Suppurative portal vein inflammation

　　The occurrence of suppurative portal vein inflammation is related to infection. The specific causes of the disease are described as follows.

　　1, Any organ drained by the portal vein branches with a suppurative focus can cause this disease. The most common diseases are appendicitis, appendiceal abscess, intra-abdominal abscess, suppurative cholangitis, liver abscess, etc.; followed by colonic diverticulitis, ileal diverticulitis, necrotizing pancreatitis, pelvic suppurative lesions, prostatic abscess, biliary and hemorrhoids, etc. postoperative infections, gastrointestinal malignant tumors, intraperitoneal vascular thrombosis, and so on.

　　2, Infants are mainly infected by umbilical vein infection, young and middle-aged adults are most commonly affected by appendicitis and appendiceal abscess. The elderly are often affected by secondary infections caused by various reasons of biliary obstruction and malignant tumors, etc.

　　The pathogenic bacteria are mainly Gram-negative bacteria, with Escherichia coli being the most common, and there are also anaerobic infections.

　　Suppurative portal vein inflammation may show symptoms of the primary disease, as well as symptoms of sepsis and changes in liver condition. Suppurative portal vein inflammation may be complicated by sepsis, gastrointestinal bleeding, peritonitis, andPulmonary abscess. .

　　Suppurative portal vein炎 shows symptoms of the primary disease, as well as sepsis symptoms and changes in liver condition, and its specific clinical manifestations are described as follows.

　　1, Symptoms of the primary disease

　　Suppurative portal vein炎 often occurs secondary to various diseases, such as right lower quadrant tenderness and rebound pain when secondary to appendiceal abscess; when there is suppurative cholangitis, it may manifest as liver enlargement, pain in the liver area, and tenderness in the upper right abdomen or Murphy's point. There may be corresponding clinical manifestations when there is prostatic abscess or suppurative infection of the female reproductive organs.

　　2, Sepsis symptoms

　　There are remitting high fever and aversion to cold.

　　3, Liver condition

　　Liver enlargement, moderate texture, pain and tenderness in the liver area, accompanied by mild jaundice.

　　4, Other conditions

　　There is abdominal muscle tension, but it is not obvious due to abdominal distension caused by peritoneal irritation. 1/4 of patients have splenomegaly, and the spleen is enlarged when there is concomitant splenic vein炎. Hemorrhage and melena may occur due to gastrointestinal congestion. 1/5 of patients have nausea, vomiting, and diarrhea in the early stage of the disease. Chronic liver disease patients may have ascites.

　　Suppurative portal vein炎 is mainly prevented by etiology, and the specific preventive measures are described as follows.

　　1, Carrying out etiological prevention through etiological investigation is the main means of preventing this disease.

　　2, Early detection, early diagnosis, early treatment, and try to find the pathogen for etiological treatment as much as possible.

　　3, Actively participate in outdoor sports in daily life to enhance personal physique and improve immunity.

　　4, Regularly participate in physical examinations, and seek medical attention in a timely manner if any illness is found.

　　The examination for suppurative portal vein炎 includes routine blood tests, erythrocyte sedimentation rate, blood bacterial culture, and imaging examination. The specific methods of examination are described as follows.

　　First, Blood tests

　　1, Almost all patients show a significant increase in white blood cells in routine blood tests, mainly due to neutrophil increase. They often have mild to moderate anemia, with an accelerated erythrocyte sedimentation rate. About 1/4 of patients have abnormal liver function.

　　2, Blood bacterial culture often shows negative due to the liver's filtering effect, and it becomes positive only when the hepatic veins are involved. Therefore, blood cultures need to be repeated, and Gram-negative bacilli are the most common pathogens, with mixed infections of anaerobic bacteria also occurring.

　　Second, Imaging examination

　　1, X-ray:Chest X-ray examination can show signs such as elevated diaphragm, restricted diaphragmatic movement, and reactive pleural effusion. Abdominal X-ray may sometimes show gas shadows at the portal vein.

　　2, CT:The portal vein can show changes such as gas in the portal vein and enhanced transparency of the portal vein and its branches, especially more明显 during CT enhancement scans. If thrombosis of the portal vein extends to the splenic vein or mesenteric vein, it is also an important basis for CT diagnosis. The course of the portal vein within the liver is often consistent with that of the intrahepatic bile ducts, but the thrombosis of the portal vein within the liver and the obstructive dilatation of the intrahepatic bile ducts are significantly different. During enhancement scans, it is possible to see lower-density portal vein branches accompanying obstructive dilated bile ducts, but this sign is absent after thrombosis forms in the main portal vein.

　　3. Ultrasound:Especially Doppler ultrasound is very helpful for diagnosis. Doppler ultrasound can accurately determine the extent and range of the lesion and its spread, and can detect dynamic changes in the treatment process through repeated observations, showing thickening of the affected portal vein wall, weakened echo, rough inner wall, blurred outer surface, dilated lumen, and intraluminal thrombus and other lesions.

　　4. Angiography:Direct portal vein angiography and selective arterial angiography can also be helpful for the diagnosis of this disease, showing thrombosis in the portal vein system and centrifugal blood flow.

　　The diet of patients with suppurative portal vein inflammation should be light and well-balanced. The specific dietary precautions are as follows.

　　Firstly, appropriate dietary intake for patients with suppurative portal vein inflammation

　　1. Consume antibacterial and anti-inflammatory foods.

　　2. Consume foods that enhance immunity.

　　3. Consume fiber-rich foods.

　　Secondly, dietary taboos for patients with suppurative portal vein inflammation

　　1. Avoid foods that produce gas easily, such as sweet potatoes, onions, and soybeans.

　　2. Avoid foods that are difficult to digest, such as rice cakes and glutinous rice dumplings.

　　3. Avoid spicy and刺激性 foods, such as chili, Sichuan pepper, and prickly ash.

　　Once the diagnosis of suppurative portal vein inflammation is confirmed, the primary focus should be promptly treated. Options include resection of the primary infection site or abscess drainage surgery, such as percutaneous liver puncture drainage for portal vein abscess within the liver and liver abscess. At the same time, active use of antibiotics is recommended, following the principles of early administration, adequate dosage, and combination therapy to quickly control inflammation. Antibiotics should be administered intravenously to quickly increase the effective concentration of the drug in the blood. Third-generation or second-generation cephalosporins can be chosen, or a combination of aminoglycosides with new semi-synthetic penicillins can be used. Quinolone drugs can also be used for those allergic to penicillin. Strengthening systemic supportive treatment is also important, and metronidazole or tinidazole should be added in cases of anaerobic bacterial infection.