Decompensated chronic liver disease with portal vein thrombosis

Stella^1*, Subathra Devi. M², Maha Lakshmi³

¹Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

²Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

³Nursing Superintendent, Kauvery Hospital, Cantonment Trichy, Tamil Nadu

*Correspondence

Abstract

Acute severe alcohol-associated hepatitis on a background of chronic liver disease (CLD) with portal hypertension is a life-threatening presentation frequently complicated by ascites, coagulopathy, renal dysfunction, and gastrointestinal bleeding. We report a 54-year-old male with jaundice, ascites, anemia with thrombocytopenia, and rectal bleeding. Evaluation revealed portal hypertensive gastropathy without varices, large internal hemorrhoids with recent bleeding, parenchymal liver disease with portal vein thrombosis, and moderate ascites. He improved with supportive care, antibiotics, vitamin supplementation, albumin infusion, diuretics, and hemorrhoidal banding, and was discharged in stable condition.

Key words: Chronic liver disease (CLD); Hepatitis

Introduction

Alcohol-associated hepatitis is an acute inflammatory injury of the liver seen in chronic alcohol users and may progress to liver failure, especially when superimposed on chronic liver disease. Portal hypertension leads to complications such as ascites, gastropathy, hemorrhoids, and varices. Early recognition and multidisciplinary management are crucial to reduce morbidity and mortality.

Case Presentation

The patient presented with complaints of yellowish discoloration of the sclera and urine for the past 18 days, abdominal distension for 4 days, generalized tiredness for 2 weeks, and blood in stools for 5 days. The patient had taken native treatment twice for jaundice on 09.12.2025 and 22.12.2025. Personal history revealed chronic alcohol consumption, with the last binge alcohol intake on 07.12.2025.

Relevant Clinical Findings

General examination showed icterus, pedal edema, and ascites.
Systemic examination was otherwise unremarkable.

Social History

Chronic alcohol consumption for several years.
No history of smoking or other substance abuse reported.
Allergies: No known drug allergies
Past Medical History: Nil
Past Surgical history: Nil

Physical Examinations

Patient conscious, oriented, afebrile

PR	85/min
BP	120/70mmHg
SpO2	98% in room air
Temp	98.6 F
P/A	Soft

Relevant Investigation

Complete Blood Count
Test	Result
Hemoglobin	8.2
PCV	22.7
RBC	2.17
MCA	104.6
MCH	37.8
MCHC	36.1
RDW	16.4
WBC	22950
Lymphocytes	5
Monocytes	8.8
Eosinophils	1.9
Basophils	0.3
Platelet Count	203000
Renal function test and Electrolytes
Test	Result
Urea Serum	47.6
Creatinine	1.9
RBS	101
Sodium	122
Potassium	3.8
Chloride	92
Calcium (Ionized)	1.02
TCO2	17
Anion Gap	18
Liver Function Test
Test	Result
Total Bilirubin	26.40
Direct Bilirubin	18.3
Indirect Bilirubin	8.10
AST	131.2
ALT	24.3
ALP	171.0
Total Protein	5.97
Albumin	2.13
Globulin	3.84
A/G Ratio	0.55
GGT	170
Ascitic Fluid
Parameter	Result
Total WBC Count	82 cells/cumm
Polymorphs	30%
Lymphocytes	70%
Total RBC Count	Nil
UGI SCOPY (27.12.2025)
No esophageal varices
No fundal varices
Portal hypertensive gastropathy
SIGMOIDOSCOPY (27.12.2025)
Large internal hemorrhoids with RCS
USG ABDOMEN SCAN REPORT (27.12.2025)
Parenchymal liver disease with portal vein thrombosis
Edematous gall bladder wall
Moderate ascites
Bilateral minimal pleural effusion (Left > right)

UGI Scopy (27.12.2025)

No esophageal varices
No fundal varices
Portal hypertensive gastropathy

Sigmoidoscopy (27.12.2025)

Large internal hemorrhoids with RCS

USG Abdomen Scan Report (27.12.2025)

Parenchymal liver disease with portal vein thrombosis
Edematous gall bladder wall
Moderate ascites
Bilateral minimal pleural effusion (Left > right)

Diagnosis

Acute severe Alcohol-associated hepatitis (MDF 60.8)
Chronic liver disease with Portal hypertension and ascites (CTP 12C; MELD-Na 30)
Portal vein thrombosis
Acute kidney injury – resolving
Large internal hemorrhoids with recent bleeding – status post banding

Management

Patients were admitted under medical gastroenterology. Blood investigations were done showing raised total bilirubin, direct bilirubin, GGT, ALT, AST, raised INR, anemia with thrombocytopenia. Patients started with IV antibiotics, IV fluids, IV thiamine, Injection vitamin K and antiencephalopthy measures. UGI scopy done showed No esophageal varices, no fundal varices, portal hypertensive gastropathy. Sigmoidoscopy done showed large internal hemorrhoids with RCS. USG abdomen showed Parenchymal liver disease with portal vein thrombosis, edematous gall bladder wall, moderate ascites, bilateral minimal pleural effusion (Left > right). Surgical gastro opinion was obtained and advised for banding on 27.12.2025. Patients underwent banding for hemorrhoid. No further episodes of bleeding P/R. Patient general condition improved. Repeat blood investigations done showed raised urea, creatinine levels, diuretics are withheld. Patients were transfused with Injection albumin for 3 days.

Outcome

The patient’s general condition improved. Renal parameters decreased after albumin therapy. No further episodes of rectal bleeding were noted. Ascites and edema are reduced with diuretics. He was discharged hemodynamically stable.

Nursing Management

Strict intake–output charting
Monitoring for signs of hepatic encephalopathy
Daily weight and abdominal girth measurement
Edema assessment and limb elevation
Skin care and pressure sore prevention
Education on alcohol abstinence and medication adherence
Monitoring stool for occult blood
Nutritional support with salt restriction and high-protein diet (as tolerated)

Drug name	Strength	Frequency	Route of admin	Relationship With meal	Days
Tab. Taxim	200mg	BD	Oral	After food	5 days
Tab. Sompraz	40mg	OD	Oral	Before food	7 days
Tab. Benalgis	100mg	OD	Oral	After food	5 days
Tab. Ursocol	300mg	BD	Oral	After food	7 days
Syp. Looz	30mg	OD	Oral	After food	7 days
Tab. Lasix	40mg	OD	Oral	After food	7 days
Tab.aldactone	100mg	OD	Oral	After food	7 days
Tab. Nusam	400mg	BD	Oral	After food	7 days

Discussion

Severe alcohol-associated hepatitis superimposed on chronic liver disease often presents with portal hypertension and its complications. This case highlights the coexistence of portal hypertensive gastropathy, hemorrhoidal bleeding, ascites, renal dysfunction, and portal vein thrombosis. Early supportive management, correction of coagulopathy, albumin therapy, and timely surgical intervention for hemorrhoids contributed to a favorable outcome.

Conclusion

Early identification and comprehensive management of alcohol-associated hepatitis with portal hypertension complications can significantly improve patient outcomes. Patient education regarding strict alcohol abstinence and regular follow-up is essential to prevent recurrence and progression.

Decompensated chronic liver disease with portal vein thrombosis

Decompensated chronic liver disease with portal vein thrombosis

Stella1*, Subathra Devi. M2, Maha Lakshmi3

Nightingale Journals

Stella^1*, Subathra Devi. M², Maha Lakshmi³