Portal vein thrombosis is a condition that does not usually lead to symptoms immediately and is therefore characterized by a rather gradual progression. In the acute state, portal vein thrombosis requires immediate action.
What is portal vein thrombosis?
The term portal vein thrombosis is a compound word that exists as portal vein and thrombosis. In the context of the location of thrombosis, this condition involves the venae portae. The venae portae is a special blood vessel responsible for carrying blood to the liver. Thrombosis is the term used in medicine when, as in portal vein thrombosis, there is an occlusion of the portal vein by a so-called clot, which becomes lodged in the vessel and impairs or prevents blood supply or blood drainage. Portal vein thrombosis is a rare manifestation of thrombosis, which is already known from other cardiovascular diseases.
Causes
Portal vein thrombosis usually occurs when unfavorable underlying conditions are already present. These are the growth of tumors in the pancreas or in the tissues of the liver. Another cause of portal vein thrombosis can be an inflammatory process in the pancreas. Like hepatitis, this is accompanied by swelling of the affected organ and can lead to portal vein thrombosis. People who suffer from an increased tendency to form blood clots, are “dehydrated” due to insufficient fluid intake, or have poisoned themselves can also develop portal vein thrombosis. This applies equally to patients who take certain medications and live with an increased risk of developing venous thrombosis. Portal vein thrombosis may also be favored by existing pregnancy or loss of liver function (cirrhosis).
Symptoms, complaints, and signs
In most cases, portal vein thrombosis remains without symptoms. It is often not noticed until complications occur, which can often be life-threatening. Some patients gradually develop varicose veins in the esophagus or stomach because of portal hypertension. This increases the risk of esophageal or gastric bleeding. This can cause vomiting of blood or so-called tarry stools. Bleeding in the upper digestive organs typically results in black, tarry, foul-smelling stools. The spleen is often greatly enlarged. This causes painful swelling of the abdomen in some patients. Meteorism and abdominal dropsy (ascites) often then occur. The blood stasis can also cause disturbances in the intestines. Sometimes diarrhea and the so-called subileus symptoms occur. Subileus symptomatology is characterized by limited forward movement of intestinal contents. This results in a backlog in the direction of the mouth. This backlog is noticeable as nausea and a feeling of fullness. Furthermore, intestinal cramps and colics occur. Food components are insufficiently absorbed. Subileus is the precursor of ileus, i.e. intestinal obstruction. However, portal vein thrombosis is rarely so dramatic. As mentioned above, there are usually no symptoms at all because a large bypass circuit forms over the course of several weeks and months. Any pre-existing upper abdominal discomfort and splenomegaly then gradually diminish.
Diagnosis and course
Medical professionals have a wide variety of methods at their disposal for the specific, precise detection of portal vein thrombosis. These are used in particular after assessing patients when they describe their sometimes nonspecific complaints. The individual procedural technologies for the diagnosis of portal vein thrombosis are based on a proven and highly complicated medical technology, which are suitable as ultrasound of the upper abdomen, computer tomography and magnetic resonance imaging, as well as a so-called color Doppler examination. These individual procedures are completed in portal vein thrombosis by extensive tests in the laboratory. These concern, for example, the so-called liver values in the serum and the determination of the coagulation factors in the plasma. The course of portal vein thrombosis is accompanied by painfulness and swelling of the upper abdomen. Diarrhea, a persistent feeling of fullness and nausea, and in rare cases vomiting accompany portal vein thrombosis.
Complications
Portal vein thrombosis does not cause symptoms in most cases. Complications usually arise from the precipitating conditions. However, accumulation of water in the abdominal cavity may occur. Furthermore, varicose veins appear in the esophagus and stomach, which in unfavorable cases may even burst, causing severe bleeding. Since the portal vein is blocked, blood pressure also rises in it. This local increase in blood pressure can cause the spleen to become very enlarged and rupture. However, portal vein thrombosis often also severely impairs liver function if it is no longer supplied with sufficient blood. Most complications, as mentioned above, are caused due to underlying diseases. For example, portal vein thrombosis caused by cirrhosis of the liver is much more likely to lead to esophageal and gastric bleeding or abdominal ascites. Ascites is otherwise not very common in other causes. Therefore, portal vein thrombosis associated with liver cirrhosis is a life-threatening complication. Severe pancreatitis, a malignant pancreatic tumor, or renal cancer may also be the cause of portal vein thrombosis. Again, the underlying diseases cause the majority of complications. Therefore, diagnosis of the underlying diseases is very important to effectively treat a complication that occurs in the setting of portal vein thrombosis.
When should you see a doctor?
People who suffer from a general feeling of illness, malaise, as well as an inner restlessness should consult a doctor. A steady decrease in resilience, sleep disturbances, or a diffuse feeling that something might be wrong should be discussed with a physician. In portal vein thrombosis, there is a gradual increase in symptoms. Over a long period of time, there is freedom from symptoms. Nevertheless, since the course of the disease can be fatal, a visit to the doctor should be made at the first perceived irregularities. Vomiting of blood, dizziness, a feeling of tightness in the body, swelling or disturbances of the blood circulation should be examined and treated. If there are abnormalities of the digestive tract, changes in the appearance of the skin or peculiarities of the excretions, a doctor is needed. Cramps, pain, as well as a loss of appetite indicate health impairment. A doctor is needed if there is constipation, a feeling of fullness, as well as a decrease in physical performance. If there is nausea, an elevated body temperature, bad breath, as well as an unwanted weight loss, a visit to the doctor is advised. If there are changes in behavior, increased irritability or bleeding when going to the toilet, a doctor must be consulted as soon as possible. An ambulance should be alerted as soon as disturbances of consciousness become apparent. In these cases, a life-threatening condition exists and must be treated immediately.
