Portal Vein Thrombosis

What is the portal vein?

It is a large abdominal vein. The portal vein supplies blood to the liver by importing blood from the parts of intestines (bowel) and other abdominal organs.      


Portal vein thrombosis (PVT)

A thrombus mostly obstructs the portal vein. When this vein is completely obstructed, it causes blood to move back in the vein that leads to high blood pressure in other veins below it. The condition is called portal vein thrombosis (PVT). Sometimes the body tries to pass this obstructed vein by establishing thin walled veins  called collaterals. These thin walled veins are large and emerge like varicose veins also called varicosities. The majority of  varicosities are found at the esophagus lower end. They may emerge anywhere in the abdominal region.

How common is PVT?

It is a rare condition in U.S. PVT is detected in  5/10,000 person. The highest rate of PVT is in Africa and India due to;

1.          Liver infections
2.          Parasites and
3.          Liver cancer

Conditions associated with PVT

There are some underlying conditions associated with PVT are;

                   

•           Heart failure
•      Budd chiari
•      Constrictive pericarditis
•      Live cirrhosis
•      Scarring
•      Liver cancer
•      Pancreas cancer
•      Stomach and bile ducts cancer
•      Liver pus
•      Pancreatitis
•      Umbilical cord infection in babies
•      Trauma
•      Disorders related to blood clotting
•      Dehydration
•      Pills related to birth control

In most cases, no cause is found. Mostly young children are affected by PVT and in adults PVT leads to cancer

Life expectancy after PVT 

There is low risk of death if there is absence of liver disease and liver failure. There is a high risk of death (30% or more deaths within 2 years) within 1 or 2 year, If a patient is experiencing a liver failure and severe bleeding at a same time. The prognosis in children experiencing PVT is much better.

Symptoms of PVT

The PVT symptoms depends on the gradual of sudden formation of blood clots. In case of acute thrombus the symptoms are not very clear. The symptoms include;  

• Fever
• Unexpected pain in right upper quadrant
• Nausea/vomiting
• Accumulation  of fluid in abdomen
•  Intestinal ischemia
•  Blood during vomit

In cases of chronic thrombus the symptoms are very clear and alarming which include;

• Bright red blood during vomiting. The bleeding amount is high and frightening for both patient and the physician. This condition occurs after 3 or 4 years of the initial diagnosis
• Accumulation of fluid in the abdomen
• Confusion
• Brain memory loss
• Coma

Can PVT dissappear suddenly?

Acute thrombus may resolve spontaneously and the signs and symptoms may improve. In some caese, the body strat making collaterals to pass the obstructions and the signs may not occue. The chronic thrombus never resolves and need treatment.

Diagnosis of PVT

The diagnosis and physical exam include;

Ultrasound, MRI  (Computed tomography scans may detect the obstructions).

Angiography ( The disease is completely detected by angiography by obtaining x rays of the infected areas)

Liver biopsy  (A tiny needle is inserted in the skin to get a tiny piece of the liver. This test is also required to confirm the diagnosis)

Treatment

Sclerotherapy or variceal banding: (This treatment require several sessions to stop the bleeding).

Octreotide: (A chemical used to stops the bleeding but risk of recurrence is high in  this approach)

Blood thinners: Sometimes blood thinners are used to dissolve the clot. It is risky treatment because if blood vomiting occurr at the same time, then these medictions make situation worse. The majority of doctors don’t recommend these medication because of the bleeding related complications.

Surgery: The aim of surgical procedures is to help preventing the thin walled varicosities from bursting and bleeding. PVT surgries needs a multidisciplinary approach and involve a high risk and many. A patient having surgery  with a liver failure, the risks of death and other complications are very high.

Radiological techniques: Throug this treatment approach a link between the liver and shunt (pressure veins) is built. This results in varices decompression and decreases symptoms. This treatment is done in the presence of a radiology suite and x rays.  Some complications related to radiological techniques include:

• Bleeding  may start in the abdomen
• Failure of high pressure veins
• Dead liver
• Re-occurrence of the shunt blockage 

Transplantation

Liver transplant is a best option and most effective treatment recommended for the patients with liver damage. Transplantation is limited to few individuals because of unavailability of donars and expenses. The surviva rate is high. The quality of patient life omprove after this surgery.

• Untreated PVT causes many complications
• Coma
• Persistent blood vomiting
•  Fluid collection in the abdominal region
• Death of different parts of intestine 
• Liver condition become worse
• Brain confusion
• Loss of life

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