Portal vein thrombosis

Portal Vein Thrombosis

Overview

Portal vein thrombosis is a blockage due to a blood clot in the portal vein. The portal vein allows blood to flow from the intestines to the liver for detoxification. With a clot in the portal vein, the toxin levels in the blood increase the risk of other complications. Although portal vein thrombosis is treatable, it can be life-threatening if not detected early.

Signs and symptoms

Portal vein thrombosis may not cause any symptoms at all until it is very severe. In severe cases, it presents as upper abdominal pain, the build-up of fluid in the abdomen and fever. Some patients also experience chills, vomiting blood, jaundice, varices in the liver and gastric bleeding.

Causes and risk factors

Blood clots tend to form in the vessels where blood flows slowly or irregularly. Hardening of the liver (cirrhosis), liver injury or liver cancer increases the risk. Inflammatory conditions, including infections in the pancreas, intestines and appendicitis, can also cause the condition. In infants, an infection of the umbilical cord stump can trigger blood clots in the portal vein too. Some individuals may be genetically predisposed to increased blood clotting and have an increased risk of portal vein thrombosis.

Complications

Portal vein thrombosis causes portal hypertension, which can cause bleeding from the gullet and intestines (variceal bleeding), fluid accumulation in the abdomen (ascites) and even liver failure.

Diagnosis

Portal vein thrombosis is usually suspected based on a detailed clinical history and examination. Diagnosis required imaging with a Doppler ultrasound scan or a CT scan.

Treatment and Surgical Interventions

The treatment for portal vein thrombosis aims to dissolve existing blockages and address their cause. Drug therapies can dissolve the blood clots. If there is oesophageal bleeding, the patient may be prescribed beta-blockers. If the bleeding is severe, the doctor may perform endoscopy and banding- a procedure in which rubber bands are used to tie off the varices in the oesophagus to stop the bleeding. In the case of a total blockage due to portal vein thrombosis, the surgeon may sometimes perform a shunt procedure to reduce the portal hypertension or bypass the blockage and restore blood flow to the liver.

Prevention

Healthy lifestyle, regular exercise, avoiding excess alcohol consumption and hepatitis vaccination can prevent cirrhosis and liver tumors which are the most common causes of portal vein thrombosis. Dehydration increases blood viscosity and can cause portal vein thrombosis. Maintaining good hydration status at all times is hence essential.

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