Wednesday, February 4, 2015

Study group discussion: Splenic vein thrombosis and hepatic vein thrombosis

One quick review question!
What is the most likely cause of varices in the fundus of the stomach?

Umm varices in the fundus? Something to do with the splenic artery?

Artery?
Sorry vein! Or high pressure in the spleen? I don't know.

Yeah, splenic vein thrombosis!

Oh yes, which is the most common cause of splenic vein thrombosis?

Umm.. Something to do with compression?
Pregnancy?
Nope.

Hint: Something to do with alcohol
Short of knowledge here.

For splenic vein thrombosis, most common cause is chronic pancreatitis.

Oh do you know the mechanism for splenic vein thrombosis?

I don't know the mechanism of splenic vein thrombosis, I'll find out and let you know.

I think cytokines are probably producing hypercoagulable state in splenic vein.

Splenic vein thrombosis in acute or chronic pancreatitis results from perivenous inflammation caused by the anatomic location of the splenic vein along the entire posterior aspect of the pancreatic tail, where it lies in direct contact with the peripancreatic inflammatory tissue. The exact mechanism of thrombosis is likely multifactorial, including both intrinsic endothelial damage from inflammatory or neoplastic processes and extrinsic damage secondary to venous compression from fibrosis, adjacent pseudocysts, or edema. Obstruction of the splenic vein may also be caused by enlarged retroperitoneal lymph nodes or by pancreatic or perisplenic nodes that are located near the splenic artery, superior to the splenic vein. These nodes lie adjacent to the pancreas and the splenic vein and compress the splenic vein when involved in an inflammatory or neoplastic process.

Awesome.

Thanks for the explanation!

And speaking of thrombosis, which is the most common cause of hepatic vein thrombosis?

For hepatic vein thrombosis, most common cause is PNH. It's also known as Budd Chiari syndrome.

PNH?

Paroxysmal nocturnal hemoglobinuria.

Study link! http://medicowesome.blogspot.ae/2015/01/paroxysmal-nocturnal-hemoglobinuria.html

I think both are different entity.

They are! Sorry didn't make myself clear.
Paroxysmal nocturnal hemoglobinuria causes hepatic vein thrombosis.
Hepatic vein thrombosis causing liver dysfunction is known as Budd Chiari syndrome.

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