By Dr. Siddharth Jain, Gastroenterology,
Dear all, these two words ‘Cirrhosis’ and ‘Portal Hypertension’, will affect anyone and everyone suffering from end-stage liver disease. These two terms are used by us doctors, innumerable times while we try to explain the problem of liver failure. But whenever we throw this medical jargon at our patients, we very commonly get a look, perplexed and anxious. Our patients hear these terminologies for the first time. But if we expect them to understand everything that we tell them.
As physicians, it’s our job to make things easy to understand for our patients. So what does these two terms mean? Why are they so important? A simplified answer is that cirrhosis may signify failing liver. It may result in portal hypertension which can later have life-threatening repercussions. Let me first say this. When someone is informed about having liver failure for the very first time, it is a difficult situation, both for the patient and the treating doctor. For the patient, it is not easy to understand what liver failure will do to him. With something like heart failure, it is easy to imagine that if heart stops working, then one will die. But what about liver failure or cirrhosis? What is going to happen to me when liver stops working?
These are the initial questions that come to one’s mind. By the time acceptance come, it brings with it a deafening silence….. a moment of standstill, because it brings down with it all big life plans that one dreams of. A doctor is aware of this fact. He faces a dual challenge of explaining the complex nature of this life threatening disease and then to make the patient understand that he or she may need medicines for life or may even need a transplant. So, how to break the medical jargon into simple language for liver patients? This requires time and effort. This is what I try to do when spending time with my patients. That’s what prompted me to write this piece of information.
“Cirrhosis” (can be equated to scarring of liver). For instance, when there is a cut, the body repairs the wound but leaves behind a scar. Similarly, when liver gets hurt and tries to repair itself, that too may leave a scar behind. With repeated insult to the liver a cycle of injury, repair and scar formation ensues. Gradually, normal liver cells are lost, liver becomes shrunken and hard from replaced scar tissue. Common causes of insult to liver are alcohol, viral hepatitis or steatohepatitis (fatty liver disease).
HEALTHY, SOFT, SMOOTH LIVER, RED BROWN COLOUR PALE LOOKING HARD LIVER with IRREGULAR SURFACE “Portal Hypertension” (PHT): Liver cirrhosis leads to portal hypertension which is increased pressure in portal vein (a large vein draining blood from the stomach and intestines into the liver). Normally, portal vein is a low pressure system. When the liver becomes hard from scarring, back pressure in the portal vein increases. COMMONLY PORTAL HYPERTENSION IS CONFUSED WITH INCREASED BLOOD PRESSURE. THE TWO THINGS ARE NOT RELATED. PORTAL HYPERTENSION≠INCREASED BLOOD PRESSURE
How can Portal Hypertension be life threatening?
A lot of complications in cirrhosis occur because of PHT. Blood vessels in the gut coalesce to form the portal vein. As pressure in portal vein increases, back pressure in these vessels increases too. Once the pressure rises significantly, these vessels rupture and can cause severe bleeding. This will be seen as blood in vomiting or as black stools. This can be a life threatening complication of portal hypertension. PHT can decrease the level of platelets in the blood, which also increased the risk of bleeding. Ascites (fluid in the abdomen) forms because of portal hypertension. Ascites if gets infected (SBP) becomes a serious condition. Excessive ascites formation is also related to reduced blood flow to kidneys resulting in kidney failure. Liver filters/cleanses this blood before it goes to the heart. In failure, this does not happen and unfiltered blood circulates in the body, which if affects the brain (increased ammonia level in blood) can cause confusion, drowsiness or even coma (hepatic encephalopathy).