Portacaval Shunt

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 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.