Portal Hypertension

Common Characteristics of Liver Disease

Portal Hypertension | Johns Hopkins Medicine

Linkedin Pinterest Liver Gallbladder and Pancreas

When diagnosing liver disease, the doctor looks at the patient's symptoms and conducts a physical examination. In addition, the doctor may request a liver biopsy, liver function tests, an ultrasound, a computed tomography (CT) scan, and/or a magnetic resonance imaging (MRI) scan.

Some common liver disease symptoms include the following, each of which are described briefly below:

  • Jaundice. A yellowing of the skin and eyes.
  • Cholestasis
  • Liver enlargement
  • Portal hypertension
  • Esophageal varices
  • Ascites. A fluid buildup in the abdominal cavity.
  • Liver encephalopathy
  • Liver failure

What is jaundice?

Jaundice is a yellow discoloration of the skin and whites of the eyes due to abnormally high levels of bilirubin (bile pigment) in the bloodstream. Urine is usually dark because of the bilirubin excreted through the kidneys.

High levels of bilirubin may be attributed to inflammation, or other abnormalities of the liver cells, or blockage of the bile ducts. Sometimes, jaundice is caused by the breakdown of a large number of red blood cells, which can occur in newborns.

Jaundice is usually the first sign, and sometimes the only sign, of liver disease.

What is cholestasis?

Cholestasis means any condition in which bile flow is reduced or stopped. “Chole” refers to bile and “stasis” means “not moving.” Bile flow may be blocked inside the liver, outside the liver, or in both places. Symptoms may include:

  • Jaundice
  • Dark urine
  • Pale stool
  • Easy bleeding
  • Itching
  • Ascites
  • Chills
  • Pain from the biliary tract or pancreas
  • Enlarged gallbladder

Some causes of cholestasis include the following:

  • Hepatitis
  • Alcoholic liver disease
  • Primary biliary cirrhosis
  • Drug effects
  • Hormonal changes during pregnancy
  • A stone in the bile duct
  • Bile duct narrowing
  • Bile duct cancer
  • Pancreatic cancer
  • Inflammation of the pancreas

What is liver enlargement?

Liver enlargement is usually an indicator of liver disease, although there are usually no symptoms associated with a slightly enlarged liver (hepatomegaly). Symptoms of a grossly enlarged liver include abdominal discomfort or “feeling full.”

What is portal hypertension?

Portal hypertension is high blood pressure in the portal vein, which supplies the liver with blood from the intestine and spleen. Portal hypertension may be due to increased blood pressure in the portal blood vessels, or resistance to blood flow through the liver.

Portal hypertension can lead to the growth of new blood vessels (called collaterals) that connect blood flow from the intestine to the general circulation, bypassing the liver. When this occurs, substances that are normally removed by the liver pass into the general circulation.

Symptoms of portal hypertension may include:

  • Ascites
  • Development of varicose veins. Varicose veins (esophageal varices) develop most commonly at the lower end of the esophagus and in the stomach lining, although they can develop anywhere from the mouth to the anus.

What are esophageal varices?

Esophageal varices are dilated blood vessels within the walls of the lower part of the esophagus that are prone to bleeding. They can appear in people with severe liver disease.

A diseased liver can cause portal hypertension, which is high blood pressure in the portal vein. The portal vein supplies the liver with blood. Over time, this pressure causes blood vessels to grow, called collateral blood vessels.

These vessels act as channels to divert the blood under high pressure. The extra pressure in these vessels causes them to dilate and become tortuous. These vessels can eventually reach the lower esophagus and stomach and are prone to rupture.

The rupture can lead to significant blood loss from vomiting or from lost blood passing through the gastrointestinal tract. Symptoms of esophageal varices may include:

  • Painless vomiting of blood
  • Black, tarry or bloody stools
  • Decreased urine output
  • Excessive thirst
  • Light-headedness
  • Paleness
  • Anemia. A condition that indicates a low red blood cell count.

What is ascites?

