Reason: Please evaluate for cause of acute decompensation of cirrhosis; portal vein or other thrombosis, biliary obstruction History: h/o HCV cirrhosis, adm with SBP, acutely worsened bilirubinemia, ascites, generalized abd pain LIVER: Extensive cirrhotic changes, including nodular contour and coarse, heterogeneous echotexture. Extensive subcapsular adhesions. No focal mass. The hepatic veins are not visualized, but this may be related to decompensated cirrhosis and hepatic fibrosis. The portal vein demonstrates ambiguous directional slow flow. No definite evidence of thrombus in the main portal vein.GALLBLADDER, BILIARY TRACT: Echogenic shadowing stones in the gallbladder neck and sludge. The gallbladder wall measures 0.4 cm. No pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.5 cm. No shadowing stones or hydronephrosis.The left kidney measures 10.2 cm in length. No shadowing stones or hydronephrosis.OTHER: The spleen measures 15.8 cm in length, enlarged. Small to moderate volume of at least partially loculated ascites.
1. Findings consistent with advanced cirrhosis.2. Limited vascular exam. The portal vein is at least partially patent without complete thrombosis, however ambiguous directional slow portal venous flow is new since prior exam and may represent progressive portal hypertension.3. Extensive subcapsular adhesions, which may be related to history of spontaneous bacterial peritonitis.4. Cholelithiasis without evidence of cholecystitis.