Sometimes occurring in cirrhosis, portal hypertension is the increased pressure
in the portal vein and its tributaries resulting from blockages to the
blood flow into the liver. It is usually caused by the scarring processes
of cirrhosis. The increased pressure causes varices, or dilations of the
veins leading into the portal vein. When varices are located in
superficial tissues, they may rupture and bleed profusely. Two such
locations are the lower esophagus and the perianal region.
Esophageal varices are likely to bleed most heavily, and this bleeding is frequently associated with the onset of hepatic encephalopathy or coma. Because of their location at the lower end of the esophagus or the upper portion of the stomach, bleeding from varices is often difficult to control. If variceal bleeding persists, surgical formation of a shunt, or artificial passageway, from the portal vein to an abdominal vein may be done.