Ascites is fluid buildup in the abdominal cavity caused by fluid leaks from the surface of the liver and intestine. Ascites due to liver disease usually accompanies other liver disease characteristics, such as portal hypertension. Symptoms of ascites may include a distended abdominal cavity, which causes discomfort and shortness of breath. Causes of ascites may include the following:

  • Liver cirrhosis (especially cirrhosis caused by alcoholism)
  • Alcoholic hepatitis
  • Obstruction of the hepatic vein

Ascites can also be caused by nonliver disorders.

What is liver encephalopathy?

Liver encephalopathy is the deterioration of brain function and damage to the nervous system due to toxic substances building up in the blood, which are normally removed by the liver. Liver encephalopathy is also called portal-systemic encephalopathy, hepatic encephalopathy, or hepatic coma. Symptoms may include:

  • Impaired consciousness
  • Changes in logical thinking, personality, and behavior
  • Mood changes
  • Impaired judgment
  • Drowsiness
  • Confusion
  • Sluggish speech and movement
  • Disorientation
  • Loss of consciousness
  • Coma
  • Seizures (rare)
  • Muscle stiffness or tremors
  • Uncontrollable movement

What is liver failure?

Liver failure is severe deterioration of liver function. Liver failure occurs when a large portion of the liver is damaged due to any type of liver disorder. Symptoms may include:

  • Jaundice
  • Tendency to bruise or bleed easily
  • Ascites
  • Impaired brain function
  • General failing health
  • Fatigue
  • Weakness
  • Nausea
  • Loss of appetite
  • Diarrhea

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/common-characteristics-of-liver-disease

Chronic Liver Disease/Cirrhosis

Portal Hypertension | Johns Hopkins Medicine

Linkedin Pinterest

Cirrhosis is when scar tissue replaces healthy liver tissue. This stops the liver from working normally.

Cirrhosis is a long-term (chronic) liver disease. The damage to your liver builds up over time.

The liver is your body’s largest internal organ. It lies up under your ribs on the right side of your belly.

The liver does many important things including:

  • Removes waste from the body, such as toxins and medicines
  • Makes bile to help digest food
  • Stores sugar that the body uses for energy
  • Makes new proteins

When you have cirrhosis, scar tissue slows the flow of blood through the liver. Over time, the liver can’t work the way it should.

In severe cases, the liver gets so badly damaged that it stops working. This is called liver failure.

What causes cirrhosis?

The most common causes of cirrhosis are:

  • Hepatitis and other viruses
  • Alcohol abuse
  • Nonalcoholic fatty liver disease (this happens from metabolic syndrome and is caused by conditions such as obesity, high cholesterol and triglycerides, and high blood pressure)

Other less common causes of cirrhosis may include:

  • Autoimmune disorders, where the body’s infection-fighting system (immune system) attacks healthy tissue
  • Blocked or damaged tubes (bile ducts) that carry bile from the liver to the intestine
  • Use of certain medicines
  • Exposure to certain toxic chemicals
  • Repeated episodes of heart failure with blood buildup in the liver
  • Parasite infections

Some diseases passed from parent to child (inherited diseases) may also cause cirrhosis. These may include:

  • Alpha1-antitrypsin deficiency
  • High blood galactose levels
  • Glycogen storage diseases
  • Cystic fibrosis
  • Porphyria (a disorder in which certain chemicals build up in the blood)
  • Hereditary buildup of too much copper (Wilson disease) or iron (hemochromatosis) in the body

What are the symptoms of cirrhosis?

Your symptoms may vary, depending on how severe your cirrhosis is. Mild cirrhosis may not cause any symptoms at all.

Symptoms may include:

  • Fluid buildup in the belly (ascites)
  • Vomiting blood, often from bleeding in the blood vessels in the food pipe (esophagus)
  • Gallstones
  • Itching
  • Yellowing of the skin and eyes (jaundice)
  • Kidney failure
  • Muscle loss
  • Loss of appetite
  • Easy bruising
  • Spider- veins in the skin
  • Low energy and weakness (fatigue)
  • Weight loss
  • Confusion as toxins build up in the blood

The symptoms of cirrhosis may look other health problems. Always see your healthcare provider to be sure.

