What is the portal vein?
The portal vein is a very large vein in the abdomen which is responsible for carrying blood from the bowels and other abdominal organs to the liver.
Why is it medically important?
For some unknown reason(s) the portal vein is prone to developing a blood clot. This blood clot usually completely blocks the portal vein. When the vein is blocked, it causes blood to back up in the vein causing high pressures in all the veins below it. The condition is medically known as portal vein thrombosis (PVT). In addition, the organs returning blood to the portal vein, like the spleen, get engorged with blood. In many cases, the body attempts to bypass this blocked vein by developing thin walled veins (collaterals). These collaterals are large and appear like varicosities. The majority of these varicose veins are seen at the lower end of the esophagus (eating tube) but may appear anywhere in the abdomen.
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What conditions are associated with PVT?
- Heart failure
- Budd chiari (a childhood condition)
- Constrictive pericarditis (the heart is encased with a stiff covering which
- Prevents the heart from beating well)
- Live cirrhosis or scarring
- Cancers of the liver, pancreas, stomach and bile ducts
- Pus in the liver
Treatment
Acute Bleeding:
Many times patients with severe vomiting of blood require urgent treatment and therapy is undertaken to prevent further bleeding.
Sclerotherapy: In the acute setting, treatment is most effective with variceal banding or sclerotherapy, often requiring several sessions to obliterate the bleeding. Both Sclerotherapy and/or banding require the use of a flexible camera placed in the swallowing tube (esophagus). The physician may then either apply a rubber band to ligate or inject the varices with a chemical. This has a success rate of 95% for the acute bleed.
Octreotide: Sometimes a chemical called Octreotide is administered. In the majority of individuals it stops the bleeding but recurrence is high with this approach.
Blood thinners: Sometimes if a recent blood clot has occurred, medications to dissolve the clot are administered. However, this is a very risky procedure because if vomiting of bright red blood is occurring at the same time, the blood thinner will make things worse. The majority of physicians stay away from this therapy because of the tendency to make the bleeding worse.
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