Portal vein thrombosis Quiz: Ace Your Exams
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A 58-year-old man with a history of compensated cirrhosis due to nonalcoholic steatohepatitis presents to the emergency department with two days of worsening abdominal pain that comes and goes abruptly. The pain is most pronounced in the right upper quadrant. He notes an increase in fatigue and abdominal girth. He has not had any recent alcohol intake, changes in medications, or history of similar episodes. Temperature is 37℃ (98.6℉), pulse is 88/min, respirations are 22/min, blood pressure is 122/84 mmHg, and oxygen saturation is 98% on room air. There is scleral icterus. The abdomen is tender to palpation diffusely with a positive fluid wave and splenomegaly. Laboratory tests reveal thrombocytopenia, elevated bilirubin, and mild transaminitis consistent with known cirrhosis. A doppler ultrasound reveals hyperechoic material in the portal vein with impaired blood flow. Which of the following is the best next step in management?
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