How is cirrhosis diagnosed?

Your healthcare provider will look at your past health. He or she will give you a physical exam.

You may also have tests including:

  • Blood tests. These will include liver function tests to see if the liver is working the way it should. You may also have tests to see if your blood is able to clot.
  • Liver biopsy. Small tissue samples are taken from the liver with a needle or during surgery. The samples are checked under a microscope to find out the type of liver disease.

Your healthcare provider may want you to have imaging tests including:

  • CT scan (computed tomography). This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs.
  • MRI (magnetic resonance imaging). This test makes detailed pictures of organs and structures inside your body. It uses a magnetic field and pulses of radio wave energy. A dye may be shot (injected) into your vein. The dye helps the liver and other organs to be seen more clearly on the scan.
  • Ultrasound. This shows your internal organs as they work. It checks how blood is flowing through different blood vessels. It uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.

You may also have an upper endoscopy (EGD). A lighted flexible camera is placed through your mouth into your upper digestive tract to look for enlarged blood vessels that are at risk of bleeding because of your cirrhosis. 

If you have fluid in the belly (ascites), you may need a low sodium diet, water pills (diuretics), and removal of the fluid with a needle (paracentesis).

How is cirrhosis treated?

Cirrhosis is a progressive liver disease that happens over time. The damage to your liver can sometimes reverse or improve if the trigger is gone, such as stop drinking alcohol or if the virus is treated.

The goal of treatment is to slow down the buildup of scar tissue and prevent or treat other health problems.

In many cases, you may be able to delay or stop any more liver damage. If you have hepatitis, it may be treated to delay worsening of your liver disease.

Your treatment may include:

  • Eating a healthy diet, low in sodium
  • Not having alcohol or illegal drugs
  • Managing any health problems that happen because of cirrhosis  

Talk to your healthcare provider before taking prescription medicines, over-the-counter medicines, or vitamins.

If you have severe cirrhosis, treatment can’t control other problems. A liver transplant may be needed.

Other treatments may be specific to your cause of cirrhosis, such as controlling excessive iron or copper levels, or using immune suppressing medicines.

Be sure to ask your healthcare provider about recommended vaccines. These include vaccines for viruses that can cause liver disease.

What are the complications of cirrhosis?

Cirrhosis can cause other health problems such as:

  • Portal hypertension. The portal vein carries blood from your intestines and spleen to your liver. Cirrhosis slows the normal flow of blood. That raises the pressure in the portal vein. This is called portal hypertension.
  • Enlarged blood vessels. Portal hypertension may cause abnormal blood vessels in the stomach (called portal gastropathy and vascular ectasia) or enlarged veins in the stomach and the food pipe or esophagus (called varices). These blood vessels are more ly to burst due to thin walls and higher pressure. If they burst, severe bleeding can happen. Seek medical attention right away.
  • Ascites. Fluid collecting in your belly. This can become infected. 
  • Kidney disease or failure
  • Easy bruising and severe bleeding. This happens when the liver stops making proteins that are needed for your blood to clot.
  • Type 2 diabetes. When you have cirrhosis, your body does not use insulin properly (insulin resistance). The pancreas tries to keep up with the need for insulin by making more, but blood sugar (glucose) builds up. This causes type 2 diabetes.
  • Liver cancer

Key points about cirrhosis

  • Cirrhosis is when scar tissue replaces healthy liver tissue. This stops the liver from working normally.
  • Cirrhosis is a long-term (chronic) liver disease.
  • The most common causes are hepatitis and other viruses, and alcohol abuse. Other medical problems can also cause it.
  • The damage to the liver usually can’t be reversed.
  • The goal of treatment is to slow down the buildup of scar tissue and prevent or treat any problems that happen.
  • In severe cases, you may need a liver transplant.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-liver-disease-cirrhosis

Portal Vein Thrombosis Misdiagnosis Lawsuit

Portal Hypertension | Johns Hopkins Medicine
Morgan v. Johns Hopkins Hospital

This is a failure to diagnose portal vein thrombosis case filed against Johns Hopkins Hospital on February 5, 2016. This is the 57th medical malpractice lawsuit filed in Maryland in 2016 and the fourth malpractice suit filed against Hopkins in the last month.

