View source for Portal vein thrombosis

==Background==
[[File:Trombosisporta.png|thumb|Drawing of portal vein thrombosis.]]
Portal vein thrombosis (PVT) is a vascular disease of the liver that occurs when a blood clot occurs in the hepatic portal vein, leading to increased pressure in the portal vein system and reduced blood supply to the liver.

===Inciting Causes===
*Abdominal [[sepsis]] 
*Abdominal surgery 
*Behçet's syndrome 
*Cholangiocarcinoma
*[[Cirrhosis]] 
*[[Collagen vascular disease]]s (eg, lupus) 
*Compression or invasion of the portal vein by tumor (eg, pancreatic cancer) 
*[[Diverticulitis]]
*Endoscopic sclerotherapy 
*[[Hepatocellular carcinoma]] 
*[[Inflammatory bowel disease]]
*Inherited thrombophilias (e.g. factor V Leiden deficiency, protein C or S deficiency, [[antiphospholipid syndrome]])
*[[Myeloproliferative disorders]] (e.g. [[polycythemia vera]] or [[essential thrombocytosis]])
*[[Omphalitis]]
*Oral contraceptives 
*Pancreatic islet cell transplantation 
*[[Pancreatitis]]
*[[Paroxysmal nocturnal hemoglobinuria]]
*[[Pregnancy ]]
*Retroperitoneal fibrosis 
*[[Splenectomy]] complication
*[[Transjugular intrahepatic portosystemic shunt]] (TIPS) 
*[[Trauma]]

==Clinical Features==
===Acute===
*Upper [[abdominal pain]] developing suddenly or progressing over a few days 
*Possibly accompanied by [[nausea]], [[hepatomegaly]], splenomegaly; may be accompanied by persistent non-spiking [[fever]] in the setting of systemic inflammation
*Other signs/symptoms based on underlying cause (e.g. bleeding disorders, hepatic stigmata if due to cirrhosis)
*May be clinically silent in a portion of patients and diagnosed incidentally during a CT exam for other reasons (e.g. acute [[pancreatitis]])

===Chronic===
*Often asymptomatic; incidental finding on imaging
*Associated with portal hypertension

==Differential Diagnosis==
*Mesenteric vein thrombosis
*[[Budd-Chiari syndrome]]
*[[Portal vein thrombosis]]
*[[Venous thromboembolism]]

==Evaluation==
[[File:R vs L Liver by CT.png|thumb|Phase contrast CT image. Contrast is perfusing the right liver but not the left due to a left portal vein thrombus.]]
*Typically diagnosed on abdominal CT with contrast
*Filling defect on Doppler ultrasound
*EGD to assess for gastric/esophageal varices if chronic PVT

==Management==
=== Acute ===
*In non-cirrhotic, [[LMWH]] -> [[warfarin]] x 6 months
=== Chronic ===
*In non-cirrhotic or hypercoagulable, anticoagulation after screening for varices
*Anticoagulate patients with cirrhosis AND 1) thrombophilia, 2) clot extension in mesenteric veins, or 3) bowel ischemia
*If severe, may require shunt, liver transplant, or bowel resection

==Disposition==


==See Also==
*[[Budd-Chiari syndrome]] (hepatic vein thrombosis)
*Pylephlebitis
*[[Venous thromboembolism]]

==External Links==


==References==
<references/>
1. DeLeve LD, Valla DC, Garcia-Tsao G (2009). "Vascular disorders of the liver". ''Hepatology''. '''49''':1729-64.

2. O'Mara SR, Wiesner L. "Hepatic Disorders". In Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH (eds.). ''Tintinalli's Emergency Medicine: A Comprehensive Study Guide'' (9 ed.). New York, NY: McGraw-Hill.

3. Simonetto DA, Singal AK, Garcia-Tsao G, Caldwell SH, Ahn J, Kamath PS (January 3, 2020). "ACG Clinical Guideline: Disorders of the Hepatic and Mesenteric Circulation". ''Am J Gastroenterol''. '''115''': 18-40.

4. Nery F, Chevret S, Condat B, de Raucourt E, Boudaoud L, Rautou P, Plessier A, Roulot D, Chaffaut C, Bourcier V, Trinchet J, Valla D (February 2015). "Causes and Consequences of Portal Vein Thrombosis in 1,243 Patients with Cirrhosis: Results of a Longitudinal Study". ''Hepatology''. '''61''': 660-667. [http://doi:10.1002/hep.27546 doi:10.1002/hep.27546]

5. Friedman LS (2020). "Noncirrhotic Portal Hypertension". In Papadakis MA, McPhee SJ, Rabow MW (eds.). ''Current Medical Diagnosis and Treatment 2020''. McGraw-Hill.
[[Category:Vascular]]