Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]
Overview
Overview
- Portal vein thrombosis must be differentiated from other diseases that cause abdominal pain, diarrhea, and nausea and vomiting, such as: Chronic pancreatitis, Pancreatic carcinoma, Dumping syndrome, Acute appendicitis, acute diverticulitis, Infective colitis, viral hepatitis, Liver abscess, Mesenteric ischemia, and Acute ischemic colitis.
Differentiating portal vein thrombosis from other Diseases
Differentiating portal vein thrombosis from other Diseases
- Portal vein thrombosis must be differentiated from other diseases that cause abdominal pain, diarrhea, and nausea and vomiting, such as: Chronic pancreatitis, Pancreatic carcinoma, Dumping syndrome, Acute appendicitis, acute diverticulitis, Infective colitis, viral hepatitis, Liver abscess, Mesenteric ischemia, and Acute ischemic colitis.
| Disease
|
Clinical manifestations
|
Diagnosis
|
Comments
|
| Symptoms
|
Signs
|
| Abdominal Pain
|
Fever
|
Rigors and chills
|
Nausea or vomiting
|
Jaundice
|
Constipation
|
Diarrhea
|
Weight loss
|
GI bleeding
|
Hypo-
tension
|
Guarding
|
Rebound Tenderness
|
Bowel sounds
|
Lab Findings
|
Imaging
|
| Portal vein thrombosis
|
Diffuse
|
±
|
−
|
+
|
±
|
−
|
+
|
+
|
±
|
−
|
−
|
−
|
N
|
|
|
|
| Chronic pancreatitis
|
Epigastric
|
−
|
−
|
±
|
±
|
−
|
+
|
+
|
−
|
−
|
−
|
−
|
N
|
- Increased amylase / lipase
- Increased stool fat content
- Pancreatic function test
|
CT scan
|
- Predisposes to pancreatic cancer
|
| Pancreatic carcinoma
|
Epigastric
|
−
|
−
|
+
|
+
|
−
|
+
|
+
|
−
|
−
|
−
|
−
|
N
|
|
|
Skin manifestations may include:
|
| Dumping syndrome
|
Lower and then diffuse
|
−
|
−
|
+
|
−
|
−
|
+
|
+
|
−
|
+
|
−
|
−
|
Hyperactive
|
|
- Upper GI series
- Gastric emptying study
|
|
| Disease
|
Abdominal Pain
|
Fever
|
Rigors and chills
|
Nausea or vomiting
|
Jaundice
|
Constipation
|
Diarrhea
|
Weight loss
|
GI bleeding
|
Hypo-
tension
|
Guarding
|
Rebound Tenderness
|
Bowel sounds
|
Lab Findings
|
Imaging
|
Comments
|
| Acute appendicitis
|
Starts in epigastrium, migrates to RLQ
|
+
|
Positive in pyogenic appendicitis
|
+
|
−
|
−
|
±
|
−
|
−
|
Positive in perforated appendicitis
|
+
|
+
|
Hypoactive
|
|
|
- Positive Rovsing sign
- Positive Obturator sign
- Positive Iliopsoas sign
|
| Acute diverticulitis
|
LLQ
|
+
|
±
|
+
|
−
|
+
|
±
|
−
|
+
|
Positive in perforated diverticulitis
|
+
|
+
|
Hypoactive
|
|
|
|
| Infective colitis
|
Diffuse
|
+
|
−
|
±
|
−
|
−
|
+
|
−
|
+
|
Positive in fulminant colitis
|
±
|
±
|
Hyperactive
|
|
CT scan
- Bowel wall thickening
- Edema
|
|
| Viral hepatitis
|
RUQ
|
+
|
−
|
+
|
+
|
−
|
Positive in Hep A and E
|
+
|
−
|
Positive in fulminant hepatitis
|
Positive in acute
|
+
|
N
|
- Abnormal LFTs
- Viral serology
|
|
- Hep A and E have fecal-oral route of transmission
- Hep B and C transmits via blood transfusion and sexual contact.
|
| Liver abscess
|
RUQ
|
+
|
+
|
+
|
+
|
−
|
±
|
+
|
−
|
+
|
+
|
±
|
Normal or hypoactive
|
|
|
|
| Mesenteric ischemia
|
Periumbilical
|
Positive if bowel becomes gangrenous
|
−
|
+
|
−
|
−
|
+
|
+
|
+
|
Positive if bowel becomes gangrenous
|
Positive if bowel becomes gangrenous
|
−
|
Hyperactive to absent
|
|
CT angiography
|
- Also known as abdominal angina that worsens with eating
|
| Acute ischemic colitis
|
Diffuse
|
+
|
±
|
+
|
−
|
−
|
+
|
+
|
+
|
+
|
+
|
+
|
Hyperactive then absent
|
|
Abdominal x-ray
CT scan
- Double halo appearance, thumbprinting
- Thickening of bowel
|
|
| Pneumonia
|
RUQ/LUQ
|
+
|
+
|
+
|
−
|
−
|
±
|
−
|
−
|
+
|
−
|
−
|
Normal or hypoactive
|
|
|
- Shortness of breath
- Cough
|
|
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram, MRA= MR angiography, CEUS=Contrast enhanced ultrasound
References
References
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