Summary of Plaintiff's Allegations

A Baltimore County woman is diagnosed with solid pseudopapillary neoplasm, a disease of the pancreas, by the Defendant doctor. She is advised that she needs Whipple surgery, an operation to remove part of the pancreas, small intestine, and bladder. She is admitted to Defendant Johns Hopkins Hospital for the surgery.

During the surgery, the Defendants cause an injury to the woman's portal vein, which they fail to discover during the surgery. For the next two years, under the care of the Defendants, the woman experiences a continuum of medical problems and complications including but not limited to difficulty eating, vomiting, nausea, and pain.

Test results reveal during the post-operative period that the woman has an enlarged spleen. This coupled with other diagnostic studies should have led the Defendants to test the woman further. Further evaluations would have led the Defendants to discover that the woman had sustained a portal vein thrombosis.

An angiogram would have definitively ruled in or out portal vein thrombosis, was not done. An endoscopy, which also would have diagnosed the problem, as also not done.

It is not until two years following the surgery, under the care of other medical providers, when the woman learns for the first time the true nature, extent, and cause of her medical injury.

The woman files a medical malpractice lawsuit in Baltimore City. She alleges that the Defendants violated the standard of care by failing to diagnose the serious nature of her problems and take proper action to treat her.

As a result, she has been forced to and continues to suffer long periods of serious physical and emotional pain and discomfort, has undergone multiple additional procedures and medical treatment, and has a diminished quality of life.

Additional Comments

  • You often see portal vein thrombosis in people who have an inflammatory bowel disease ulcerative colitis or Crohn's Disease. Any intraabdominal inflammatory process involving the bowel carries a known risk of portal vein thrombosis.
  • The majority of portal vein thrombosis arises in individuals who have cirrhosis of the liver.
  • A blockage in the portal vein area will result in back pressure called venostasis. This prevents the blood coming back from the intestines from getting into the liver unimpeded. This venostasis will cause stagnation, which means the blood is backing up. Oxygenated blood cannot get into the intestine, and parts of the intestine will die.
  • No expert report was filed with the Complaint.

Jurisdiction Defendants

  • Johns Hopkins Hospital
  • Two surgeons

Negligence

  • Failed to diagnose the serious nature of her problems and take proper action to treat her.

Specific Counts Pled

  1. Healthcare Malpractice
  2. Healthcare Malpractice – Vicarious Liability
  3. Negligence

Plaintiff's Experts and Areas of Specialty Examples of Lawsuits Against Hopkins More Malpractice Claim Information

  • Looking for co-counsel to help you fight your client's medical malpractice claim? Learn about what Miller & Zois can deliver to you and your client to increase the settlement and trial value of your case. Our firm will split attorneys' fees with co-counsel consistent with the Maryland Rules
  • This is what a sample legal complaint against Hopkins looks
  • CALL 800-553-8082 or get a free online medical negligence serious injury and wrongful death claims. Miller & Zois handles medical mishap claims throughout the entire state of Maryland and the District of Columbia

Getting a Lawyer for Your Malpractice Claim

If you have suffered as a result of the negligence of a doctor, nurse or hospital, Miller & Zois can help you. You are entitled to justice and monetary compensation for the needless harm that has been done to you.

Miller & Zois has a very long history of results in medical malpractice and nursing home cases in Maryland, earning large verdicts and settlements, including at $10 million verdict in 2016 in a wrongful death case.

Call today to speak with a caring medical negligence attorney who will help you at 800-553-8082 or get a free online case review.

Source: https://www.millerandzois.com/thrombosis-misdiagnosis-lawsuit.html

Portal Hypertension

Portal Hypertension | Johns Hopkins Medicine

Linkedin Pinterest

Portal hypertension is elevated pressure in your portal venous system. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver.

