1. PORTAL VEIN THROMBOSIS ETIOLOGY, DIAGNOSIS AND MANAGEMENT (original) (raw)
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Diagnosis and management of portal vein thrombosis in patients with cirrhosis of liver
The Southwest Respiratory and Critical Care Chronicles, 2018
Portal vein thrombosis (PVT) is an occlusion of the portal venous system and is a common complication of liver cirrhosis. It can present as either an acute or chronic complication. Acute PVT can present with abdominal pain, diarrhea, ileus, and bleeding. Chronic PVT is often asymptomatic; however, it can be discovered in cases of worsening portal hypertension. Portal vein thrombosis is diagnosed by imaging modalities, such as ultrasound and computed tomography. Contrast-enhanced imaging can be used in cases with difficult visualization. Despite the hemostatic imbalance in cirrhosis, anticoagulants can be safely used to recanalize the vein. Transjugular intrahepatic portosystemic shunt procedures are also an effective method for recanalization.
Portal vein thrombosis (PVT): A study of 20 non-irrhotic cases
Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
Portal and mesenteric venous thrombosis (PVT) is an uncommon disease with serious consequences if not discovered early in order to prevent complications such as variceal bleeding and intestinal ischaemia. The objective of this study was to describe the clinical presentation and outcome of patients with PVT with a view to early diagnosis and treatment of this disease. The study was restricted to patients with PVT not caused by underlying liver cirrhosis. To analyse important clinical characteristics of this entity we performed a retrospective study of 20 non-cirrhotic patients seen in our hospital from February 1998 to March 2003. The main clinical symptom was abdominal pain (13 patients, 86%), sometimes in combination with diarrhoea and vomiting (5 patients, 33%), nausea and anorexia (3 patients). Laboratory signs were non-specific and diagnosis was usually by computed tomography (19 patients, 95%). Causative factors included prothrombotic states (9 patients, 45%) and/or local facto...
Abdominal Pain: An Ominous Sign of Portal Vein Thrombosis—Case Series
OALib
Portal vein thrombosis (PVT) is a disease in which thrombosis occurs from the intrahepatic branches of the portal vein and may extend to the splenic vein and/or superior mesenteric vein. It is most often associated with liver cirrhosis. PVT not associated with cirrhosis is rare. The aim of this case series of portal vein thrombosis is to give importance that even though PVT is a rare cause of abdominal pain, timely diagnosis, and appropriate management is vital due to its lethal complications such as mesenteric ischemia and mesenteric infarction and late complication like portal hypertension.
Saudi Journal of Gastroenterology, 2015
Noncirrhotic portal hypertension (NCPH), as it generally is termed, is a heterogeneous group of diseases that is due to intrahepatic or extrahepatic etiologies. In general, the lesions in NCPH are vascular in nature and can be classified based on the site of resistance to blood flow as "prehepatic," "hepatic," and "posthepatic." The "hepatic" causes of NCPH can be subdivided into "presinusoidal," "sinusoidal," and "postsinusoidal [Table 1]." Portal vein thrombosis was first seen by Stewart and Balfour in the late 1860s in a patient with splenomegaly, ascites, and variceal dilatation. Kobrich coined the term cavernoma to describe spongy appearance of portal vein (PV). [1] Generally a hypercoagulable state, intra-abdominal infection/peritonitis, and PV anomaly (PV stenosis and atresia) are considered important predisposing factors of EHPVO; however, vast majority of cases are due to primary thrombosis of the PV and often with more than one cause. Accurate epidemiological data on PVT is difficult to obtain. Prevalence of autopsy research in the United States and Japan ranges from 0.05% to 0.5% population prevalence of portal vein thrombosis (PVT) studied by Ogran et al. seen on autopsy series is 1%. [2] Thus PVT is responsible for 5%-10% of all cases of portal hypertension in western countries. Of all cases of portal hypertension (PHT) in developing countries, 40% are attributed to PVT. In children, EHPVO accounts for 80% cases of PHT. [3] Incidence of PVT among liver cirrhotics ranges from 0.6% to 64.1%. [4] After cirrhosis, EHPVO is the most common cause of portal hypertension globally. In the Indian subcontinent, 20%-30% of all variceal bleeds are due to EHPVO. In Japan, 10%-20% of variceal bleeds and in the west, 2%-5% of variceal bleeds are due to EHPVO. Clinical presentation of PVT is different in acute and chronic thrombosis. This depends on development and extent of collateral circulation. Intestinal congestion and ischemia with abdominal pain, fever, diarrhea, rectal bleeding, distension, sepsis, and lactic acidosis with or without splenomegaly are common features of acute PVT.
Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment
World Journal of Gastroenterology, 2010
Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a patient's outcome. In this review, we analyze the physiopathological mechanisms of PVT development, together with the hemodynamic and functional alterations related to this condition. Moreover, we describe the principal factors most frequently involved in PVT development and the recent knowledge concerning diagnostic and therapeutic procedures. Finally, we analyze the implications of PVT in the setting of liver transplantation and its possible influence on patients' future prognoses.
Non Cirrhotic Portal Vein Thrombosis: Diagnostic and Therapeutic Challenge
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
Portal vein thrombosis (PVT), the second most common cause of portal hypertension, can be found in cirrhosis and non-cirrhosis patients. Various factors can cause non-cirrhosis PVT, such as biliary infection. Upper gastrointestinal bleeding without sign of liver failure, must be considered as non-cirrhosis PVT manifestation. Combining physical, laboratory, endoscopic and radiological examination is needed to establish the diagnosis of PVT. The principle of PVT management consists of 3 keypoints. They are prevention and treatment of gastrointestinal bleeding, prevention of recurrent thrombosis and portal cholangiopathy therapy. Many aspect should be considered regarding the administration of anticoagulants in PVT patients, especially chronic PVT with cavernomas.
Portal vein thrombosis: A concise review (Review)
Experimental and Therapeutic Medicine, 2021
Portal vein thrombosis (PVT) is a frequent complication in cirrhotic patients, but it may also exist as a basic vascular condition even without any liver damage. Local and systemic factors play a significant role in the pathogenesis of PVT; yet, in practice, more than one factor may be identified. PVT can be considered a result of liver fibrosis and hepatic insufficiency. The JAK2 mutation has been accepted as a factor producing PVT. In general, the anticoagulants are recommended but this therapy should be used carefully in treating patients that associate coagulopathy or thrombocytopenia and esophageal varices. Acute PVT without bowel infarction has a good prognosis. In liver cirrhosis, the mortality due to hemorrhage is higher than in chronic PVT. Therefore, for the patients with PVT, the survival rate is decreased by 55% in two years, due to hepatic insufficiency. Regarding the treatment, LMWH (low molecular weight heparine) is the most utilized in patients with cirrhosis, non-malignancies, infections, or those who are awaiting a liver transplant. DOACs (direct-acting oral anticoagulants) may be used in the rest of the medical conditions, being safe and equal to LMWH.
Background and objectives: Portal vein thrombosis (PVT) is an increasingly recognized complication of liver cirrhosis. It is associated with worsening liver function, ascites and the occurrence of gastroesophageal variceal bleeding. The aim of this work was to clarify the risk factors, clinical presentation and complications of portal vein thrombosis in Egyptian patients with liver cirrhosis and to study the outcome with and without treatment after 6 months follow up period. Methods: Hospitalized cirrhotic patients (N = 80) were segregated into the PVT and non-PVT groups. PVT was detected by Doppler ultrasonography; each group was divided in two sub groups (A and B) according to presence or absence of HCC respectively. The 2 groups were compared as regards risk factors, clinical presentation and complications. The outcome of treatment with anticoagulation in 6 patients was evaluated. Result: PVT developed as result of combination of both local and systemic risk factors. HCC, abdominal infection especially spontaneous bacterial peritonitis and abdominal intervention were the most important local risk factors. Abnormalities of coagulation system were among systemic risk factors. Most of cases were asymptomatic and accidentally discovered, others presented with upper GIT bleeding or other complications of liver cell failure. Anticoagulant administration was associated with increased incidence of partial or complete recanalization and less mortality without increased risk of bleeding. Conclusion and Recommendations: Portal vein thrombosis occurs mostly in cirrhotic patients with advanced liver disease. HCC is the most common local risk factor in our country. Patients with less prolonged coagulation parameters might be at particular risk for developing PVT, so regular monitoring using Doppler-ultrasound should be carried out in these patients. Development of varices is a time dependent phenomenon; it is advisable to screen all PVT patients endoscopically. Owing to decrease complications, early administration of anticoagulation is advised in selected cases.