The myth that patients with liver cirrhosis are “auto‐anticoagulated” is outdated, and evidence shows that these patients frequently experience thrombosis. Portal vein thrombosis (PVT), although considered as rare, it gradually increases complications that are more likely to occur during late‐stage liver cirrhosis. The aim of this chapter is to perform a review of nonmalignant portal vein thrombosis in cirrhosis, in terms of prevalence, pathogenesis, diagnosis, clinical course, and management. Studies were identified by a search strategy using MEDLINE and EMBASE databases. For the MEDLINE search, we used the following terms: (“liver cirrhosis” [MeSH Terms] OR “cirrhosis” [All Fields] OR “cirrhosis” [All Fields]) AND (“portal vein” [MeSH Terms] OR “portal vein” [All Fields]) AND (“Thrombosis” [MeSH Terms]). For the EMBASE search, we used the following terms: (cirrhosis OR phrase liver cirrhosis) AND (phrase thrombosis/OR phrase vein thrombosis/OR phrase thrombosis prevention/OR phrase portal vein thrombosis/OR phrase liver vein thrombosis/OR phrase mesenteric vein thrombosis/OR thrombosis). Studies were considered eligible if they referred to any aspect of prevalence, pathophysiology, clinical presentation, diagnosis and management, or therapy of PVT in cirrhosis. We put forward possible responses to these unsettled issues starting with prevalence, pathogenesis, and treatment options.
Part of the book: Liver Cirrhosis
Immunoglobulin A vasculitis, formerly called Henoch-Schönlein purpura (HSP), is the most common systemic vasculitis in childhood. It is a small-vessel vasculitis mediated by type III hypersensitivity, manifested as rash accompanied by gastrointestinal (GI) symptoms, arthritis, and nephritis. The etiology of this disease (a leukocytoclastic vasculitis) is still uncertain, but immune complexes of IgA and unidentified antigens seem to have a central pathogenic role. Most often the diagnosis is established after the clinical examination; it is easy at first glance when the clinical presentation includes the classic tetrad of rash (nonthrombocytopenic palpable purpura), arthralgia/arthritis, abdominal pain, and renal manifestations but may be difficult when the gastrointestinal manifestations precede the skin purpuric rash. Gastrointestinal involvement is frequently seen and varies from mild symptoms to severe complications; sometimes the gastrointestinal symptoms (colicky abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding) are the first manifestations of the disease. Immunoglobulin A vasculitis is usually a self-limited disease with a benign course, and the treatment is often symptomatic; in severe cases corticosteroids are necessary.
Part of the book: Digestive System