Portal Hypertension Symptoms

If you have an advanced liver disease, such as cirrhosis, you have an increased risk of developing portal hypertension. Be aware of unusual symptoms and report them to your doctor right away. Symptoms and signs of portal hypertension include:

  • Gastrointestinal bleeding: You may notice blood in the stools, or you may vomit blood if any large vessels around your stomach that developed due to portal hypertension rupture.
  • Ascites: When fluid accumulates in your abdomen, causing swelling
  • Encephalopathy, or confusion and fogginess in thinking
  • Jaundice, the yellowing of the skin and the whites of the eyes
  • Edema, (swelling) of the legs
  • Caput medusa, a visible network of dilated veins surrounding your navel

Portal Hypertension Diagnosis at Johns Hopkins

There are a number of ways to diagnose portal hypertension. For patients with end-stage liver disease who present with ascites and varices, the doctor may not need to perform any diagnostic tests and can confirm a diagnosis symptoms.

Diagnostic procedures your doctor may order include:

  • Imaging and blood tests
  • Pressure measurement studies
  • Endoscopic diagnosis

Imaging Studies

An imaging study helps in the diagnosis of cirrhosis and portal hypertension. They are noninvasive and can give your doctor a detailed image of your portal venous system. A duplex Doppler ultrasound is typically the first imaging test ordered.

A Doppler ultrasound uses sound waves to see how the blood flows through your portal vein.

The ultrasound gives your doctor a picture of the blood vessel and its surrounding organs, as well as the speed and direction of the blood flow through the portal vein.

Pressure Measurement Studies

An interventional radiologist may perform a pressure measurement study to evaluate the level of pressure in the hepatic (liver) vein. This can be done as an outpatient, where a radiologist will access one of your veins, usually via internal jugular vein.

Endoscopic Diagnosis

Endoscopy is another way to diagnose varices, which are large vessels associated with portal hypertension.

An endoscopy can provide a definitive diagnosis of the varices and allow your doctor to treat and reduce the risk of bleeding or active bleeding.

During a gastrointestinal endoscopy, your doctor can see the mucous lining of the upper gastrointestinal tract, including the esophagus, stomach and duodenum (first part of the small intestine).

During an upper endoscopy:

  • You receive an anesthetic to help relax your gag reflex. You will also receive pain medication and a sedative.
  • You lie on your left side, referred to as the left lateral position.
  • Your doctor inserts the endoscope (a thin, flexible, lighted tube with a camera) through your mouth and pharynx, into the esophagus.
  • Your doctor can visualize the esophagus, stomach and duodenum with the endoscope.

Ascites

Ascites is excess fluid in your abdominal cavity. Patients with chronic liver disease often develop ascites, though it may be caused by other factors. Symptoms of ascites include:

  • Early feeling of fullness
  • Increase in size of abdomen
  • Feeling breath (if the fluid begins pushing on your lungs)

You will need to follow a low-sodium diet, as sodium causes fluid retention in your body. In severe cases, you may need to restrict your water intake. A prescription diuretic may help reduce sodium retention in your kidneys.

Sometimes, a large volume paracentesis may be necessary if the ascites is difficult to manage. During a paracentesis, your doctor inserts a needle into your abdomen to remove the fluid.

Varices

Varices are varicose veins associated with portal hypertension. Your doctor can view them during an endoscopy (internal viewing of your gastrointestinal tract) or other imaging study. Varices most often occur in the esophagus or stomach as a result of portal hypertension. This is often because the liver tissue is scarred and blood cannot flow through normally.

As the portal blood is rerouted due to the increased resistance, varices develop. In patients with cirrhosis, most often the bleeding is related to esophageal varices, which are enlarged veins in your esophagus. Acute bleeding from varices in patients with portal hypertension requires immediate attention in order to control the bleeding and prevent it from recurring.

Encephalopathy

Hepatic encephalopathy is impairment in neuropsychiatric function associated with portal hypertension. Symptoms are usually mild, with subtle changes in behavior, changes in sleep pattern, mild confusion or slurred speech.

However, it can progress to more serious symptoms, including severe lethargy and coma.  Although we lack clear understanding of encephalopathy, there is an association with increase in ammonia concentration in the body.

(However this does not correlate to regular blood test levels of ammonia).

