1 / 11

Pylephlebitis

Pylephlebitis. Megan Brundrett October 19, 2009. Outline. Etiology Microbiology Clinical Manifestations Diagnosis Complications Treatment Prognosis Take Home Points. Etiology. Pylephlebitis is septic thrombophlebitis of the portal venous system

scorpio-goldberg
Download Presentation

Pylephlebitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pylephlebitis Megan Brundrett October 19, 2009

  2. Outline • Etiology • Microbiology • Clinical Manifestations • Diagnosis • Complications • Treatment • Prognosis • Take Home Points

  3. Etiology • Pylephlebitis is septic thrombophlebitis of the portal venous system • Is a rare complication of ruptured viscera – including appendicitis and diverticulitis • Much more common in early 20th century prior to antibiotic therapy • Most common cause is diverticulitis (about 70% of cases) • May be more common in pts with hypercoaguable states

  4. Microbiology • Common enteric organisms • Most common organisms are B. fragilis, and E. coli • Bacteroides species have pro-coagulant properties – have enzyme that breaks down heparin and have surface components that promote fibrin clotting • Proteus mirabilis, Klebsiella pneumoniae, anaerobic streptococci, Clostridium species, yeasts • 80% of patients have concurrent bacteremia, oftentimes polymicrobial

  5. Clinical Manifestations • Abdominal pain, fever, nausea, vomiting, headache • Hepatomegaly, splenomegaly, and jaundice • Leukocytosis, neutropenia, elevated GGT, and elevated alk phos • Imaging studies – CT scan, or abdominal ultrasound can demonstrate thrombus in portal vein

  6. Complications • Liver abscesses • Progression of thrombus to mesenteric vein and bowel ischemia • Portal hypertension

  7. Treatment • Antibiotic therapy – Mainstay of therapy - Metronidazole/Flouroquinolone - Zosyn, Unasyn, or Ertapenem No accepted regimen because of the rarity of the condition. Length of treatment – 4 to 6 weeks • Anticoagulation – Unsure about use in this condition - Help prevent clot extension or if clot is extending - If patient has hypercoaguable state - If Bacteroides is isolated

  8. Prognosis • Prior to antibiotic era – uniformly fatal • Still 10-30% fatal, most fatalities are from quickly progressing sepsis • Long term - portal hypertension

  9. Take Home Points • Pylephlebitis – not common, but something to think about with fever/abdominal pain, especially in patient with diverticulitis. • Complications – liver abscess, portal HTN, bowel ischemia. • Antibiotics can save a person’s life!

  10. References • Spelman. (2009). Pylephelbitis. UpToDate. Retrieved from http://www.uptodate.com • Saxena et al, 1996 Jun;91(6):1251-3. The American Journal of Gastroenterology.

More Related