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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56983
Experience:  GP in the United States
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My 75 year old aunt has auto immune hepatitis with cirrhosis

Resolved Question:

My 75 year old aunt has auto immune hepatitis with cirrhosis and oesophageal varices. She has been treated medically with prednisolone and azathiaprine and we were told she was responding to treatment. Today she has become critically unwell due to a clot in her mesenteric vein leading to her portal vein. Please please can you tell us how this condition should be treated. Thank you for your time.
Submitted: 4 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 4 years ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Thanks for this question.

I'm very sorry this happened.

Mesenteric vein thrombosis is a devastating complication of liver disease.

This is very serious and causes a lot of problems including possible liver failure.

Also, the backup of blood can cause bleeding

Basically, the treatment is anticoagulation and controlling complications like bleeding and infection

This is a very tricky situation in patients with liver disease. You always want to give blood thinners in order to save the portal vein and resupply blood flow but patients with liver disease bleed easily

So your aunt needs to be anticoagulated and also monitored closely for bleeding with frequent vital sign checks and blood counts every few hours.

Also, any complications like fluid overload need to be dealt with immediately.

So the mainstay of treatment is anticoagulation. Side effects are where trouble ensues. So we need to watch closely for that.

Here's an article for you to review

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104181/
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Customer: replied 4 years ago.
Thank you so much for your advise . Would surgery be an option to remove the clot?
Expert:  Dr. Phil, MD replied 4 years ago.
Thanks for this reply. :)

Initial therapy is anticoagulation

If this is not fully successful then yes surgery is an option

There are also other less invasive options

An interventional radiologist or vascular surgeon can insert a catheter into the vein and inject "clot busters"

This is another option. Start with blood thinners and see what happens first though. :)
Customer: replied 4 years ago.
She has heart dysrythmia also .does this complicate matters and make any treatment impossible
Expert:  Dr. Phil, MD replied 4 years ago.
It complicates matter because any additional illness will but it will not preclude using blood thinners or other treatments

It can be worked around