Portal Hypertension ... what is it?

So what is it?  Basically Patrick's portal vein has a blood clot that completely blocks the blood flow from his spleen to his liver.  This causes the blood to flow back into spleen.  If you go back to high school or college biology the liver is important in processing food and medicine so the body can use them.  It acts as a filter for the blood and removes poisons and toxins and other byproducts made by our cells and tissues.  The liver helps control our cholesterol and even blood sugar too.  It helps produce other chemicals that help blood clot too.

So...the doctor at the Children's Hospital of Atlanta helped us best understand with his diagram.  You can see the heart...then below left is the liver and the vein systems ... the main vein has the 'P' which is his portal vein which has 'run-offs' that go to the intestines ('I') and the spleen.  Now, the shaded in area by the 'P' is the blood clot that completely blocks any passages to the liver so then it reverses flow back to the intestines and the spleen. In Patrick's case, this is why his spleen (splenomegaly) is so enlarged and his blood counts, especially his platelets are always not what they should be.  The blood flow is going back to the intestines as well.

So when the blood gets back to the spleen there is really nowhere to go and it gets stuck in the spleen, making it big, and then it effects the blood that is coming from his esophagus which causes these things called varices.  Varices are like varicose veins and they can become engorged.  There are different grades of varices (grade I, grade II, etc.).  Grade I is very small and they just let those go but as they grow they have the potential to rupture and cause very bad bleeding which gives you a very short time to get to the hospital.  These are called esophageal varices.  There are also varices that can form off of that vein that go to the intestine and stomach which would cause a dark, tarry stool with some blood.

The best treatment therapy for these esophageal varices are endoscopies and bandings.  They send a scope down the throat and if they see a varice of grade II or higher they will band.  These bands will cut off circulation and 'slough' off.

That is the skinny on portal hypertension...from me....and the kind drawing from the doctor at CHOA...but for more details....

A very technical article . . .
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309906/

An article more my speed . . .
http://www.childrenshospital.org/conditions-and-treatments/conditions/p/portal-hypertension-liver-disease/overview

An adult living with portal hypertension and great resource . . .
http://www.portal-hypertension.com/my-own-portal-hypertension-journey/