emDocs - December 27, 2017 - Authors: Hanlin E and Kaelin A
Edited by: Koyfman A and Long B
"Clinical Pearls- Patients with PVT are often asymptomatic. Knowledge of risk factors associated with the disease is important to ensure the disease is considered.
- Abdominal pain in patients with PVT is often associated with mesenteric vein occlusion and subsequent intestinal ischemia.
- Consider PVT in patients with hematologic cancers or other pro-thrombotic conditions presenting to the ED with abdominal pain or new ascites.
- Color Dopper US is sufficient for diagnosing PVT in clinically stable patients.
- Consider contrast-enhanced CT in patients with severe symptoms or those who are clinically deteriorating to look for sequelae of PVT.
- LFTs are usually normal in patients with PVT.
- Timely initiation of anticoagulation with heparin or LMWH followed by warfarin is the recommended treatment for acute PVT.
- Patients with acute PVT should be admitted to surgery or a medicine service with a surgery consult for frequent abdominal checks and initiation of anticoagulation therapy."