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Suggest Treatment For Portal Hypertension Disease
Question: Dear Sir,
With reference to above subject my son having Extra Hepatic portal vain obstruction and
portal Hypertension disease detected in last October 2014.During investigation it has
been observed that his main SMV vain totally absent but by god gifted him well
established co laterals.But whenever he has having acute Asthmatic problem during seasonal changes
and pollution like dust energy,due to this cough and acute conjunction in chest he has
omitted blood in twice in a year and admitted in hospital and banding was done in esophageal .So sir please give some advice what to do
for my son XXXXXXX His detail is as below from birth.
(1) Twins child birth one XXXXXXX (Son) & XXXXXXX (Daouther).
(2) Date of Birth: 04/01/2009 time:- 5:25 am and 5:27 am.
(3) Birth Place : Chopda Dist.:-Jalgaon., State:-Maharashtra.
With Regards.
XXXXXXX XXXX
Baroda XXXXXXX XXXXXXX XXXXXXX No. 0000 & 0000
With reference to above subject my son having Extra Hepatic portal vain obstruction and
portal Hypertension disease detected in last October 2014.During investigation it has
been observed that his main SMV vain totally absent but by god gifted him well
established co laterals.But whenever he has having acute Asthmatic problem during seasonal changes
and pollution like dust energy,due to this cough and acute conjunction in chest he has
omitted blood in twice in a year and admitted in hospital and banding was done in esophageal .So sir please give some advice what to do
for my son XXXXXXX His detail is as below from birth.
(1) Twins child birth one XXXXXXX (Son) & XXXXXXX (Daouther).
(2) Date of Birth: 04/01/2009 time:- 5:25 am and 5:27 am.
(3) Birth Place : Chopda Dist.:-Jalgaon., State:-Maharashtra.
With Regards.
XXXXXXX XXXX
Baroda XXXXXXX XXXXXXX XXXXXXX No. 0000 & 0000
Brief Answer:
Please upload test reports
Detailed Answer:
Hello, Sir.
I can certainly understand your concerns.
I can guide you better if you can upload ultrasound and other relevant reports of your child for further verification and assessment.
Thank you
Please upload test reports
Detailed Answer:
Hello, Sir.
I can certainly understand your concerns.
I can guide you better if you can upload ultrasound and other relevant reports of your child for further verification and assessment.
Thank you
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am sending herewith all related report as following sequence manner.
1) Page No. 10 to 14 Shital diagnostic clinic USG & Doppler Upper ABDOMEN report.
2) Page No. 9 Case Summary Report from Dr. XXXXXXX Buch MD,DM (AIIMS) Consultant
Gastroenterologist.
3) Page No. 7 to 8 On dated 11/11/2015 Hemetemesis episode XXXXXXX admitted in B.A.G.H
Hospital and some investigation done that is Blood report.
4) Page No. 5 to 6 UPP GI endoscopy & Binding done report.
5) Page No. 4 Discharge summary Report.
6) Page 1 to 3 Fall up done by Endoscopy report.
Thanking You,
With Regards.
1) Page No. 10 to 14 Shital diagnostic clinic USG & Doppler Upper ABDOMEN report.
2) Page No. 9 Case Summary Report from Dr. XXXXXXX Buch MD,DM (AIIMS) Consultant
Gastroenterologist.
3) Page No. 7 to 8 On dated 11/11/2015 Hemetemesis episode XXXXXXX admitted in B.A.G.H
Hospital and some investigation done that is Blood report.
4) Page No. 5 to 6 UPP GI endoscopy & Binding done report.
5) Page No. 4 Discharge summary Report.
6) Page 1 to 3 Fall up done by Endoscopy report.
Thanking You,
With Regards.
Brief Answer:
The cause is umbilical vein XXXXXXX at birth.Overall good prognosis.R/O ICD.
Detailed Answer:
Hello, Sir.
I worked through your query in detail.
I apologize for the delayed response owing to my hectic work schedule.
