Portal Hypertension

• The portal vein brings blood from the intestine to the liver. This vein flows behind the pancreas and collects blood from there, the gallbladder and the spleen before entering the liver. After entering the liver, it divides into two branches, right and left, and then into tiny channels throughout the liver. When leaving the liver, blood flows through the hepatic vein into general circulation. Mayo Clinic.com notes that portal hypertension occurs when there is an abnormally high pressure in the portal vein.
  
  

Ascites

• Stedman's Medical Dictionary defines ascites as an accumulation of serous fluid in the peritoneal cavity. This serous or ascitic fluid comes from the surface of the liver and intestines and, as a possible consequence of elevated portal pressure, the fluid leaks into the abdominal cavity. While ascites itself is without symptoms, Mayo Clinic.com notes the resultant buildup of fluid, if severe enough, will cause the abdomen to distend and may cause difficulty breathing, abdominal pressure and tenderness.
  
  

Causes of Portal Hypertension

• Merck and Company, a global research and development/pharmaceutical company, at merck.com reports the most common cause of portal vein hypertension is scarring in the liver. This scarring causes a buildup of fibrotic tissue that restricts blood flow from the portal vein through the liver. Lucile Packard Children's Hospital at Stanford (LPCH) notes (at lpch.org) that this scarring or cirrhosis in an adolescent is likely due to disease caused by viral or bacterial infections, certain toxic exposures, immune system disorders or congenital abnormalities.
  
  

Treatment

• For ascites, MayoClinic.com cites bed rest, salt restriction and diuretics (drugs used to increase discharge of urine) as typical treatments. Physicians sometimes try therapeutic paracentesis (needle inserted through the abdominal wall to drain fluid). Unfortunately, treatment for portal hypertension consists mainly of controlling symptoms and managing complications. According to LPCH, a bypass or shunt between the portal vein and the general venous system may lower pressure in the portal vein. However, the main treatment for portal hypertension caused by end-stage liver disease is liver transplant.
  
  

Prognosis Following Liver Transplantation

• While every case is unique, the prognosis for those experiencing liver transplant continues to improve. While a patient's age and overall health are important factors, the physicians at LPCH suggest a child's health will likely improve following transplant if he strictly complies with medical advice. This includes adherence to antirejection and other medications, keeping all appointments for lab tests and examinations, and genuine commitment by the patient and family to follow the guidelines.