Portal Vein Thrombosis - Symptoms, Causes & Treatment

Portal vein thrombosis (PVT) refers to the constriction or obstruction of the portal vein (a major blood vessel responsible for carrying blood from the digestive organs to the liver) caused by the formation of a blood clot. 

This clot can occur in the primary section of the portal vein or its branches within the liver, and in some cases, it may extend to the splenic or superior mesenteric veins (SMV). It can also happen in the absence of any underlying liver illness, such as a tumour, abdominal infection, pancreatitis, etc.

Portal vein thrombosis is commonly seen as a complication in patients with liver cirrhosis. Patients with portal hypertension or liver cirrhosis are estimated to have a PVT prevalence of between 0.6% and 15.8%. The prevalence of PVT rises as cirrhosis becomes more advanced.

Portal vein thrombosis can be classified into two main types: acute and chronic portal vein thrombosis. Understanding the different types of PVT is essential for accurate diagnosis and appropriate management of the condition.

1. Acute Portal Vein Thrombosis: Acute PVT refers to the sudden onset of blood clot formation in the portal vein. 

1. It usually involves a quick onset of symptoms and necessitates urgent medical care. 

2. Liver Cirrhosis, localised inflammation or infection of the portal vein, abdominal trauma, or abdominal surgeries are some of the major causes of acute PVT. 

3. In acute PVT, prompt diagnosis and therapy are essential to halt additional problems and maintain liver function.

2. Chronic Portal Vein Thrombosis: Chronic PVT refers to the long-standing presence of blood clots within the portal vein.

1. It is distinguished by the delayed onset of symptoms and is frequently linked to underlying liver conditions such as liver cirrhosis. 

2. Acute PVT that is left untreated or poorly managed may also develop into chronic PVT. 

3. Complications from this kind of PVT include liver injury, portal hypertension, and the development of collateral blood arteries to avoid the blocked portal vein.

Portal vein thrombosis symptoms are not very prominent in the majority of patients. However, when they appear, the following portal vein thrombosis symptoms are seen:

1. Stomach pain, specifically near the ribs in the upper right quadrant 

2. Abdominal swelling due to fluid build-up

3. Fever 

Some severe portal vein thrombosis symptoms may include:

1. High fever and chills 

2. Liver pain

3. Enlarged spleen 

4. Jaundice 

5. Gastric bleeding

6. Ascites

7. Vomiting blood

8. Tarry-looking stools 

9. Blood in stools 

Portal vein thrombosis (PVT) can occur due to various underlying causes and understanding the potential causes of PVT is important for proper diagnosis and management. 

Portal vein thrombosis is primarily seen as a complication in patients with liver cirrhosis (a condition characterized by extensive scarring of the liver tissue). However, PVT may also occur in patients without any pre-existing liver conditions.

Portal Vein Thrombosis Risk Factors

There are several risk factors that may increase an individual’s risk of developing portal vein thrombosis. Some of these risk factors include the following: 

1. Liver Tumours: Both primary liver tumours, such as hepatocellular carcinoma, and metastatic tumours that spread to the liver can increase the risk of PVT. 

2. Abdominal Infections: Infections of the abdominal organs, such as diverticulitis, appendicitis (a condition where the appendix becomes inflamed), or pancreatitis (a condition that causes inflammation of the pancreas), can cause inflammation and lead to the formation of blood clots in the portal vein.

3. Inflammatory Bowel Disease: Inflammatory bowel disease, including Crohn's disease and ulcerative colitis, is also associated with an increased risk of PVT.

4. Abdominal Injury or Trauma:  Blood clots can result from any injury or trauma involving the abdomen, such as accidents. This can occur as a result of direct injury or as a consequence of prolonged immobility after the procedure.

5. Sepsis: It is a life-threatening condition that occurs when the body reacts improperly or extremely to an infection.

6. Congenital Birth Defects: Congenital disorders or congenital birth defects are abnormalities in structure or function that develop before birth.

7. Polycythemia: It is a condition characterised by an increase in red blood cells in the body. 

8. Infection of the Umbilical Stump: Also known as Omphalitis, this condition refers to an infection that affects the umbilical cord or the tissues around it, predominantly occurring in newborn babies.

9. Pregnancy: Pregnancy is the term used to explain the duration during which an embryo or foetus develops within a woman's uterus.

10. Oral contraceptives: These are medicines that contain hormones to prevent pregnancy and are meant to be taken orally. 

In order to prevent PVT, it is important to address the underlying risk factors and implement measures that will lessen the possibility of blood clot development in the portal vein. 

Even if PVT cannot always be prevented, there are steps that may be taken to lessen the risk. The following are some crucial methods for preventing portal vein thrombosis:

1. Manage Underlying Liver Diseases: It is crucial to properly manage underlying liver conditions as liver cirrhosis carries a significant risk for portal vein thrombosis (PVT). 

1. This involves appropriate medical treatment for liver cirrhosis, including regular monitoring, lifestyle adjustments, and medication adherence.

