Portal Vein Thrombosis

Acute Portal Vein Thrombosis

• Clinical, ⊕ Portal HTN: asymptomatic (incidentaloma) → acute ascites, abdominal pain

• Clinical, ⊖ Portal HTN: inflammatory symptoms or IBD flare mimicker

• Laboratory, AST/ALT: normal LFTs (i.e. liver has hepatic artery blood flow) > moderate ↑ in AST/ALT (⊕ hepatic infarction)

• Laboratory, Lactate: if PVT extends into proximal mesenteric vasculature (e.g. SMV), patient may develop post-prandial lactate → constitutive lactate

Chronic Portal Vein Thrombosis

• Cavernous transformation of PVT → formation of collaterals to bypass chronic PVT→ portal cavernoma → CBD compression ( “portal biliopathy”)