The portal vein thrombosis causes portal hypertension and gastrointestinal variceal bleeding, usually in the lower esophagus or stomach. The diagnosis is based on ultrasound examination. The treatment involves the control of variceal bleeding (usually by endoscopic banding, IV terlipressin or both), relapse prevention with beta-blockers and sometimes surgical shunts and thrombolysis in acute thrombosis.
(See also Overview of vascular diseases of the liver.)
The portal vein thrombosis causes portal hypertension and gastrointestinal variceal bleeding, usually in the lower esophagus or stomach. The diagnosis is based on ultrasound examination. The treatment involves the control of variceal bleeding (usually by endoscopic banding, IV terlipressin or both), relapse prevention with beta-blockers and sometimes surgical shunts and thrombolysis in acute thrombosis. (See also Overview of vascular diseases of the liver.) Etiology Common causes by age group (s. Common causes of portal vein thrombosis *). Common causes of portal vein thrombosis * Age group Basic remarks newborns umbilical stump associated infection or omphalitis (spread over the Nabelveme into the portal vein) Congenital malformations of the portal vein (more rarely) are congenital changes in the portal vein usually with other congenital defects. Older children pylephlebitis In acute appendicitis, the infection spreads from the portal system; vascular infection / inflammation then triggers a thrombosis. Adults operations (eg. As splenectomy) Hyperkoagulationszustände (z. B. myeloproliferative disease, protein C or S deficiency, pregnancy) cancer (eg. As hepatocellular or pancreatic cancer, kidney or adrenal cancer) cirrhosis trauma may cause the portal hypertension the shutter and the stowage * the cause is multifactorial in most cases, and unknown in about a third of cases. Symptoms and signs Acute portal vein thrombosis is often asymptomatic, unless they shall meet with another event such. B. pancreatitis (the cause), or other complications, such as a mesenteric vein thrombosis. The most frequent clinical manifestations develop – splenomegaly (especially in children) and esophageal varices – over time as a result of portal hypertension. Ascites is rare (10%). The ascites can be caused when the same cirrhosis is present or if the serum albumin (and therefore, the oncotic pressure) is lowered, decreases about by the supply of large amounts of liquid because of gastrointestinal bleeding. Diagnosis Clinical examination and liver function tests Doppler sonography The suspicion of portal vein thrombosis is in the following patients: signs of portal hypertension without cirrhosis Slight increase in liver enzymes, as well as risk factors such as umbilical cord infection in newborns, appendicitis in children or thrombophilia A Doppler ultrasound examination usually leads to the diagnosis, by showing the reduced or absent portal venous flow and sometimes the thrombus. In difficult cases, possibly an MRI or a CT scan with contrast medium has to perform. Angiography may be necessary to determine the procedure for shunt operations. Therapy thrombolysis in some acute cases Long-term anticoagulation supply of portal hypertension and its complications in acute cases is sometimes thrombolysis successfully. This should be especially reserved fresh closures in hypercoagulable anticoagulation dissolves blood clots not, but has some value for the long-term prevention of hypercoagulable states despite the risk of variceal bleeding. In infants and children, the treatment depends on the cause (omphalitis, appendicitis). Otherwise, the patient care aims to portal hypertension and its complications; the treatment may comprise terlipressin and endoscopic band ligation for acute variceal bleeding, as well as and non-selective ?-blocker to prevent rebleeding. These therapies reduce the need to surgically implanted shunt (z. B. mesokavaler and Splenorenal shunt) which may be closed and were associated with a surgical mortality of 5-50%. Transjugular portosytemische shunt (TIPS) are not recommended. TIPS are in this situation technically difficult to close and may not decompress the liver sufficient. Important points causes and risk factors for portal vein thrombosis are umbilical infection (neonatal), appendicitis (in children) and Hyperkoagulabilitätszustände (in adults). Portal vein thrombosis in patients should be adopted, in which a portal hypertension is present in the absence of cirrhosis or that have minor non-specific liver abnormalities and risk factors. The diagnosis is confirmed by Doppler sonography or if the results are inconclusive, with contrast-enhanced MRI or CT. The cause of portal vein thrombosis and complications of portal hypertension are treated.