2. Control Hypercoagulable States: Specific management techniques may be advised if a person has a known hypercoagulable state, such as a hereditary or acquired clotting problem. 

1. This can involve taking drugs, making lifestyle changes, and receiving close medical supervision.

3. Optimise Surgical Procedures: During abdominal surgeries or procedures, steps (prophylactic measures such as compression stockings or intermittent pneumatic compression) can be taken to minimise the risk of blood clot formation in the portal vein.

4. Recognize and Treat Infections: Prompt recognition and treatment of abdominal infections, such as diverticulitis or pancreatitis, can help reduce the risk of PVT. Effective management of the underlying infection can minimise inflammation and the potential for blood clot formation.

5. Lifestyle Modifications: Maintaining a healthy lifestyle can play a role in reducing the risk of PVT. This includes regular exercise, a balanced diet, maintaining a healthy weight, and avoiding excessive alcohol consumption.

Doctors can diagnose the presence of a portal vein blood clot by considering various symptoms, including an enlarged spleen, variceal bleeding (bleeding from enlarged veins in the oesophagus or stomach), vomiting blood, and liver infections. 

In addition to evaluating symptoms, several tests can be conducted to assess the size and severity of portal vein thrombosis. These tests for portal vein thrombosis diagnosis include the following:

1. Blood Tests: Blood tests are conducted to assess liver function and determine the presence of any underlying disorders that may contribute to PVT.

1. These tests measure liver enzymes, bilirubin levels, and blood clotting factors. 

2. They can help identify liver diseases, such as cirrhosis or hepatitis, which may increase the risk of PVT.

2. CT Scans: A computerised tomography (CT) scan utilises a sequence of X-ray images captured from various angles around the body. A computer then processes these images to generate cross-sectional pictures.

3. Abdominal MRI Scan: Magnetic resonance imaging (MRI) is a noninvasive diagnostic test that utilises a combination of magnets and radio waves to generate detailed images of the internal structures and organs of the body.

4. Angiography: Angiography is a medical procedure that employs X-ray technology to examine and evaluate blood vessels in the body.

5. Doppler ultrasonography: Doppler ultrasound is a noninvasive procedure employing high-frequency sound waves (ultrasound) to assess blood flow within blood vessels. 

1. It achieves this by reflecting the ultrasound off the moving red blood cells in circulation.

2. Doppler ultrasounds are commonly used by doctors as an initial test to assess blood flow in blood vessels due to their accessibility and non-invasive nature. 

When a person is suspected of portal vein thrombosis, a doctor will likely suggest an endoscopy as the next step. An endoscopy involves using a thin, elongated tube to visualise the digestive tract and identify any signs of bleeding.

How to Prepare for Doctor’s Consultation?

Preparing for a doctor's consultation for portal vein thrombosis (PVT) can help ensure a productive and informative discussion. Here are some tips to help one prepare:

1. Gather Medical Information: Compile all relevant medical records, including previous test results, imaging reports, and medications the one is taking. Provide a detailed medical history, including any existing liver conditions or risk factors for PVT.

2. Note Symptoms and Concerns: List the symptoms, including any changes in the body or discomfort that one is experiencing. 

3. Prepare Questions: Note any questions or concerns about PVT. These may include queries about the diagnosis process, treatment options, potential complications, and lifestyle modifications. Some of the questions that one can ask are:

1. What is the cause of my condition?

2. Would this condition have a major impact on my life?

3. What is the best treatment for my condition?

4. Are there any risks associated with the treatment method?

4. Bring a Support Person: Consider bringing a trusted family member or friend to the appointment. They can provide emotional support, help remember important information, and take notes during the consultation.

5. Follow Pre-Appointment Instructions: If the doctor has provided any specific instructions before the appointment, such as fasting for blood tests, make sure to follow them diligently.

The appropriate portal vein thrombosis treatment varies depending on the underlying cause of the blood clot. The treatment aims to dissolve the clot or prevent its further enlargement, restore blood flow and manage the underlying health condition. 

The specific treatment approach recommended to the patient will depend on the severity of the condition, the cause, and the patient’s overall health. The various portal vein thrombosis treatment options include the following:

Medications

Medications play a pivotal role in treating acute portal vein thrombosis. Some of the medications prescribed by the doctor may include the following.

1. Thrombolytic Medication: In acute portal vein thrombosis (PVT) cases, physicians often recommend thrombolytic medication as a treatment option. These prescribed drugs can dissolve blood clots.

2. Anticoagulants: Patients may be prescribed anticoagulant medicines or blood thinners when the clot grows. These anticoagulants can prevent the clots from recurring again and limit their further growth.

3. Beta-Blockers: In cases of severe portal vein thrombosis (PVT) leading to oesophageal bleeding, doctors may advise taking beta-blockers as a treatment approach. These medications assist in lowering the pressure within the portal vein, thereby reducing the risk of further bleeding.

Portal Vein Thrombosis Treatment with Surgery

In rare cases, surgical interventions may be necessary to remove or bypass the clot, especially if there is a significant clot burden or if other treatment options are not feasible. Some of the surgical methods to treat portal vein thrombosis include.

1. Thrombectomy: Thrombectomy or a minimally invasive technique called mechanical thrombectomy through the liver may be performed to remove the blood clot in the portal vein.

1. However, it's important to note that these procedures can sometimes cause the clot to return due to damage to the blood vessel walls. 

2. Another approach is percutaneous transhepatic thrombo-aspiration, which involves using a needle to suction out the clot within 72 hours of its formation. This method has been successful in certain patients.

2. Transvenous Intrahepatic Portosystemic Shunt (TIPS): This non-surgical portal vein thrombosis treatment involves using a tube to connect the portal vein and another blood vessel within the liver.

1. This connection helps in enhancing the flow of blood. 

2. Typically, the procedure is performed when the person is in the senses, and a doctor inserts a tube through another vein, commonly in the neck.

Cost of Portal Vein Thrombosis Treatment

The cost of portal vein thrombosis treatment is influenced by several factors. These factors include the type of hospital or clinic, hospital location, doctor’s expertise, type of technique used, patient’s age, patient’s comorbidities, and much more.

One should consult with their doctor to know the exact cost of the treatment. Also, the table below provides the approximate cost of the treatment method performed for portal vein thrombosis.

Portal vein thrombosis may cause various complications depending on the extent and location of the blood clot. Some of these portal vein thrombosis complications may include the following: 

1. Liver Damage: PVT can cause liver damage, particularly when blood flow to the liver is significantly impaired. The lack of blood supply can lead to liver dysfunction and may even progress to liver failure in severe cases.

2. Portal Hypertension: Portal hypertension is characterised by increased blood pressure in the portal vein and its smaller branches.

3. Septic Portal Vein Thrombosis: It is a condition characterised by the formation of clots in the portal vein, often along with a bacterial infection.

4. Ascites: Ascites is the accumulation of fluid in the abdominal cavity, typically caused by cirrhosis.

5. Intestinal Ischemia: Intestinal ischemia refers to a range of conditions where blood flow to the intestines is reduced.

When to See a Doctor?

When dealing with portal vein thrombosis (PVT), it is important to seek medical attention promptly. Here are some situations when a patient should consider seeing a doctor for portal vein thrombosis:

1. Symptoms of PVT: If a patient experiences symptoms such as abdominal pain, especially in the upper right side, unexplained weight loss, fatigue, jaundice (yellowing of the skin or eyes), or the development of varicose veins in the abdomen or legs.

2. Complications: If the patient has been diagnosed with PVT and experiences complications such as variceal bleeding (severe bleeding from dilated blood vessels in the abdomen), ascites (accumulation of fluid in the abdominal cavity), or signs of liver dysfunction. 

3. Worsening Symptoms: If the patient is already been diagnosed with portal vein thrombosis and notice a worsening of the symptoms, it is crucial to consult the doctor.

4. Recurrent Thrombosis: If the patient has a history of portal vein thrombosis and experiences a recurrence of blood clots in the portal vein, it is important to inform the doctor.

While diet changes are not typically considered standard treatment for portal vein thrombosis (PVT), individuals with underlying liver disease may experience challenges in adhering to their regular diet due to their diagnosis. 

Consulting with a dietitian can be beneficial in managing a healthy weight and making appropriate food choices.

Below mentioned are some of the dietary changes for patients with portal vein thrombosis.

1. Adequate Hydration: Drink plenty of water and stay hydrated to maintain optimal blood flow.

2. Low-Sodium Diet: Limit the intake of high-sodium foods, as excessive sodium can contribute to fluid retention and worsen symptoms associated with portal vein thrombosis.

3. High-Fibre Foods: Include plenty of fiber-rich foods in the diet, such as whole grains, fruits, vegetables, and legumes. Fibre helps regulate bowel movements and can prevent constipation, which is important in managing portal vein thrombosis.

4. Healthy Fats: Choose sources of healthy fats, such as avocados, nuts, seeds, and fatty fish like salmon, which provide omega-3 fatty acids that have anti-inflammatory properties.

5. Moderate Protein Intake: Consume moderate amounts of lean proteins, including poultry, fish, tofu, and legumes. Protein is important for tissue repair and overall health.

6. Limit Alcohol Intake: If one has portal vein thrombosis, it is advisable to limit or avoid alcohol consumption, as excessive alcohol can contribute to liver damage and worsen symptoms.

Portal vein thrombosis (PVT) occurs when a clot partially or fully obstructs the vein responsible for transporting blood to the liver. Although portal vein thrombosis is commonly seen in patients with liver conditions, it may also develop in people with certain other conditions such as pancreatitis, appendicitis, sepsis, and cancers.

Portal vein thrombosis symptoms may not be visible in the early stages. Upon experiencing unusual symptoms, it is essential to see your doctor.

At HexaHealth, we provide various diagnostic tests, high-quality treatment, and palliative care for all conditions, including portal vein thrombosis. At HexaHealth, we provide the best quality treatment and services at affordable costs.
So do not hesitate to contact our experts TODAY!

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