Portacaval shunt
Key points
- A portacaval shunt is a treatment for high blood pressure in the liver.
- The most common causes of liver disease resulting in portal hypertension are Cirrhosis caused by Alcohol Abuse and viral hepatitis (Hepatitis B and Hepatitis C).
- Patients with portal hypertension will have varices, which are swellings of veins near the esophagus and rectum caused by backup of blood in the diseased liver.
- Many different laboratory tests are used to determine the presence and causes of liver disease.
Definition
A portacaval shunt is a treatment for high blood pressure in the liver. A connection is made between the portal vein, which supplies 75% of the liver's blood, and the inferior vena cava, the vein that drains blood from the lower two-thirds of the body.
Causes, incidence, and risk factors
The most common causes of liver disease resulting in portal hypertension are Cirrhosis caused by Alcohol Abuse and viral hepatitis (Hepatitis B and Hepatitis C). Less common causes include diseases such as Hemochromatosis, primary biliary cirrhosis, (PBC), and portal vein thrombosis.
Symptoms
Patients with portal hypertension will have varices, which are swellings of veins near the esophagus and rectum caused by backup of blood in the diseased liver. Varices may bleed, leading to the Vomiting of blood or blood discharge from the rectum. Patients may also have enlarged veins on the surface of the abdominal wall.
Liver diseases involving portal hypertension often also cause jaundice (a yellow tinge to the skin and eyeballs), ascites (accumulation of fluid in the abdomen), and difficulty with stopping bleeding, due to an inability of the diseased liver to make clotting factors. As the liver fails to clear toxins from the body, patients may also suffer from hepatic encephalopathy, a disorder where concentration, mental status, and memory are affected; in extreme cases, encephalopathy can lead to coma.
Signs and tests
Many different laboratory tests are used to determine the presence and causes of liver disease.
- Liver function tests may be abnormal.
- Blood tests may detect the presence of viral hepatitis.
- Percutaneous liver biopsy may help diagnose liver disease.
- Endoscopy may be used to diagnosis esophageal varices.
Hemochromatosis, primary biliary cirrhosis, and primary sclerosing cholangitis may be diagnosed with a combination of laboratory blood tests and physical exam.
Treatment
Portacaval shunting is a major operation, requiring an abdominal incision.
Blood flow is diverted around the liver, usually by creating a connection between the portal vein and the inferior vena cava. This reduces pressure in the veins draining the liver, decreasing the dilation of variceal veins in the esophagus, which otherwise are prone to rupture and bleeding.
Written and revised by
David Cohen, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
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