Treatment and therapy
Treatment of portal vein thrombosis opens different variants in the course of modern medical procedures and interventions. Basically, in portal vein thrombosis, the same therapy is used which is adequate in other thrombosis. In this regard, the primary goal is to dissolve the thrombus and unblock the portal vein. This is done in portal vein thrombosis, which can affect either the entire portal vein or only a part of it, by means of specifically selected drugs. These are also known as anticoagulants in thrombosis therapy and are also based on Marcumar and heparin in portal vein thrombosis. Unlike thromboses, which can develop in various other blood vessels in the body, there is no risk of pulmonary embolism in portal vein thrombosis. Nevertheless, it is important to act as quickly as possible to avoid damage to the liver tissue due to a lack of blood supply. In addition, treatment of portal vein thrombosis is equally based on alleviating the symptoms and causes by the underlying diseases present.
Prospect and prognosis
Thrombosis, regardless of location, is always a worrisome event. The prognosis of portal vein thrombosis is favorable only if the blood clot is noticed quickly, and can be resolved promptly. If it becomes chronic, the prognosis is less good. A problem is that portal vein thrombosis can be asymptomatic. It is therefore often not noticed.It is more likely to be detected with non-specific symptoms such as pain in the abdomen or fever. Often, however, the discovery is rather accidental. This can lead to a delayed start of treatment. In this case, there is a risk of intestinal necrosis occurring in some of those affected. This can subsequently lead to peritonitis, which is fatal due to multiple organ failure. Portal vein thrombosis, which has already become chronic, may result in cavernous changes with subsequent portal hypertension. The prognosis worsens significantly if bleeding from ruptured varices occurs as a complication. Since portal vein thrombosis is more likely with certain pre-existing conditions or hereditary components, physicians should take special care during check-ups in this case. In only 10-40 percent of those affected, portal vein thrombosis can be resolved by several months of therapy with blood-clotting agents. The unfavorable prognosis for the remaining affected persons can be deduced from this. With early diagnosis and early initiation of treatment, the chances are still best.
Prevention
Prevention of portal vein thrombosis lies particularly in the fact that appropriate treatment of the causative diseases is undertaken. In addition, if these pre-existing conditions are present, it is important to have regular specialist check-ups and, above all, to pay close attention to coagulation factors. According to laboratory findings, these should not be above the normal permissible parameter. This is the only way to initiate meaningful prevention against portal vein thrombosis. In addition, it is important to drink enough to prevent portal vein thrombosis. This applies in particular to elderly people, who often suffer from a limited sense of thirst.
Follow-up
The measures of an aftercare are very limited in many cases of portal vein thrombosis, because the disease is usually detected late and is therefore also treated in many cases in an advanced stage. Affected individuals should therefore seek medical attention at the first signs and symptoms of the disease to avoid further complications or other medical conditions. As a rule, portal vein thrombosis cannot heal itself. Most sufferers are dependent on taking various medications for this condition. The correct dosage and also regular intake should always be observed in order to alleviate the symptoms permanently and properly. Likewise, those affected should always consult a medical professional first in the event of any uncertainties, questions or severe side effects in order to prevent further complications. Strenuous activities or physical exercise should be refrained from in portal vein thrombosis in order not to put unnecessary strain on the body. Most patients are dependent on care and also on the support of their own family in their daily lives. This can also prevent depression and other psychological upsets in many cases. It is not uncommon for portal vein thrombosis to drastically reduce the life expectancy of the affected person.
What you can do yourself
Once this diagnosis is made, it is important to find out how this rare form of thrombosis could have occurred. What diseases caused it? The answer to this question will determine how treatment proceeds, because portal vein thrombosis itself often causes little to no symptoms. However, any underlying diseases may be serious and complicated. Patients with portal vein thrombosis should pay attention to their blood pressure because it may be elevated due to the blocked portal vein. Even though liver-sparing diets are no longer recommended nowadays, it makes sense for portal vein thrombosis patients to avoid alcohol and overly fatty foods. Instead of animal fats, oils with high-quality omega-3 fatty acids such as linseed or walnut oil are recommended. Empty” carbohydrates such as white bread or pasta and sweets should be avoided in the long term. If the patient is overweight, it would be desirable to reduce this excess weight and reach normal weight. If varicose veins in the stomach have also been detected with the portal vein thrombosis, it is recommended to eat smaller meals several times a day, as they are easier to digest than three large ones. Furthermore, anything that reduces stress is helpful.This includes regular rest periods as well as daily exercise in the fresh air. Gentle sports such as yoga, Reiki, Tai Chi or Qi Gong also help to relieve stress.