Hepatic encephalopathy is diagnosed by healthcare providers in clinic. It is usually treated with medications such as lactulose, which can decrease the ammonia absorption in the GI tract. It is also treated with antibiotics, such as rifaximin and neomycin.

Portal Hypertension Treatment at Johns Hopkins

The goal of treatment for portal hypertension is to prevent further complications and decrease pressure. However, it can be difficult to maintain the proper pressure. Learn more about portal hypertension treatment at Johns Hopkins.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/portal-hypertension

My Transamerica Retirement Account

Portal Hypertension | Johns Hopkins Medicine

Important information about consolidation: Transfer specialists are registered representatives of TISC.

Review the fees and expenses you pay, including any charges associated with transferring your account, to see if consolidating your accounts could help reduce your costs.

Be sure to consider whether such a transfer changes any features or benefits that may be important to you.

The role of the onsite Retirement Planning Consultant is to assist you with your retirement plan.

There are no additional charges for meeting with your Retirement Planning Consultant, who is a registered representative with Transamerica Investors Securities Corporation (TISC), member FINRA, 440 Mamaronek Avenue, Harrison, NY 10528, and registered investment advisor of Transamerica Retirement Advisors, LLC (TRA), Registered Investment Advisor. All Transamerica companies are affiliated, but are not affiliated with your employer.

IMPORTANT INFORMATION: About Probability Illustrations, Limitations, and Key Assumptions

The probability illustrations generated from the engine are “Monte Carlo” simulations of 500 possible investment scenarios for a given time period and assume a range of possible returns.

The illustrations are generated according to models developed by Morningstar Investment Management LLC, a leading independent provider of asset allocation, manager selection, and portfolio construction.

The Your Retirement Outlook® graphic reflects the difference between the model’s estimated annual income (which corresponds to a 70% probability level of income in the investment scenarios simulated) and your annual income goal.

When forecasting the probability of achieving your income goal, the model employs different returns for different asset classes, Morningstar Investment Management’s capital market assumptions developed using historical and forward-looking data.

Forecasts of expected return, expected standard deviation and correlation among asset classes Morningstar Investment Management LLC's proprietary equity, fixed income, currency and risk models.

Current assets are assigned to asset classes Morningstar Categories, and fees and charges inherent in investing are incorporated with an average fee assumption for each asset class. The benchmarks used for modeling the various asset classes are below.

Return assumptions are updated annually; these updates may have a material impact on your projections. Return assumptions are estimates not guarantees. The returns you experience may be materially different than projections. You cannot invest directly in an index.

Lower Risk/Volatility Asset ClassCash Alternatives Short Term Bonds Aggregate Bonds Foreign Bonds Direct Real Estate High Yield Bonds TIPS Long Term Bonds Large Cap Value Equity Large Cap Equity Mid Cap Value Equity Mid Cap Equity International Equity Commodities Mid / Small Cap Value Equity Large Cap Growth Equity Mid / Small Cap Equity Small Cap Value Equity Small Cap Equity Mid Cap Growth Equity Mid / Small Cap Growth Equity REITs Small Cap Growth EquityEmerging Markets Equity BenchmarkBofA ML US Treasury Bill 3 Month USD BarCap US Govt/Credit 1-3 Yr TR USD Barclays Capital US Agg Bond TR Barclays Global Aggregate Ex USD TR NCREIF Transaction Based Index Barclays Capital US Corporate High Yield TR Barclays Capital Global Inflation Linked US TIPS TR Barclays Capital US Govt/Credit Long TR Russell 1000 Value TR Russell 1000 TR Russell Mid Cap Value TR Russell Mid Cap TR MSCI EAFE GR Bloomberg Commodity TR Russell 2500 Value TR Russell 1000 Growth TR Russell 2500 TR Russell 2000 Value TR Russell 2000 TR Russell Mid Cap Growth TR Russell 2500 Growth TR FTSE NAREIT Equity REITs TR Russell 2000 Growth TRMSCI EM GR
Higher Risk/Volatility

Unless you choose otherwise or your employer supplies different information, the probability illustrations assume retirement at the age at which you qualify for full Social Security benefits and an annual retirement income goal of 80% of your projected final working salary.

