Portal Vein Thrombosis

Aka: Portal Vein Thrombosis

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II. 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

III. Symptoms

  1. Acute
    1. Sudden onset Right Upper Quadrant or Epigastric Abdominal Pain
    2. Vomiting
  2. Chronic
    1. Intermittent mild Abdominal Pain

IV. Signs

  1. Hepatomegaly
  2. Splenomegaly
  3. Ascites
  4. Ankle edema

V. Differential Diagnosis

  1. Budd-Chiari Syndrome (Hepatic Vein Thrombosis)
  2. Cirrhosis
  3. Sarcoidosis

VI. Labs

  1. Liver Function Tests
  2. Hypercoagulable evaluation

VII. Diagnosis

  1. CT Abdomen Pelvis with IV Contrast
  2. Doppler Ultrasound
  3. MRI with MRA
  4. Angiography

VIII. 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

IX. Complications

  1. Portal Hypertension

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