Portal vein thrombosis
The portal vein is a large vessel that transports blood from the digestive system to the liver to cleanse it of toxins. In the liver, a large vessel is divided into smaller veins that fit the hepatic lobules. In portal vein thrombosis, a blood clot blocks the vascular lumen, causing it to be completely or partially blocked (occluded). The disease is localized in any part of the portal vein.
The age category of patients most susceptible to pathology is elderly patients, less often newborns. A separate category is pregnant women who developed eclampsia in late gestation. A characteristic sign of eclampsia is blood clotting in all large vessels, including the portal vein.
Content:
- Development reasons
- Classification of portal vein thrombosis
- Portal vein thrombosis symptoms
- Diagnostics
- Portal vein thrombosis treatment
Development reasons
The reason for the formation of a blood clot in the portal vein is a violation of blood flow. In half of the cases, the pathology is based on a functional disorder of the liver. Other causes may be associated with infectious and physical disorders.
Thrombus formation reasons:
- Hepatic alveococcosis;
- Thromboembolism of the hepatic veins;
- Cirrhosis;
- Oncological damage to the liver;
- Acute appendicitis (in children);
- Infection of the umbilical cord stump in newborns;
- Tumors of the abdominal cavity of any etiology;
- Badda-Chiari syndrome - liver vein thrombosis;
- Pancreatic necrosis;
- Operations on the digestive organs;
- The consequences of removing the spleen;
- Pylephlebitis in history;
- Ulcerative colitis;
- Increased blood density;
- Infection of the umbilical vein in the fetus;
- Acute bacterial (constrictive) inflammation of the bursa.
Classification of portal vein thrombosis
The disease is classified for several reasons.
By the time of occurrence:
- Acute thrombosis - the development of the pathological process occurs with lightning speed, within 5-7 minutes the patient dies due to necrosis of the digestive tract (liver, spleen, intestines, stomach, pancreas);
- Chronic thrombosis - blood flow in a vein does not stop immediately, due to a growing thrombus, it gradually decreases, while an alternative blood flow path is formed bypassing the blocked area.
Stages of thrombosis development:
- The localization of the thrombus is the transition of the portal vein to the splenic vein, the area of distribution is less than 50% of the vascular system.
- The localization of the thrombus is the area up to the mesenteric vessel.
- The area of distribution in the third stage is all the veins of the peritoneum.
- In the fourth stage, there is an extensive circulatory disorder.
Portal vein thrombosis symptoms
This type of thrombosis has no specific symptoms inherent only to it. The manifestations of the disease may be similar to the symptoms of hepatitis, liver cancer or cirrhosis, gastritis, pancreatitis, colitis, enteritis. They depend on the localization of a blood clot that blocks blood flow in various parts of the portal vein system.
Stem thrombosis symptoms:
- Pain in the left hypochondrium, in the epigastric region;
- Diarrhea;
- Vomiting blood;
- Peritonitis;
- Expansion of the veins of the abdominal cavity;
- Ascites, portal hypertension;
- Jaundice;
- Swelling of the extremities;
- Anemia.
Symptoms of radicular mesenteric vein thrombosis:
- Increasing pain in the epigastrium;
- Intestinal necrosis.
Symptoms of radicular splenic vein thrombosis:
- Rapid debut of the disease;
- Pain in the epigastrium, in the left hypochondrium;
- Enlarged spleen
- Bloody black stools;
- Vomiting blood;
- Ascites;
- Venous bleeding from the esophagus and stomach.
Terminal thrombosis symptoms:
- Enlarged liver;
- Ascites;
- Expansion of the veins of the subcutaneous mesh.
In chronic thrombosis in 30% of cases, the disease cannot be diagnosed at the initial stage.
Diagnostics
When a patient is admitted to the hospital, laboratory tests are carried out to confirm the diagnosis:
- General blood test - the content of hemoglobin, erythrocytes, color indicator is reduced;
- Coagulogram - reduced blood clotting time, increased prothrombin index;
- Blood for biochemistry;
- Liver function tests;
- Lipidogram;
- General urine analysis.
Instrumental research:
- Computed tomography of the abdominal cavity (CT) - determines symptoms such as varicose veins of the portal vein system, localization of a thrombus, ascites, enlargement of the spleen.
- Doppler ultrasound - determines the size and location of the thrombus, the speed of blood flow in the portal vein.
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Angiography is an accurate method that monitors the movement of contrast medium through a vein using an X-ray unit. Determines the size of the thrombus, its localization, blood flow velocity.
Portal vein thrombosis treatment
The goal of portal vein thrombosis treatment is to restore blood flow, minimize the consequences of vein blockage, and prevent relapse. Conservative and surgical treatment of pathology is used.
Conservative treatment - drugs for the treatment of thrombosis:
- Anticoagulants - Vikasol, Heparin, Biscumacetate, Acenocoumarol;
- Plasma substitutes that replenish the blood flow after bleeding - Reopolygluken, Reogluman;
- Thrombolytics - Streptokinase, Fibrinolysin;
- Antibiotics in case of inflammation - Cilastin, Ceftriaxone;
- Hepatoprotectors - Hepabene;
- Diuretics for ascites for the treatment of edema - furosemide;
- Glucocorticosteroids - Prednisolone, Dexamethasone;
- Enzymes for the treatment of pancreatitis - Creon, Pancreatin;
- Means for intoxication - sodium chloride, glucose.
With the ineffectiveness of drug therapy, as well as in acute conditions, surgical treatment is practiced.
Surgical methods:
- Placement of a Sengstayken-Blackmore probe into the stomach to force air and press the veins against the esophageal wall. Every 6 hours, the veins are freed from the probe to prevent pressure ulcers. The use of the probe lasts for 48 hours.
- Sclerosing injection therapy - the introduction of the drug Trombovar into the veins for gluing varicose veins.
- Splenorenal vein anastomosis;
- Clogged vein prosthetics;
- Tanner's operation - stitching of the stomach;
- Opening and draining the inflamed areas of the vein to prevent the development of a vein abscess.
For the prevention of the disease, you need to forget about bad habits, strengthen the vascular system with dosed physical exertion. You should eat right, if you see signs of malaise, consult a doctor.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
