Portal vein thrombosis results when a large blood clot blocks the portal vein. This major vein is responsible to carry blood from different organs of the abdomen to the liver. When the blood clot blocks the portal vein, the smaller veins of the abdominal organs get congested with the blood and become tortuous and varicose. It causes rise of pressure in all the veins of the abdomen.
In most cases the tortuous and varicose veins develop in the lower end of the esophagus, but it can develop anywhere in the abdomen. This condition in medical term is known as portal vein thrombosis.
Very less people suffer from Portal vein thrombosis in United States. In countries like Africa and India the disease is more prevalent. It can affect both the genders and there is no ethnic preference.
What Causes Portal Vein Thrombosis?
The common causes associated with portal vein thrombosis are:
- Cancer of the abdominal organs such as stomach cancer, cancer of pancreas or liver cancer.
- Cirrhosis of liver.
- Liver infection: abscess of liver
- Inflammation of bile duct.
- Pregnancy related pre eclampsia.
- Budd chiari syndrome.
- Congestive heart failure.
- A patient suffering from blood disorders or clotting disorders may be vulnerable for portal vein thrombosis.
- A remote chance of portal vein thrombosis is due to birth control pills.
- Idiopathic cause: in half the cases of portal vein thrombosis the cause is not known.
PVT generally affects children but the rate of prevalence in adults is also not less. Cancer of stomach, pancreas or liver is most often causative factor in adults.
Portal Vein Thrombosis Symptoms
The symptoms can be divided in two categories: acute in onset and gradual.
In the acute portal vein thrombosis, it is difficult to clinch the diagnosis only with clinical history and physical examination as the symptoms are not unique. Sudden pain in the right side of the abdomen, nausea and vomiting, fever, sometimes the patient may vomit blood.
In chronic cases the first indication is massive vomiting of blood. It is cased due to esophageal varices. There is accumulation of fluid in the abdomen. There may be confusion, loss of memory and sometime the patient may slip into coma.
In many cases the acute episode of portal vein thrombosis resolves of its own. Sometimes, with the help of collaterals, the blood circulation can be maintained. Chronic cases of PVT needs treatment as it cannot resolve on its own.
By doing Ultrasound study or MRI, it is possible to detect portal vein thrombosis. It is confirmed after performing a liver biopsy.
Treatment Of Portal Vein Thrombosis
The treatment of portal vein thrombosis is focused on two subjects; reduce the portal vein pressure and prevent esophagus variceal bleeding (bleeding from the congested veins of the esophagus or food pipe). A surgeon or a gastroenterologist ligates the bleeding esophageal varices (veins) by applying a band or injecting sclerosing agent (Chemical).
Most of the time experienced gastroenterologists and surgeon are able to stop the bleeding. The procedure is done with the help of endoscope (a flexible tube that is introduced in the esophagus).
In more serious cases if the vital parameters of the patient are stable and there is no other complication, the surgeon may create a shunt between the vena cava and portal vein. This will cause the blood to flow in the vena cava bypassing the liver, there are risks associated with this surgery and it can cause liver damage in few cases.