The major cause of portal vein obstruction is portal vein thrombosis in your child's case.This is most likely caused by Umbilical vein catheterization at the time of birth.This has lead to infection and subsequent blood clot in the main portal vein.
The SMV isn't really absent as per your perception.The SMV , PV are present.They are obscured and could be visualized by the in situ thrombus in 2015.Any recent (JAN 2016) Ultrasound and Colour Doppler of the Abdomen post variceal banding is required to confirm this fact.
This thrombus has lead to portal hypertension and esophageal varices over a period of time that lead to blood vomiting .
These varices have been dealt pretty well(via endoscopic variceal banding) by the consultant Gastroenterologist at XXXXXXX Currently there are no recurrent varices.
In majority of cases, the portal vein thrombus will resolve spontaneously.
One major thing we need to evaluate this stage is inherited coagulopathy(blood clotting disorder) that may cause portal V thrombosis and responsible for symptoms.This doubt was even raised by the consultant Gastroenterologist in 2014.But no tests were done since as per the reports attached.Inherited thrombophilias(blood clotting disorder) have to be ruled out via a panel of blood tests.
Some expert authors suggest checking for an inherited coagulation disorder(ICD) even when a local factor for portal vein thrombosis is obvious and, conversely, also checking for local factors even in the presence of inherited coagulation disorders because more than one risk factor may be present in a single patient.
Hence, I recommend for the following testing.
1.Factor V leiden mutation.
2.Prothrombin gene mutation (20210).
3.Antithrombin 3 levels.
4.Protein C and S levels.
5.PT,APTT, CT and BT.
Once these blood tests results are out, we can predict the possibility of recurrence of symptom events in your child.If these tests are negative, then a Portal vein thrombus can be solely attributed to a LOCAL CAUSE ie; Umbilical vein catheterization at the time of birth.
Please check with your doctor if he shares my view and if can prescribe these tests to your child.
Additional I would like to tell you that seasonal changes can only precipitate Asthmatic episodes and NOT hematemesis episodes(bloody vomitings).
So far excellent treatment modalities have been given to your child and he recovered pretty well and should recover more.Lately no varices have been detected .
It's important to to have routine Upper GIT endoscopy and Liver Function tests at periodic intervals of every 6 months.
Also, I would like to know the list of medications prescribed to your child, since I would like to know if he was treated by any anticoagulant medications(either in the past or present).Kindly attach them in your follow up query.
To conclude,
Your son has recovered well.
The probability of symptoms in near future are unlikely.
It's safe to rule out Inherited thrombophilias through relevant and prescribed blood tests.
His esophageal varices(that contribute to blood vomitings have been pretty effectively treated by Dr PRASANT BUCH).
Regular follow up mandatory.
Post your further queries if any.
Thank you.
The cause is umbilical vein XXXXXXX at birth.Overall good prognosis.R/O ICD.
Detailed Answer:
Hello, Sir.
I worked through your query in detail.
I apologize for the delayed response owing to my hectic work schedule.
The major cause of portal vein obstruction is portal vein thrombosis in your child's case.This is most likely caused by Umbilical vein catheterization at the time of birth.This has lead to infection and subsequent blood clot in the main portal vein.
The SMV isn't really absent as per your perception.The SMV , PV are present.They are obscured and could be visualized by the in situ thrombus in 2015.Any recent (JAN 2016) Ultrasound and Colour Doppler of the Abdomen post variceal banding is required to confirm this fact.
This thrombus has lead to portal hypertension and esophageal varices over a period of time that lead to blood vomiting .
These varices have been dealt pretty well(via endoscopic variceal banding) by the consultant Gastroenterologist at XXXXXXX Currently there are no recurrent varices.
In majority of cases, the portal vein thrombus will resolve spontaneously.
One major thing we need to evaluate this stage is inherited coagulopathy(blood clotting disorder) that may cause portal V thrombosis and responsible for symptoms.This doubt was even raised by the consultant Gastroenterologist in 2014.But no tests were done since as per the reports attached.Inherited thrombophilias(blood clotting disorder) have to be ruled out via a panel of blood tests.
