Contributor: Travis Barlock, MD
Educational Pearls:
What is Portal Vein Thrombosis?
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The formation of a blood clot within the portal vein, which carries blood from the gastrointestinal tract, pancreas, and spleen to the liver
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Not only can this cause problems downstream in the liver, but the backup of venous blood can cause ischemia in the bowels
How does it present?
How is it diagnosed?
What causes it?
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Cirrhosis
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Coagulopathy (Factor V Leiden mutation, Prothrombin gene mutation, Antiphospholipid syndrome, Protein C, protein S, antithrombin III deficiency, etc.)
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Oral Contraceptive Pills (OCPs)
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Cancer such as hepatocellular carcinoma
How is it treated?
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Aggressive fluid resuscitation
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Antibiotics. Be sure to cover enteric gram-negative bacteria and anaerobes
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Heparin, same dosing as a bolus for a DVT
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Endovascular treatment, such as a thrombectomy with IR
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Surgical evaluation if there has been tissue death in the mesentery
References
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Hilscher, M. B., Wysokinski, W. E., Andrews, J. C., Simonetto, D. A., Law, R. J., & Kamath, P. S. (2024). Portal Vein Thrombosis in the Setting of Cirrhosis: Evaluation and Management Strategies. Gastroenterology, 167(4), 664–672. https://doi.org/10.1053/j.gastro.2024.05.017
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Intagliata, N. M., Caldwell, S. H., & Tripodi, A. (2019). Diagnosis, Development, and Treatment of Portal Vein Thrombosis in Patients With and Without Cirrhosis. Gastroenterology, 156(6), 1582–1599.e1. https://doi.org/10.1053/j.gastro.2019.01.265
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Ju, C., Li, X., Gadani, S., Kapoor, B., & Partovi, S. (2022). Portal Vein Thrombosis: Diagnosis and Endovascular Management. Pfortaderthrombose: Diagnose und endovaskuläres Management. RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 194(2), 169–180. https://doi.org/10.1055/a-1642-0990
Summarized by Jeffrey Olson MS3 | Edited by Jorge Chalit, OMS3
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