portal vein thrombosis

Question 1

can PVT affect prognosis in cirrhotic patients

Answer 1

Yes

- PVT may affect the prognosis of cirrhotic patients with poor liver function

Question 2

main causes of portal vein thrombosis

Answer 2

1. decreased portal vein velocity (< 15 cm/sec)
2. local vessel injury (eg: abdominal surgery, splenectomy)
3. thrombophilia (inherited or acquired)
4. Inflammation

Question 3

do non-selective beta blockers decrease or increase portal vein velocity

Answer 3

decrease - they are associated with a 4-fold higher risk of PVT

Question 4

think of this in a cirrhotic patient with PVT and splenomegaly with a normal or elevated platelet count

Answer 4

myeloproliferative neoplasm

Question 5

two ways you can classify cirrhotic PVT

Answer 5

1. acute symptomatic
2. non-acute symptomatic

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252415/pdf/CDD-22-176.pdf

Question 6

grades of PVT

Answer 6

1. mural (<50% stenosis)
2. partial
3. complete obstruction
4. fibrotic cord

Question 7

how to classify the evolution of PVT

Answer 7

1. new onset
2. partial recan
3. complete recan
4. progression
5. stable
6. recurrence

Question 8

what should initiation of AC for PVT depend on

Answer 8

1. is there a major indication?
2. what is the grade/extent
3. what is evolution over time
4. any complications of portal HTN (GEV bleed or high risk GEVs)
5. risks of bleeding (high risk GEVs, prior bleed, coag panel, thrombocytopenia?)

Question 9

what are the major indications for AC in PVT

Answer 9

1. Acute symptomatic PVT
2. candidate for liver transplant
3. extension into the mesenteric vein

Question 10

what to check before starting a patient with PVT on AC

Answer 10

1. History of bleeding
2. High-risk GEVs (need nonselective beta blocker and banding prior to starting AC)
3. severe thrombocytopenia
4. advanced liver cirrhosis (especially Child Pugh C)

Question 11

what tests should be done prior to initiating AC in patients with cirrhosis and PVT

Answer 11

EGD and coagulation panel

Question 12

what should be considered as the primary prophylaxis of variceal bleeding before starting AC in patients with PVT with high risk GEVs

Answer 12

nonselective beta blocker and/or endoscopy with variceal therapy (banding)

Question 13

recommended duration of AC for cirrhosis with portal vein thrombosis

Answer 13

12 months if still not recanalized after 6 months

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252415/#:~:text=The%20Baveno%20VI%20consensus%20and,or%20those%20with%20hereditary%20thrombophilia.

Question 14

if the portal vein was successfully recanalized, when should surveillance imaging be done when AC has been discontinued

Answer 14

3 months