Portal vein thrombosis

Introduction to portal vein thrombosis Portal thrombosis (PT) can occur in any part of the portal vein and refers to thrombosis in the portal vein, superior mesenteric vein, inferior mesenteric vein, or splenic vein. Portal vein thrombosis can cause obstruction of the portal vein, causing increased portal pressure and intestinal congestion, which is the main cause of extrahepatic portal hypertension. Clinically rare. However, it is easy to be ignored. If it is not treated in time, it can lead to serious consequences and endanger the life of the patient. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal varices and rupture

Causes of portal vein thrombosis

Portal hypertension (20%):

Due to various causes of cirrhosis and congestive splenomegaly, mainly due to increased portal pressure, resulting in decreased hepatic blood flow of the portal vein and its branches and slowing of blood flow caused by eddy currents Stacked to form a blood clot.

Abdominal infection (20%):

Caused by bacteria entering the portal vein system, such as neonatal umbilical inflammation, umbilical vein sepsis, acute appendicitis in adults, pancreatitis, cholecystitis, perforation of hollow organs, intestinal inflammation Lesions, abdominal pelvic abscess and postoperative abdominal infection.

Other factors (10%):

Abdominal tumors in hypercoagulable state, especially in the colon and pancreas, often accompanied by hypercoagulable state of the portal system, can lead to thrombosis. In recent years, it has also been found that hereditary coagulopathy is also involved in the formation of portal vein thrombosis, including protein C. Protein S and anti-thrombin deficiency, etc.

Tumors such as tumors, such as pancreatic tumors, hepatocellular carcinoma, compression, and intestinal torsion cause blood flow in the portal system to be blocked, leading to portal vein thrombosis. Other causes include primary venous sclerosis, splenic vein or mesenteric venous thrombosis, some patients have a history of long-term use of contraceptives, rare factors such as various congestive heart failure, polycythemia.

Portal vein thrombosis prevention

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Portal vein thrombosis complications Complications Esophageal and gastric varices and their rupture

Esophagus, gastric varices and rupture are common complications of portal vein thrombosis, which seriously threaten the life of the patient, and there may be recurrent bleeding after the first bleeding stops, but it is not a symptom that every patient must have.

Symptoms of portal vein thrombosis Common symptoms Abdominal pain Diarrhea Venous varicose ascites Abdominal muscle Abdominal tension Peritonitis Abscess Nasal bleeding Loss of appetite

Acute type

The onset of the disease, severe abdominal pain, abdominal distension and vomiting, mainly due to gastrointestinal congestion; if the thrombus multiplies to the superior mesenteric vein, there may be diarrhea, bloody stools, abdominal pain, bloating, abdominal tenderness, abdominal muscle tension and snoring pain and other peritonitis Or the performance of paralytic ileus, in infants and young children, can be characterized by sudden upper gastrointestinal bleeding, splenomegaly is mostly mild, if the thrombus spread to the portal vein and intrahepatic branches, there may be a large amount of ascites.

2. Chronic type

If the patient has passed the acute phase, due to the extensive collateral circulation established by the portal-body vein, that is, the formation of natural shunt, ascites may be relieved or reduced. Splenomegaly is often a prominent symptom. In general, splenomegaly The degree depends on the length of the disease; after long-term congestion of the spleen, the proliferation of spleen and myeloid cells and fibrous tissue deposition, a large number of hemostatic cells cause increased blood cell destruction, hypersplenism, clinical manifestations of varying degrees of anemia, decreased platelet count, at this time The patient developed nosebleeds, but cyanosis rarely occurred.

Portal vein thrombosis examination

1. When the abdominal X-ray film is combined with intestinal necrosis or paralytic ileus, the intestinal dilatation is thickened with the gas-liquid level.

2. Abdominal B-ultrasound shows the location, size and extent of portal vein thrombosis. It is mainly found that the portal vein trunk, the splenic vein stump and the superior mesenteric vein are widened, and there are abnormal echoes in the vein, which are substantial irregularities or Waiting for the echo point (Fig. 1), there is a portal vein sponge-like change, the portal vein trunk and branch disappear, and the portal vein is replaced by a small and irregular tubular structure.

3. Color Doppler (Fig. 2) The portal vein, splenic vein or superior mesenteric vein has a widened inner diameter and a substantial echo. The blood flow becomes fine. When completely blocked, the blood flow signal disappears and the distal vein is dilated.

4. Abdominal CT includes conventional plain and enhanced scans (arterial phase and venous phase). CT typical signs of portal vein thrombosis are non-enhanced low-density strips or massive lesions in the portal vein, with collateral veins and abnormal intestines. The correct rate is over 90%, and the spleen or spleen can be found at the same time.

Diagnosis and differentiation of portal vein thrombosis

diagnosis

The diagnosis of this disease should be considered in the following different situations: abdominal pain, abdominal abscess, portal hypertension, upper gastrointestinal bleeding, etc. In the course of clinical diagnosis and treatment of cirrhotic portal hypertension, for acute onset, unexplained abdominal pain, abdominal distension, blood sample However, there is no clear cause of upper gastrointestinal bleeding or splenomegaly, unexplained paralytic ileus, combined with hypercoagulable state, especially for patients after portal hypertension, should be alert to the possibility of portal vein thrombosis However, the diagnosis depends on color Doppler ultrasound or CT examination. Magnetic resonance angiography is performed in patients with difficult diagnosis, and portal venography can make a diagnosis.

Differential diagnosis

Acute intestinal obstruction

Abdominal bulging, abdominal pain is intensely paroxysmal, physical examination shows intestinal or reverse peristaltic waves, bowel sounds are hypertrophic or metallic tones, when paralyzed intestinal obstruction, the bowel sounds weaken or disappear, the abdomen X-ray or plain film examination showed multiple stepped fluid levels in the intestine, and a few patients had a history of abdominal surgery.

2. Chronic cholecystitis

Most of the pain is located in the right upper abdomen, which can be radiated to the right back and scapular area. The pain is often aggravated after eating greasy food. B-ultrasound or CT examination can establish a diagnosis. Sometimes it can be found coexisting with gallstones, and the shape of the pancreas is normal. There is no expansion of the pancreatic duct, but it must be pointed out that a small number of patients with chronic cholecystitis, gallstones and chronic pancreatitis can coexist.

3. Chronic pancreatitis

Pancreatic cancer patients with clinical manifestations of upper abdominal fullness, dull pain, diarrhea and weight loss are not unique, chronic pancreatitis patients also have the above symptoms, and the latter can also appear jaundice and mass similar to pancreatic cancer, so the two Identification is very difficult, but chronic pancreatitis generally has a long history and has a history of recurrent episodes. Diarrhea and wasting symptoms are only significant after a long course of disease. Pancreatic cancer has a short course of disease, no history of recurrent episodes, and weight loss occurs earlier. Pancreatitis X-ray film can be found in the pancreatic calcification, B-ultrasound, CT examination or pancreatic mass cytology can confirm the diagnosis, it must be pointed out that chronic pancreatitis can evolve into pancreatic cancer.

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