portal vein obstruction

• • causes-
    
  • In adults, cirrhosis is the major etiology, accounting for 24-32% of cases of portal vein thrombosis.
  • Neoplasms are another major cause, accounting for 21-24% of cases of portal vein obstruction, with hepatocellular carcinoma and pancreatic carcinoma causing most of these cases. These tumors can cause compression or direct invasion of the portal vein and lead to thrombosis by inducing a hypercoagulable state. Local ablative therapies for hepatocellular or metastatic disease have been linked to its development.
  • Although less common than in children, infections (predominantly intra-abdominal) still play an important role, with a particular association to Bacteroides fragilis bacteremia.
  • Myeloproliferative disorders and inherited or acquired coagulation disorders account for 10-12% of cases in adults.
  • Approximately 8-15% of cases have been reported to be idiopathic in the recent literature. For other less common etiologies, such as abdominal trauma, surgery, and inflammatory bowel disease

    Physical findings-
    

    • Splenomegaly is found in 75-100% of patients, most presenting in the chronic stage. Mild hepatomegaly is often present, as is right upper quadrant epigastric tenderness, especially in the acute setting.
    • Ascites is found infrequently. Stigmata of chronic liver disease, such as spider angiomata or palmar erythema, are usually found in the presence of underlying liver disease.
    • The presence of caput medusae indicates posthepatic or intrahepatic portal hypertension because it forms by recanalization of the umbilical vein, which connects with the left hepatic branch of the portal vein. It should not be observed in isolated extrahepatic portal vein obstruction because the obstruction is below the origin of the umbilical vein.
    • In children, growth retardation may be present.
    • Abnormalities of the extrahepatic biliary tree may occur in 80% of cases due to compression by choledochal or periportal varices or from ischemic stricturing. These findings manifest by jaundice, cholangitis, hemobilia, cholecystitis, or a hilar mass that can be mistaken for a cholangiocarcinoma.

    
    

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