In addition to ascites and hepatic encephalopathy, splenomegaly and varices are common manifestations of liver disease. All of these manifestations are the result of portal hypertension. Portal hypertension is caused by disorders that obstruct or impede blood flow through any component of the portal venous system or vena cava. The most common cause of portal hypertension is obstruction caused by cirrhosis of the liver (Huether & McCance).
Splenomegaly, (enlargement of the spleen) is caused by increased pressure in the splenic vein, which branches from the portal vein. The spleen is a small organ located just below the rib cage on the left side. The spleen has many important functions. It filters out and destroys old and damaged blood cells, along with storing blood and platelets (the cells that help your blood clot). It also plays a key role in preventing infection by producing lymphocytes (white blood cells), and acting as a first line of defense against invading pathogens. Treatment for the enlarged spleen focuses on relieving the underlying condition, in this case, liver disease resulting in portal hypertension.
Splenomegaly can reduce the number of healthy red blood cells, platelets, and white blood cells. This may cause anemia, increased bleeding, and increased susceptibility to infection. More serious is the risk of a ruptured spleen. Even healthy spleens are soft and easily damaged. When the spleen is enlarged, the possibility of rupture is greater. A ruptured spleen can cause life- threatening bleeding into the abdominal cavity (Mayo Clinic Staff, 2008).
Varices are distended, tortuous, collateral veins. They occur when there is long term portal hypertension. This prolonged elevation of pressure in collateral veins causes their transformation into varices. This often occurs in the lower esophagus and stomach, but can also occur in the rectum (Huether & McCance, 2008).
Vomiting of blood from bleeding esophageal varices is the most common clinical manifestation of portal hypertension (Huether & McCance, 2008). Once a bleeding episode has occurred, there is greater risk of it occurring again. In fact, up to seventy percent of people will have another bleeding episode within one year of the first (Mayo Clinic Staff, 2008). The risk of repeat bleeding is compounded if you are older, have liver or kidney failure, or drink alcohol.
Portal hypertension is often diagnosed at the time of variceal bleeding and confirmed by endoscopy and evaluation of portal venous pressure (Huether & McCance, 2008). Emergency management of bleeding varices includes the use of vasopressors and compression of the varices with an inflatable Senstaken-Blakemore tube, sclerotherapy, or variceal ligation. Surgical shunts may also be used to decompress the varices, but this can worsen encephalopathy of liver failure. Liver transplant is an alternative with end-stage liver disease (Huether & McCance, 2008).
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