Gastroenterology Education and CPD for trainees and specialists

1. Which one of the following statements regarding PVT is false?

1. General risk factors are more common than local factors
2. Complete repermeation can be achieved with anticoagulation therapy in 90% of patients.
3. Anticoagulation therapy is recommended for at least 3 months for acute PVT and life long if there is permanent thrombotic risk factors.
4. Portal cavernoma is a radiological sign of acute PVT.
5. PVT is associated with varix at atypical location

Explanation :PVT is caused by a combination of local and general risk factors. A local risk factor can be identified in about 30% of patients, and a general risk factor in 70%. Spontaneous repermeation is possible but uncommon, whereas complete or partial repermeation can be achieved with anticoagulant therapy in up to 90% of patients. Anticoagulation therapy is recommended for at least 3months in all patients with acute PVT. Anticoagulation therapy should be continued long term in patients with acute PVT and permanent thrombotic risk factors that are not correctable otherwise. Long term anticoagulation should also be considered in patients with acute PVT and thrombus extension distally into the mesenteric vein. In chronic PVT, tortuouos venous channels develop inside a mature clot -also called portal cavernoma. A diagnosis of cavernoma is readily made by abdominal imaging with ultrasound, CT or MRI which shows serpiginous structures while the main portal vein and/or its main branches are not visible. In chronic PVT, portosystemic anastomoses develop in unusual situations like gall bladder bed, choledochal varix (sometime presenting with obstructive jaundice often mascquarading as cholangiocarcinoma on ERCP) , colonic varix beside varices in usual sites.

2. Which one of the following statements regarding PVT is false?

1. Commonest cause of PVT in children is umbilical sepsis
2. JAK2 mutation in granulocytes is 100% specific for myeloproliferative disease.
3. Ham-Dacie and sucrose tests can diagnose Paroxysmal nocturnal hemoglobinuria where flowcytometry is unavailable
4. Rebleeding after endoscopic therapy and bleeding from varices distal to the oesophagus are indication for surgical shunts
5. Abdominal pain along with bloody diarrhoea and alkalosis should alert about possibility of mesenteric ischemia in patients of acute PVT

Explanation :Infection particularly umbilical sepsis is the commonest cause of PVT in children.CD55 and CD59 deficient clone at flowcytometry of peripheral blood cells is diagnostic of Paroxysmal nocturnal hemoglobinuria. Ham-Dacie and sucrose tests are used where flowcytometry is unavailable. Rebleeding after endoscopic therapy and bleeding from varices distal to the oesophagus are indication for surgical shunts. Both mesocaval and speno-renal shunts have been performed with low mortality rate and long survival. Radiological shunts ie TIPS is difficult if not impossible because of difficult access. Most surgeons request angiogram before performing a shunt. Report of abdominal pain along with bloody diarrhoea and acidosis should alert about possibility of mesenteric thrombosis with intestinal ischaemia in patient with acute PVT. Surgical exploration with intestinal resection might be needed.

Gastroenterology training and education

MCQ On Portal vein thrombosis

Help in the growth of the Gastrotraining community by submitting your MCQ.

Submit a MCQ

MCQs