HWN Suggests

Liver Let Die? Approach to Splanchnic Vein Thrombosis & Shock Liver

We are rapid to interrogate the possibility of cauda equina syndrome (CES) in our patients with back pain or to apply Well’s criteria for PE or DVT. We are much less likely however to think about splanchnic vein thrombosis in our abdominal pain patients. Compared to PE/DVT, splanchnic vein thrombosis is 22.5x more likely... Therefore we need to start including it in our differential diagnoses.

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 An Approach to Acute Portal Vein Thrombosis

The presentation is often asymptomatic. Knowing the risk factors is essential... Intestinal congestion from PVT can present with abdominal pain, distension, diarrhea, nausea, vomiting, anorexia, fever, splenomegaly, ischemia, lactic acidosis, and sepsis.

 How I treat splanchnic vein thrombosis

Antithrombotic treatment of splanchnic vein thrombosis (SVT) is a clinical challenge. Depending on the site of thrombosis, patients are at risk of developing liver insufficiency, portal hypertension, or bowel infarction and may experience recurrence in both the splanchnic veins and other vein segments. To prevent recurrence, anticoagulant therapy should be started as soon as possible after diagnosis and is often continued for an indefinite period of time. However, active bleeding is not infrequent at the time of SVT diagnosis, and major risk factors for bleeding, such as esophageal varices or a low platelet count, are frequently present in these patients. In real-world clinical practice, a proportion of SVT patients are left untreated because the risks associated with anticoagulant therapy are felt to exceed its benefits.

 Portal vein thrombosis and cirrhosis—old wine, new wine

The diagnosis of PVT can be divided into two broad headings of clinical and radiological assessments. Clinically, patients could present with acute abdominal symptoms with catastrophic consequences, worsening portal hypertension complications or be completely asymptomatic. Radiologically, PVT can be diagnosed when there is presence of thrombus formation in the portal vein in the presence of/or absence of Porto-portal collateral formation (also referred to as cavernoma).

Articles of Interest

Liver Emergencies: Thrombosis and Bleeding, Portal Vein Thrombosis, SBP, Paracentesis Tips and Tricks

We clear up the confusing balance between thrombosis and bleeding in liver patients, the elusive diagnosis of portal vein thrombosis, spontaneous bacterial peritonitis diagnosis and treatment and some tips and tricks on paracentesis.

Portal vein thrombosis in cirrhosis: A literature review

It was believed that PVT occurred predominantly due to prothrombotic potential. However, recent studies have shown that decreased blood flow related to portal hypertension appears to increase PVT risk as per Virchow’s triad.

Portal vein thrombosis – a primer for the general physician

PVT is often picked up incidentally on a radiological test that was not intended to diagnose the condition. In any patient who has been diagnosed with PVT, continuous monitoring to look for signs of intestinal ischaemia is important.

Portal Vein Thrombosis: A Primer for Emergency Medicine Physicians

In general, treatment is aimed at recanalization and prevention of thrombotic extension, especially into the mesenteric vein. There is conflicting data on the risks and benefits of anticoagulation, but general consensus is to begin anticoagulation as early as possible regardless of which venous segment is involved.

Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment

Although in the general population PVT is considered a rare event, its prevalence among cirrhotic patients ranges between 4.4%-15%, and is responsible for about 5%-10% of overall cases of portal hypertension.

Portal Vein Thrombosis: The Overlooked Association between Pancreatic Cancer and PVT

Portal vein thrombosis (PVT) is a complication of prothrombic disorders liver cirrhosis and malignancies. Pancreatic malignancy, specifically, is notorious for this complication because it upregulates tissue factor production, which activates the extrinsic coagulation cascade, thus inducing a hypercoagulable state.

The ABCD of portal vein thrombosis: a systematic approach

Here, we present a brief review of the anatomy of the portal venous system and a systematic approach to analyzing the condition, using a mnemonic (ABCD, for age, biology, collaterals, and diffusion). We discuss the various imaging methods and illustrate our discussion with images selected from the case files archived at our facility.

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Life in the Fastlane

If cirrhosis, then mimics portal hypertension with ascites, if no cirrhosis, then ascites is absent.

StatPearls

PVT frequently occurs with cirrhosis of the liver. It may also occur with malignancy, abdominal sepsis, pancreatitis, systemic lupus erythematosus, or other conditions, particularly conditions involving hypercoagulable states.

Thrombosis Canada

The portal vein is one of the splanchnic veins, formed at the confluence of the superior mesenteric and splenic veins and carries blood from the gastrointestinal tract to the liver. PVT can occur in the main portal vein, in the left or right portal branches, and/or in the smaller, intrahepatic branches. PVT is an uncommon site of thrombosis, estimated to occur in 4 per 100,000 individuals.