liver, the other is supply of blood in and around the liver. The problem is clarity and unfortunately the medical people never answer or give proper straight answers. Beta Blockers, are there to slow the heart and reduce pressure on blood circulation. I'm not a medical person, but they whoever they are are confusing you because Ascites are one thing, PH is another. I'm not on any medication at all. If you are bleeding from your rear or bringing up blood, seek urgent medical attention, without delay. The problem is very frustrating, because they do like to scare people for no valid reason, when they could actually give straight answers. We are all different and no two people are the same.

[deanw41 in reply to vinylcollector]

It’s was portal hypertension that cause my ascites 2 years. I don’t have it now or varcies.

[Porcupine_Tree]

Triple phase CT scans will show whether there is an occlusion, and subsequent cavernoma. Varices; Ascites and HE are all potential symptoms. The scan will also show if "minor veins," exist to assist flow from intestine to liver so at least some blood can be detoxified before reaching the brain. Once interpreted by your Consultant then solutions can be proposed..

[Kristian]

The simple answer is yes. Even a straight forward ultrasound can tell if portal hypertension is present. Usually this would manifest itself by an increase in spleen size in conjuction with signs of liver disease/ cirrhosis such as surface nodularity, hepatomegaly or other hyperechoic changes. Other scans can also pick up changes to blood vessel formations and varices known to occur with portal hypertension.

[Fibro2021 in reply to Kristian]

The difficult answer is that the normal diameter of the portal vein and spleen does not exclude portal hypertension and everything depends on the presence of blood shunting in the portal system and collaterals may be recruited to decompress the portal vein.

However, a stepwise diagnostic approach in the search for signs of portal hypertension is likely to be proposed. At the first stage, this can probably be fibrogastroscopy and ultrasound with Dopplerography of the portal system, then CT and MRI with contrast enhancement, and a biopsy may be needed for the final check of the diagnosis.

[Kristian in reply to Fibro2021]

Yes, there are indeed exceptions to every rule, as in your case, where a bit more of an in depth investigation is required.

I must admit its not too typical to need a biopsy to prove portal hypertension as in most cases the tell tale signs can be pretty obvious on imaging. It certainly wasn't needed for me anyway, lol. But, as you very well point out, there can be cases where that is required. As seems to have been the case for you.

As you very well set out too, if there are indications that there may be portal hypertension present, like the presence of varices, there can be a bit of a process of illimination needed to ascertain the cause, or confirm diagnosis, if the more obvious signs aren't seen on imaging.

[Fibro2021 in reply to Kristian]

Yes, I agree with you, but the stories of some patients make me think that in most cases only the tip of the iceberg is visible and few people want to look under the water.

[YvonneM60]

Hi ,I have portol hypertension . It was detected by a ct scan ..If this helps . Take care x

[jazzjam]

The spider, hair loss and pain in the joints can definitely be put down to hormonal changes as I went though this at 38. I am just saying it is worth checking your hormones. Also food and water intake, again I have been though this. When I eventually saw a nutritionist and I followed the plan to the letter my blood results improved amazingly. Just from my own experience if it helps My portal vein is seen and measured as is the speed of my blood which is related.