Portal vein thrombosis

Question 1

Management of acute PVT

Answer 1

AC with lovenox (prevents rapid clot propagation). Then bridge to coumadin.

Question 2

AC not to use + why

Answer 2

heparin (PVT is associated with higher rates of hit)

Question 3

Patients in whom PVT occurs

Answer 3

1) cirrhotics
2) underlying prothrombotic disorder
3) aute pancreatitis

Question 4

Distinction in PVT

Answer 4

occlusive vs. nonexclusive

Question 5

Physiologic effects of chronic PVT

Answer 5

• collateral circulation

- portal hypertension

Question 6

Presentation

Answer 6

• asymptomatic, diagnosed incidentally
  OR
  abdominal pain (often due to Super mesenteric vein occlusion)
• may have ileus

Question 7

medical term for septic PVT

Answer 7

Acute pylephlebitis

Question 8

Diagnosis of suspected acute PVT

Answer 8

contrast-enhanced CT

Question 9

Findings suggestive of malignant PVT

Answer 9

• elevated AFP
• portal vein diameter greater than 23 mm
• disruption of vessel walls or tumor encroaching on portal vein
• arterial-like pulsatile flow seen with doppler US

Question 10

goal INR with warfarin for PVT anticoagulation

Answer 10

2-3

Question 11

evidence for NOACs

Answer 11

• 1 trial saying they work, but other studies suggesting less efficacy in cirrhotics
• inadequate data currently

Question 12

Problem with using warfarin for cirrhotics

Answer 12

• INR may not reflect patients level of anticoagulation

Question 13

Why portal vein recanalization is important

Answer 13

• failure to restore venous drainage of small intestine puts patients at risk for intestinal ischemia and infarction

Question 14

sequelae to be worried about

Answer 14

intestinal infarction

Question 15

Prognosis

Answer 15

IF anticoagulated, prognosis is good

Question 16

aside – how long does it take patients to achieve full anticoagulation with warfarin?

Answer 16

5 day

Question 17

Pathologies associated with PVT

Answer 17

1) PV
2) essential thrombocythemia
3) PNH
4) malignancy