Social Security estimates are the Social Security Administration methodology and your current salary.

The probability illustrations also assume a consistent contribution percentage and asset allocation (no future changes or rebalancing unless you are subscribed to a managed account or a target date asset allocation service), annual inflation of approximately 2%, and annual salary increases a calculation that incorporates multiple factors including a salary growth curve and inflation. Mortality assumptions are the Society of Actuaries tables.

The engine utilizes models, algorithms and/or calculations (“Models”). The Models are subject to a number of limitations. Returns associated with market extremes may occur more frequently than assumed in the Models. Some asset classes have relatively limited histories; for these classes the Models use historical data for shorter time periods.

The Model does not consider other asset classes such as hedge funds or private equity, which may have characteristics similar or superior to those used in the Model.

Capital market assumptions are forecasts which involve known and unknown risks, uncertainties, and other factors which may cause the actual results to differ materially and/or substantially from any future results, performance, or achievements expressed or implied by those projections for any reason. Additionally, Models have inherent risks.

Models may incorrectly forecast future behavior or produce unexpected results resulting in losses.

The success of using Models depends on numerous factors, including the validity, accuracy and completeness of the Model’s development, implementation and maintenance, the Model’s assumptions, factors, algorithms and methodologies, and the accuracy and reliability of the supplied historical or other data. If incorrect data is entered into even a well-founded Model, the resulting information will be incorrect. Investments selected with the use of Models may perform differently than expected as a result of the design of the Model, inputs into the Model, or other factors.

There is no guarantee that your income goal will be achieved or that the aggregate accumulated amount will ensure a specified annual retirement income. Results may vary with each use and over time.

IMPORTANT: The projections or other information generated by the engine regarding the lihood of various investment outcomes are hypothetical in nature, do not reflect actual investment results, and are not guarantees of future results.

Moreover, even though the tool’s estimates are statistically sound based upon the simulations it runs, the tool cannot foresee or account for every possible scenario that may negatively impact your financial situation.

Thus you should monitor your account regularly and base your investment decisions on your time horizon, risk tolerance, and personal financial situation, as well as on the information in the prospectuses for investments you consider.

Transamerica has licensed the Morningstar® Wealth Forecasting EngineSM from Morningstar, Inc.

, which is used by Morningstar Investment Management LLC, a registered investment adviser and subsidiary of Morningstar, Inc, in the services it provides to participants.

Morningstar and Morningstar Investment Management are not affiliated with Transamerica. The Morningstar name and logo are registered marks of Morningstar, Inc.

Source: https://www.transamerica.com/portal/jhm/

Everything You Should Know About Portal Hypertension

Portal Hypertension | Johns Hopkins Medicine

The portal vein carries blood from your stomach, pancreas, and other digestive organs to your liver. It differs from other veins, which all carry blood to your heart.

The liver plays an important role in your circulation. It filters out toxins and other waste matter that the digestive organs have deposited in your bloodstream. When the blood pressure in the portal vein is too high, you have portal hypertension.

Portal hypertension can be quite serious, though it’s treatable if diagnosed in time. It’s not always easy to diagnose, however. Typically, you become alerted to the condition when you start experiencing symptoms.

Fast fact

Arteries carry oxygen-rich blood from your heart to your organs, muscles, and other tissue. Veins carry blood back to your heart, except for the portal vein, which carries blood to your liver.

Gastrointestinal bleeding is often the first sign of portal hypertension. Black, tarry stools can be a sign of gastrointestinal bleeding. You may also actually see blood in your stools.

Another symptom is ascites, which is a buildup of fluid in your belly. You may notice that your belly is getting bigger because of ascites. The condition can also cause cramps, bloating, and shortness of breath.

As well, becoming forgetful or confused could be a result of a circulation problem related to your liver.

The main cause of portal hypertension is cirrhosis. This is a scarring of the liver. It can result from several conditions such as hepatitis (an inflammatory disease) or alcohol abuse.

Autoimmune diseases of the liver such as autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cholangitis also are causes of cirrhosis and portal hypertension.

Whenever your liver is harmed, it attempts to heal itself. This causes scar tissue to form. Too much scarring makes it harder for your liver to do its job.

Other cirrhosis causes include:

  • nonalcoholic fatty liver disease
  • iron buildup in your body
  • cystic fibrosis
  • poorly developed bile ducts
  • liver infections
  • reaction to certain medications, such as methotrexate

Cirrhosis can cause the normally smooth inner walls of the portal vein to become irregular. This can increase resistance to blood flow. As a result, blood pressure in the portal vein increases.

A blood clot can also form in the portal vein. This can increase the pressure of blood flow against the walls of the blood vessel.

People at an increased risk for cirrhosis are at an increased risk for portal hypertension. If you have a long history of alcohol abuse, you face a higher risk of cirrhosis. You’re at a higher risk of hepatitis if any of the following apply to you:

  • You use needles to inject drugs.
  • You received tattoos or piercings in unsanitary conditions.
  • You work in a place where you may have had contact with infected needles or infected blood.
  • You received a blood transfusion before 1992.
  • Your mother had hepatitis.
  • You have unprotected sex with multiple partners.

Portal hypertension is difficult to diagnose if symptoms aren’t obvious. Screenings such as a doppler ultrasound are helpful. An ultrasound can reveal the condition of the portal vein and how blood is flowing through it. If an ultrasound is inconclusive, a CT scan may be helpful.

Another screening method that’s becoming more widely used is a measurement of the elasticity of your liver and surrounding tissue. Elastography measures how tissue responds when it’s pushed or probed. Poor elasticity suggests the presence of disease.

If gastrointestinal bleeding has occurred, you’ll ly undergo an endoscopic examination. This involves the use of a thin, flexible device with a camera at one end that allows your doctor to see internal organs.

Portal vein blood pressure can be determined by inserting a catheter fitted with a blood pressure monitor into a vein in your liver and taking a measurement.

Lifestyle changes such as these can help treat portal hypertension:

  • improving your diet
  • avoiding alcohol consumption
  • exercising regularly
  • quitting smoking if you smoke

Medications such as beta-blockers are also important to help reduce your blood pressure and relax your blood vessels. Other medications, such as propranolol and isosorbide, may help lower the pressure in the portal vein, too. They can also reduce the risk of more internal bleeding.

If you’re experiencing ascites, your doctor may prescribe a diuretic to help reduce fluid levels in your body. Sodium must also be severely restricted to help reduce fluid retention.

A treatment called sclerotherapy or banding uses a solution that can help stop bleeding in the blood vessels of your liver. Banding involves the placement of rubber bands to block unhealthy blood flow to enlarged veins, known as varices or varicose veins, in your digestive system.

Another increasingly popular therapy is called nonsurgical transjugular intrahepatic portal-systemic shunt (TIPSS). This therapy helps control acute bleeding. It creates new pathways for blood to flow from the portal vein into other blood vessels.

One of the more common complications associated with portal hypertension is portal hypertensive gastropathy. The condition affects the mucus membrane of your stomach and enlarges blood vessels.

The pathways created between blood vessels in TIPSS can become blocked. This can lead to further bleeding. If liver problems continue, you could have further cognitive problems as well.

You can’t reverse damage caused by cirrhosis, but you can treat portal hypertension. It may take a combination of a healthy lifestyle, medications, and interventions. Follow-up ultrasounds will be necessary to monitor the health of your liver and the results of a TIPSS procedure.

It will be up to you to avoid alcohol and live a healthier life if you have portal hypertension. You’ll also need to follow your doctor’s instructions. This goes for medications and follow-up appointments.

Drink alcohol moderately, if at all. And take steps to avoid hepatitis. Talk with your doctor about hepatitis vaccinations and whether you should have them. You may also want to be screened for hepatitis if you’re in an at-risk group.

Portal hypertension is caused by declining liver health, but you may be able to avoid this challenging vascular disease through healthy lifestyle choices.

Source: https://www.healthline.com/health/portal-hypertension