S1590 Medication, Nutrition, Education: A Quality Improvement Initiative to Reduce Readmissions in Patients with Overt Hepatic Encephalopathy
AMERICAN JOURNAL OF GASTROENTEROLOGY(2023)
摘要
Introduction: Ischemia caused by venous thrombosis has been implicated in the pathogenesis of amebic liver abscess (ALA). This study aimed to report venous thrombosis and associated perfusion defect indicating segmental ischemia in ALA using multidetector computed tomography (MDCT). Methods: MDCT images of 62 patients with ALA were reviewed for venous thrombosis and associated perfusion abnormalities. Hypoperfusion was considered when segmental or subsegmental hypo-enhancement(attenuationvalue , 30HUcomparedtothehealthyparenchyma)wasdetectedsurroundingtheALAonthevenousphaseofCTexamination.Responsetomedicaltherapyandtheoutcomeswere assessed in the patients with venous thrombosis. Results: Thestudyfound43(69%)patientswithvenousthrombosis:portalveinthrombosis(PVT)occurredin39,hepaticveinthrombosis(HVT)in37andinferiorvenacava(IVC)thrombosisin4.Combined PVT and HVT occurred in 33 (77%) patients. The portal vein thrombi remained localized in subsegmental branches in 25 patients and extended to segmental branches in 14. The hepatic vein thrombi were con fi ned to peripheral branches in 18 patients; they progressed to the main trunk in 19 and to the IVC in 4. A wedge-shaped hypoattenuating zone suggesting ischemia was identi fi ed in 33 (77%) patients in portal phase: 31 had combined PVT and HVT, 2 had HVT alone, but none had PVT alone. It occurred signi fi cantly more often with combined PVT and HVT than HVT alone ( P 5 0.05). Laboratory data
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