Physical exam

The following describes this patient’s physical exam when you see her in the emergency room:

General appearance: No acute distress

Vital signs: Heart rate 79/min, blood pressure 152/80 mmHg, respiratory rate 13/min, T 98oF

Head and neck: No lymphadenopathy

Chest: Normal to inspection, palpation, percussion, and auscultation

CVS: S1, S2, no extra heart sounds, no murmurs

Abdomen: Soft, non-tender, no hepatosplenomegaly

CNS: No focal changes

Clinical presentation of acute portal vein thrombosis:

  • May be clinically silent – diagnosed during a radiologic examination for other reasons
  • May present with:
    • Abdominal pain that develops suddenly or progresses over a few days
    • Fever
    • Dyspeptic symptoms
    • Symptoms of Intestinal infarction, especially abdominal pain that:
      • Radiates to the back
      • Persists beyond five to seven days
      • Is associated with abdominal distension
      • Is associated with bloody diarrhea
  • Patients with cirrhosis may present with variceal bleeding
  • Presence of spiking fevers, chills, and a painful liver is suggestive of septic PVT (acute pylephlebitis). 
  • Most patients with acute PVT do not have abnormal findings on physical examination.
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