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A patient with a history of myeloproliferative neoplasm and presenting with abdominal symptoms.

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27 mentions

Mentions in Podcasts

The Clinical Problem Solvers
Episode 455 – Spaced Learning Series: Abdominal pain and distension

As the workup became more and more complex, and we started to talk about doing repeat paracentesis to trend ascites fluid white blood cell counts, the patient was just exhausted.

The Clinical Problem Solvers
Episode 455 – Spaced Learning Series: Abdominal pain and distension

So this brings into consideration entities like hepatic veno-occlusive disease, which can be seen in association with conditions such as myeloproliferative neoplasms, as is seen in this patient.

The Clinical Problem Solvers
Episode 455 – Spaced Learning Series: Abdominal pain and distension

The next question which has been lingering on since the last aliquot is that does this patient actually have cirrhosis?

The Clinical Problem Solvers
Episode 455 – Spaced Learning Series: Abdominal pain and distension

In this patient, the hepatic venous pressure gradient is only mildly elevated, and that is a critical pivot point in this case.

The Clinical Problem Solvers
Episode 455 – Spaced Learning Series: Abdominal pain and distension

So I can pretty much understand why the transjugular approach was taken for this patient.

The Clinical Problem Solvers
Episode 455 – Spaced Learning Series: Abdominal pain and distension

This route is particularly useful in patients with ascites or coagulopathy as it minimizes the bleeding risk by keeping any potential hemorrhage within the vascular system rather than in the peritoneal cavity.

The Clinical Problem Solvers
Episode 455 – Spaced Learning Series: Abdominal pain and distension

This patient has risk factors for vaso-occlusive disease affecting the irrigation of his liver, and I wonder if we didn't have an infection on top, we would see Zach more compatible with non-cirrhotic portal hypertension.