Portal Vein Obstruction Follow-up

  • Author: Adnan Said, MD, MSPH; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 5, 2012
 

Further Inpatient Care

  • After endoscopic therapy of bleeding varices, propranolol is instituted with a goal of reducing the heart rate by 25% below baseline.
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Further Outpatient Care

  • Patients that had endoscopic ligation of varices should have repeat endoscopies every 2-4 weeks with the goal of ligating to eradication.
  • After TIPS placement, repeat ultrasonography is recommended (initially, 4 wk after placement, then every 3 mo) to check patency of the stent. If significant occlusion is discovered, revision can be performed, usually in the outpatient setting.
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Transfer

  • For variceal bleeding refractory to endoscopic therapy or recurrent after endoscopic therapy, transfer to a center experienced in TIPS placement or shunt surgery is recommended.
  • Transfer to a liver transplantation center is recommended for patients with hepatic dysfunction related to cirrhosis in the setting of portal vein thrombosis.
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Complications

  • Variceal hemorrhage
  • Ascites
  • Mesenteric infarction
  • Hypersplenism
  • Hepatic encephalopathy (rare)
  • Worsening hepatic function in patients with cirrhosis
  • Death
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Prognosis

  • The overall prognosis is good, with 75% of patients alive after 10 years and an overall mortality rate of less than 10%.
  • In the presence of cirrhosis and malignancy, the prognosis is understandably worse and is dependent upon the underlying condition.
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Contributor Information and Disclosures
Author

Adnan Said, MD, MSPH  Assistant Professor, Department of Medicine, Section of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health at Madison; Consulting Staff, Department of Medicine, William S Middleton Memorial Veterans Hospital

Adnan Said, MD, MSPH is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, and American Society of Transplantation

Disclosure: Nothing to disclose.

Coauthor(s)

Jennifer T Wells, MD  Fellow, Department of Gastroenterology and Hepatology, University of Wisconsin Hospitals and Clinics, Madison

Jennifer T Wells, MD is a member of the following medical societies: American Medical Association and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Ann Ouyang, MBBS  Professor, Department of Internal Medicine, Pennsylvania State University College of Medicine; Attending Physician, Division of Gastroenterology and Hepatology, Milton S Hershey Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Noel Williams, MD  Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors, Mark Reichelderfer, MD, and Andrew Taylor, MD, to the development and writing of this article.

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The etiology of portal vein obstruction.
Coagulation disorders in portal vein thrombosis.
Portal vein thrombosis with cavernous transformation. The long arrow indicates the splenic vein at the junction with the superior mesenteric vein just below the site of thrombosis. The short arrow points to a serpiginous mass consistent with periportal collaterals, the so-called cavernous transformation of the portal vein.
Hepatocellular carcinoma with portal vein thrombosis. The short arrow indicates the tumor thrombus with an abrupt cut off of the portal vein. The long arrow points to a compensatory, prominent left hepatic arterial branch.
 
 
 
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