Portal portal vein thrombosis( TBV) is a process of closing the lumen of the thrombus, sometimes even until complete occlusion. The probability of developing portal vein thrombosis against a cirrhosis of the liver is 5%, and for hepatocellular carcinoma - 30%.Thrombosis eventually leads to the appearance of intestinal bleeding, so the main goal of treatment is to prevent this development. So, what is the prevention and treatment of such venous thrombosis?
Features of the
Disease According to the ICD-10, portal vein thrombosis has the code I81, which also carries the name "portal vein thrombosis".
- In newborns, portal vein thrombosis develops usually due to infectious processes affecting the umbilical cord stump, through which it affects the portal vein.
- If the child is more adult, the cause of the appearance of the pathology may be the transferred acute appendicitis.
- In adulthood, the cause of the onset of the disease is more likely to be transferred surgery, pregnancy, tumors, cirrhosis or hypercoagulable syndrome. In almost every case, obstruction develops. Below you will find photos of venous thrombosis.
Photo of portal vein thrombosis
Classification and forms of
- For the first stage of the disease, it is characteristic that less than 50% of the vessels remain closed, and the thrombus is located at the site of the vein transfer into the splenic.
- In the second degree, the thrombus already occupies the site up to the mesenteric vessel.
- The third stage is characterized by the maintenance of normal blood flow or only a minor violation of it, but thrombosis affects all the veins in the abdominal cavity. At the last stage there is a violation of blood circulation.
The form of vascular occlusion can be acute or chronic.
- In the first case, thrombosis can quickly lead to death, because complications develop rapidly.
- The chronic form of the flow is long, develops against a background of other problems, which complicates the diagnosis. This degree of blockage often has a variety of manifestations of diseases of the abdominal cavity.
For reasons and symptoms of portal vein thrombosis, read on.
On how the portal vein thrombosis looks, you will learn from the following video:
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Causes of portal thrombosis
Thrombosis may occur due to congenital features and defects, including those described above. There are several pathogenic factors that can create a favorable developmental background for pathology. These include:
- hereditary predisposition,
- the presence of tumors or cysts in the vein,
- purulent pylephlebitis,
- high blood clotting,
- the presence of chronic inflammation,
- operative interventions.
Symptoms of
The narrowing of the lumen of the portal vein is divided into stages, each of which is characterized by the presence of several different signs. However, the progress of the disease is rapid, therefore, soon after its onset, there is a clinical picture.
The most significant symptom is the extensive esophageal hemorrhage due to dilated veins. There may be flatulence, lack of appetite, bloating or missing stools, as well as other similar symptoms indicative of bowel dysfunction.
Yellowing of the eyeballs can also become a symptom of thrombosis, as well as other signs that are revealed in hepatic insufficiency. As for ascites, it is only against the background of pathology that it occurs rarely, so its appearance may indicate other diseases.
Diagnosis
When diagnosing "portal hypertension," doctors are always suspected of having a vein thrombosis. The research methods used are as follows:
- ultrasound. Check the lumen of the portal vein to detect a thrombus in it and reveal an abscess. When introducing contrast in the cavity of blood vessels, the signal from the blood flow may be absent. Often, ultrasound can help determine the root causes of the pathology, including liver cirrhosis, hepatocellular carcinoma, metastases, etc.
- Coagulogram, which determines a number of signs characteristic of thrombosis( increased PTI, increased fibrinogen, short coagulation time).
- MRI reveals a pathological signal in different parts of the vessels.
- With the help of CT, the thrombus itself is detected, as well as the defect of filling the portal vein.
- Angiography is used as the main method for confirming the diagnosis. The vascular cavity may not be in general contrasted or a filling defect is detected.
Treatment of
The goal of treatment of portal vein thrombosis is to prevent the effects typical of pathology, restore blood flow and prevent further blockage of blood vessels.
We will begin with the fact that we will understand what preparations are used for venous thrombosis.
Drug method
Antibiotics are used only in the development of pylephlebitis, with a wide spectrum of action. The main tool for treating portal vein thrombosis remains the use of a number of anticoagulants. Initially, they select drugs that are administered intravenously. Selection of medications is strictly individual, so they are selected according to the results of thromboelastography, blood clotting and tolerance to plasma heparin. Then use indirect drugs, gradually reducing the dose.
There are also contraindications to the use of anticoagulants:
- previous operations,
- bleeding,
- intolerance,
- pregnancy.
Carefully select them after strokes, with ulcers. In a complex with them use thromboembolic drugs.
Operation
Surgical treatment does not necessarily involve surgery, as there are conservative therapies.
- The Sengstaiken-Blakmore probe is placed in the stomach, after which it starts to pump air. This helps to press the veins against the wall of the esophagus. Cylinders are obligatory for a few minutes after 6 hours are released from the air, which helps to avoid pressure sores. By the time the continuous application of the probe is also limited and is 48 hours.
- Sclerosing injection therapy. In this case, enter a special drug( thrombovar), which helps to glue varicose veins. Such an intervention is performed with esophagoscopy( method of examination of the esophagus).
Operative treatment is used in those cases when neither the medicinal nor the conservative therapy technique yields results.
- If the splenic vein remains passable, splenorenal anastomosis can be imposed.
- If it is clogged, the vessel is reconstructed with a prosthesis, which is located between the lower hollow and the superior mesenteric vein.
If the bleeding is prolonged and does not stop, use stitching. Thus, in the operation of Tanner, the stomach in the cardiac section is cross-transversely crossed, and the walls themselves are stitched. If the patient develops pylephlebitis, then further liver abscess should be prevented. For this, the areas that have already arisen are opened and drainage is established.
Prevention of disease
Progression of portal vein thrombosis can be avoided by carefully approaching preventive recommendations and performing them with precision. This is especially true for those patients who are at risk. The most effective methods are:
- maintaining a normal level of physical activity, walking;
- proper nutrition;
- rejection of bad habits, including excessive use of caffeine;
- performing cardio exercises;
- use a variety of methods to strengthen the cardiovascular system.
On how acute pancreatitis, complicated by thrombosis of the portal vein, read further.
Acute pancreatitis complicated by
Acute pancreatitis is a disease characterized by rapid development. Often it can lead to death. Its probability increases when there is a blockage of veins. After the onset of an attack, rapid hospitalization is necessary.
The cause of development of TBI is often pancreatitis. The clinical picture is complemented by the symptoms of both pathologies, which complicates the precise diagnosis. Thrombosis in pancreatitis often affects the portal and splenic veins.
Complications of
Provided there are no medical measures, purulent peritonitis develops, or another infection that leads to attacks of intoxication. With a complex picture of the course of the disease, a violation of the temperature regime occurs, the liver changes pathologically, which can be felt even with palpation - it becomes tuberous, dense, increases, and pressure is painful.
Prolonged postponement of treatment is fraught with massive bleeding, intestinal infarction, the development of various abscesses or the occurrence of purulent peritonitis. All these pathologies many times worsen the prognosis of the course of the disease.
On what prognosis for portal vein thrombosis, read on.
Forecast
The most unfavorable prognosis is the most severe stages of occluding the portal vein, so you can not delay with treatment in any case. The outcome of such events almost always becomes a fatal outcome.
Even more useful information on the issue of thrombosis contains the following video: