Lvr

Portal Vein Thrombosis

search

Portal Vein Thrombosis

  • Causes
  1. Cirrhosis
  2. Pancreatitis
  3. Hepatocellular Carcinoma
  4. Abdominal Surgery (esp. Gastric Sleeve, the most common surgical cause)
    1. Presents 7-10 days post-op with diffuse Abdominal Pain, Nausea, Vomiting, Leukocytosis
      1. Emergent consult to Bariatric Surgery and Intervention Radiology
  • Symptoms
  1. Acute
    1. Sudden onset Right Upper Quadrant or Epigastric Abdominal Pain
    2. Vomiting
  2. Chronic
    1. Intermittent mild Abdominal Pain
  • Signs
  1. Hepatomegaly
  2. Splenomegaly
  3. Ascites
  4. Ankle edema
  • Differential Diagnosis
  1. Budd-Chiari Syndrome (Hepatic Vein Thrombosis)
  2. Cirrhosis
  3. Sarcoidosis
  • Labs
  1. Liver Function Tests
  2. Hypercoagulable evaluation
  • Diagnosis
  1. CT Abdomen Pelvis with IV Contrast
  2. Doppler Ultrasound
  3. MRI with MRA
  4. Angiography
  • Management
  1. See Portal Hypertension
  2. See Esophageal Varices
  3. Initially treated with Heparin (and in some cases catheter directed or systemic Thrombolytics)
    1. Anticoagulation
    2. Directed Thrombolysis
  4. Surgical hepatic shunt placement
  • Complications
  1. Portal Hypertension