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Riley Children's Health

Cirrhosis & Portal Hypertension

Cirrhosis & Portal Hypertension
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Cirrhosis is a condition in which the cells of the liver are damaged. As liver cells die, scar tissue forms. It occurs with many liver diseases.

The scar tissue can make it difficult for blood to flow to the liver through the portal vein (a major blood vessel). When blood flow slows down in the portal vein, the pressure from the vein backs up. This pressure is called portal hypertension.

When portal vein blood backs up into other vessels, they become swollen. The stretched vessels are called varices and occur in the esophagus and sometimes stomach and intestine. They develop thin walls caused by the unusual high-pressure blood flow and can easily break open. Bleeding from a broken blood vessel (variceal bleeding) is serious and can be life-threatening.

When blood does not flow normally through the portal vein, it returns to the heart using other blood vessels. This means toxins remain in the body because blood cannot flow through the liver to be cleaned.

Symptoms of cirrhosis and portal hypertension include:

  • Ascites (fluid in the abdomen that causes abdominal swelling)
  • Dark brown urine
  • Itchiness of the skin
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Loss of appetite
  • Nausea
  • Red palms
  • Vomiting blood
  • Weakness and fatigue
  • Encephalopathy (unclear thinking)

Diagnosis of Cirrhosis & Portal Hypertension

If your child’s symptoms indicate possible cirrhosis and portal hypertension, a pediatric gastroenterologist will complete the following exams to confirm a diagnosis:

  • Physical exam. The doctor will examine your child and look for:
    • An enlarged liver or spleen
    • Excess fluid in the tissues lining the abdomen
    • Widened (dilated) veins in the abdomen wall
    • Jaundice
    • Reddened palms
    • Red, spider-like blood vessels on the skin
  • Liver biopsy. A liver biopsy is occasionally done to confirm cirrhosis or to evaluate for causes.

Treatments

Treatments

Once liver cells are damaged, nothing can be done to repair the liver or cure cirrhosis. A pediatric gastroenterologist works with you to create a care plan for your child that will avoid further damage to the liver and prevent and treat complications such as variceal bleeding. Treatments include:

  • Medicines. Your child's pediatric gastroenterologist may prescribe propranolol, a medicine to help prevent blood vessels from breaking open. Medications that prevent broken blood vessels have some side effects. Not everyone can take them.
  • Upper endoscopy. An upper endoscopy may help stop the bleeding from broken blood vessels. During the procedure, the flow of blood to swollen blood vessels is interrupted in the area where the esophagus (the tube leading to the stomach) attaches to the stomach. Then, rubber bands or hardening chemicals are placed on the swollen blood vessels to block them off. Often multiple procedures are needed.
  • Surgery. Occasionally, a child with portal hypertension may benefit from surgery. Pediatric specialists perform two procedures to treat portal hypertension:
    • Shunt surgery. A shunt surgery drains the portal vein blood into another vein so it won't back up into the varices (swollen blood vessels).
    • Transjugular intrahepatic portosystemic shunt (TIPS). A transjugular intrahepatic portosystemic shunt (TIPS) is performed by a radiologist without surgery. The procedure helps blood flow from the liver and back to the heart without backing up.

Key Points to Remember

Key Points to Remember

  • When liver cells are damaged, they form scar tissue. This condition is called cirrhosis.
  • Cirrhosis can slow or block the flow of blood into the liver through the portal vein. This leads to pressure inside the vein which causes portal hypertension.
  • Swollen blood vessels in the esophagus (called varices) can burst, causing a life-threatening situation.
  • Treatments for cirrhosis and portal hypertension focus on preventing and managing symptoms.

Support Services & Resources

Support Services & Resources

Visit the websites below to find support groups and services and learn more about cirrhosis and portal hypertension.

We offer a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Riley at IU Health Liver Support Group

The Riley at IU Health Liver Support Group meets one or two times a year for a family-oriented education program and socializing. Topics include testing for liver disease, complications of liver disease, impact of chronic disease on the family, liver transplant, nutrition for liver disease and medicine for liver disease. Please call 317.944.3774 for meeting dates and times.

American Liver Foundation

This website provides education and support resources for patients and families living with cirrhosis and portal hypertension.

National Institute of Diabetes and Digestive and Kidney Diseases

This government website provides information about cirrhosis and portal hypertension, including its causes, symptoms, diagnosis, treatments and research.


Cirrhosis & Portal Hypertension Research

Cirrhosis & Portal Hypertension Research

The Gastroenterology, Hepatology & Nutrition Department at Riley at IU Health is part of the Childhood Liver Disease Research Network. The goal of this research network is to learn more about diagnosis, treatments and outcomes of liver disorders. Speak with your child's doctor to learn more about available clinical studies.

Locations

Locations

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.

Riley Pediatric Gastroenterology, Hepatology & Nutrition

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575 Riley Hospital Dr
Indianapolis, IN 46202

317.944.3774

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Riley Pediatric Gastroenterology, Hepatology & Nutrition

11725 N. Illinois St.
Carmel, IN 46032

317.944.3774

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Departments Treating This Condition

Departments Treating This Condition

  • Gastroenterology, Hepatology & Nutrition
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Designated as Best Children's Hospitals by U.S. News & World Report, Ranked in 10 Specialties in 2023-24

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