Some expert authors suggest checking for an inherited coagulation disorder(ICD) even when a local factor for portal vein thrombosis is obvious and, conversely, also checking for local factors even in the presence of inherited coagulation disorders because more than one risk factor may be present in a single patient.
Hence, I recommend for the following testing.
1.Factor V leiden mutation.
2.Prothrombin gene mutation (20210).
3.Antithrombin 3 levels.
4.Protein C and S levels.
5.PT,APTT, CT and BT.
Once these blood tests results are out, we can predict the possibility of recurrence of symptom events in your child.If these tests are negative, then a Portal vein thrombus can be solely attributed to a LOCAL CAUSE ie; Umbilical vein catheterization at the time of birth.
Please check with your doctor if he shares my view and if can prescribe these tests to your child.
Additional I would like to tell you that seasonal changes can only precipitate Asthmatic episodes and NOT hematemesis episodes(bloody vomitings).
So far excellent treatment modalities have been given to your child and he recovered pretty well and should recover more.Lately no varices have been detected .
It's important to to have routine Upper GIT endoscopy and Liver Function tests at periodic intervals of every 6 months.
Also, I would like to know the list of medications prescribed to your child, since I would like to know if he was treated by any anticoagulant medications(either in the past or present).Kindly attach them in your follow up query.
To conclude,
Your son has recovered well.
The probability of symptoms in near future are unlikely.
It's safe to rule out Inherited thrombophilias through relevant and prescribed blood tests.
His esophageal varices(that contribute to blood vomitings have been pretty effectively treated by Dr PRASANT BUCH).
Regular follow up mandatory.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Prasad
Hi, I have provided some attachments. Please review them.
Brief Answer:
Repeat Ultrasound Doppler of upper abdomen for current status.
Detailed Answer:
Hello, Sir.
I have worked through your attached reports again.
(PLEASE ALSO CORRELATE WITH MY EARLIER ANSWER.)
Continuation-
The veins particularly SMV(superior mesenteric vein), PV(portal vein), SV(splenic vein) are present in your child.Their view is only obscured(on US and doppler scan in 2014) by the significant blood clot within these vessels, which over a period of time lead to collateral formation and reorganization of venous flow.This is a beneficial mechanism adapted by this body.
I advise you to get a repeat ULTRASOUND AND DOPPLER UPPER abdomen(similar test which was earlier done in 2014 at SHITAL DIAGNOSTICS by Dr XXXXXXX Pachchigar) to visualize the current status of all major veins(SMV,PV,SV) and status of collaterals, and to locate a thrombus if any.
This helps us to compare his status after endoscopic variceal ligation procedure in Nov 2015.Varices did not recur in DEC 2015 ENDOSCOPY.This is a sign of improvement.
Additionally, I would like to know if your son is placed on any anticoagulant medications since 2014.?
Post your further queries if any.
Thank you.
Repeat Ultrasound Doppler of upper abdomen for current status.
Detailed Answer:
Hello, Sir.
I have worked through your attached reports again.
(PLEASE ALSO CORRELATE WITH MY EARLIER ANSWER.)
Continuation-
The veins particularly SMV(superior mesenteric vein), PV(portal vein), SV(splenic vein) are present in your child.Their view is only obscured(on US and doppler scan in 2014) by the significant blood clot within these vessels, which over a period of time lead to collateral formation and reorganization of venous flow.This is a beneficial mechanism adapted by this body.
I advise you to get a repeat ULTRASOUND AND DOPPLER UPPER abdomen(similar test which was earlier done in 2014 at SHITAL DIAGNOSTICS by Dr XXXXXXX Pachchigar) to visualize the current status of all major veins(SMV,PV,SV) and status of collaterals, and to locate a thrombus if any.
This helps us to compare his status after endoscopic variceal ligation procedure in Nov 2015.Varices did not recur in DEC 2015 ENDOSCOPY.This is a sign of improvement.
Additionally, I would like to know if your son is placed on any anticoagulant medications since 2014.?
Post your further queries if any.
Thank you.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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